Binocular Vision and Ocular Motility
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This document summarizes key concepts in binocular vision and ocular motility. It discusses two theories of binocular vision development: correspondence and disparity theory, and the neurophysiologic theory. It describes sensory adaptations that develop binocular vision such as Worth's three levels of fusion. Common motility problems are reviewed like esotropia, exotropia, and cranial nerve palsies. The extraocular muscles are defined including origin, insertion and action. Laws of ocular motility like Hering's law and Sherrington's law are also outlined.
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Binocular Vision and Ocular Motility
- 1. Binocular Vision & Ocular Motility By Alvina Pauline D. Santiago, MD © AP Santiago February 5, 2021 https://image.slidesharecdn.com
- 2. Outline Theory of Binocular Vision Stereopsis and Sensory Adaptations Extraocular Muscles Examples of Common Motility Problems
- 3. Outcomes • State the advantages of upright position • Discuss the 2 theories of development of binocular vision • Differentiate diplopia from visual confusion • Define sensory adaptations of an immature visual system • Define Worth’s 3 levels of fusion • Discuss amblyopia, its definition, types, diagnosis and management • Differentiate horror fusionis from central fusional disruption • Enumerate the EOMS, its origin, insertion, action • Define and apply laws of ocular motility • Identify some of the more common motility problems
- 5. Binocular Vision • Reduced panorama of vision • Upright position • Frontal eye position • Visuomotor tasks improved • Depth perception • Orientation of body to environment 5 http://animals.sandiegozoo.org https://previews.123rf.com
- 6. Theories of Binocular Vision Correspondence & Disparity Neurophysiologic theory 6
- 7. Correspondence & disparity Sensory binocular cooperation is based on correspondence and disparity
- 8. Diplopia vs Visual Confusion 8 From Rosenbaum & Santiago Clinical Strabismus Management 1999
- 10. • visual stimuli from retina to visual cortex modified and coded • Macaque monkey: Ar 18; Rhesus: Ar 17-18 • only 25% binocularly driven cells are stimulated equally; 75% graded influence from R & L eye • Lost binocular neurons do not recover Neurophysiologic Theory
- 11. NORMAL Figure from Wright’s Pediatric Ophthalmology Lateral Geniculate Nucleus in Strabismic Amblyopia 11
- 12. Macula Development Fine visual discrimination characteristic of high visual acuity requires sharply focused small objects as appropriate stimuli 12 http://www.macuhealth.com
- 14. 14 From Rosenbaum & Santiago Clinical Strabismus Management 1999
- 15. Worth’s level of fusion • First degree (simultaneous perception) • Dissimilar targets presented • Perceived at the same time in the same visual direction • Second degree • Third degree 15
- 16. Worth’s level of fusion • First degree (simultaneous perception) • Second degree (flat fusion) • similar targets with dissimilar components (monocular suppression checks) • Third degree 16
- 17. Worth’s level of fusion • First degree (simultaneous perception) • Second degree (flat fusion) • Third degree (stereopsis) • Same targets as 2nd degree + disparity 17
- 18. Diplopia vs Visual Confusion 18 From Rosenbaum & Santiago Clinical Strabismus Management 1999
- 19. Suppression alteration of visual sensation that results in inhibition or prevention of one eye’s image from reaching consciousness 19 https://i.ytimg.com/vi/wb2IvkBrlJc/maxresdefault.jpg
- 20. Suppression Scotoma 20 Esotropia Exotropia From Rosenbaum & Santiago Clinical Strabismus Management 1999 Esotropia
- 21. Amblyopia Definition Unilateral or bilateral decrease in VA caused by pattern vision deprivation (lack of adequate vision stimulation) or abnormal binocular interaction physical examination shows no anatomical abnormality reversible by therapeutic measures 21 http://www.ascrs.org vonNoorden GK. Amblyopia. A Multidisciplinary Approach. Proctor Lecture. IOVS; 1985; 26: 1704-16 Gunter K von Noorden
- 22. Susceptible Period 22 From Adler’s Physiology of the Eye Most sensitive first 2-3 years Decreases until age 6-7 years
- 24. Classification of amblyopia 24 Reversible (functional) Strabismic amblyopia Anisometropic / ametropic amblyopia Visual deprivation amblyopia Idiopathic amblyopia Toxic / Nutritional amblyopia Irreversible (organic) Amblyopia in nystagmus Other ocular pathologies
- 25. Amblyopia vs Suppression • Both occur to eliminate visual confusion from dissimilar retinal images • Suppression occurs only under binocular conditions • Amblyopia persists after closure of fixating eye 25
- 26. Mechanism of Ambyopia 26 Causes Abnormal Binocular Interaction Form Deprivation Strabismus + - Anisometropia + + Visual Deprivation Unilateral + + Bilateral - +
- 27. Figure from Wright’s Pediatric Ophthalmology & Strabismus 1995 27
- 28. 28 Figure from Wright’s Pediatric Ophthalmology & Strabismus 1995
- 30. Horror fusionis • “fear of fusion” • Unable to simultaneously perceive images presented to either eye in the same place in space • Seen in patients with childhood strabismus and harmonious ARC 30 From Rosenbaum & Santiago Clinical Strabismus Management, 1999
- 31. Central fusion disruption • History of closed head trauma • Diplopia persists even if images fall on fovea of both eyes • Requires haploscope or amblyoscope for diagnosis • Images swim around each other 31
- 33. Origin, Insertion, Action EOM Origin Insertion Action Levator Palpebrae Lesser wing of sphenoid Superior tarsus, superior conjunctival fornix Lift lids Medial Rectus Annulus of Zinn Medial sclera Adduct Lateral Rectus Annulus of Zinn Temporal Sclera Abduct Superior Rectus Annulus of Zinn Superior Sclera Elevate, Adducts, Intorts Inferior Rectus Annulus of Zinn Inferior Sclera Depress, Adducts, Extorts Superior Oblique Sphenoid Bone Superolateral Sclera Intorts, depress, abducts Inferior Oblique Maxillary bone Posterolateral Sclera Extorts, elevates, abducts
- 37. RADSIN
- 38. Motility terms Agonist muscle: muscle that causes a movement Antagonist muscle: muscles that inhibit the movement of the agonist Yoke muscles: muscles in either eye that work together in specific directions of gaze Synergistic muscles: muscles that move the eyes in the same direction as the agonist.
- 39. Motility Terms Ductions: movement of one eye Versions: movement of both eyes in the same direction Dextroversion, Levoversion, Supraduction Infraduction Vergence movements: movement of both eyes in opposite directions Convergence Divergence
- 42. Laws of Ocular Motility Hering’s Law of Equal Innervation Yoke muscles receive equal innervation Sherrington’s Law of Reciprocal Inhibition Increased innervation to an agonist muscle is accompanied by reduced innervation to its antagonist muscle
- 44. Pseudoesotropia
- 47. Infantile Exotropia Fig from Rosenbaum & Santiago 1999 Intermittent Exotropia
- 48. Ocular Motility Evaluation 1 9 8 4 2 3 7 5 6
- 49. Fig from Rosenbaum & Santiago 1999 VI Nerve Palsy
- 51. Fig from Rosenbaum & Santiago 1999 III nerve paresis
- 52. Fig from Rosenbaum & Santiago 1999 Paralytic Exotropia: III nerve palsy
- 53. Ciliary Muscle Spasm AP Santiago, MD
- 54. References • Rosenbaum & Santiago: Clinical Strabismus Management 1999 • Von Noorden: Binocular Vision and Ocular Motility, 5th ed 1996 • Wright: Pediatric Ophthalmology and Strabismus, 1995 • Taylor & Hoyt’s Pediatric Ophthalmology & Strabismus 2016 • Nelson: Pediatric Ophthalmology • Moses & Hart: Adler’s Physiology of the Eye, 1987 #binocularvision (c) APSantiago2017 54
- 55. Thank you!