The Synaptophore is a device that measures binocular vision anomalies using optical tubes positioned in front of each eye. It allows measurement of the angle of deviation, detection of retinal correspondence, and treatment through orthoptic and pleoptic methods like vergence exercises. Measurements include the objective and subjective angles of deviation in different directions, as well as suppression scotomas and fusion ranges. A variety of slides are used for diagnostic and therapeutic tests of binocular vision skills.

1. Presented by-
Naman Jain

2. Synaptophore is a haploscopic device which
not only provides the means of measuring the
angle of deviation & of treating binocular
vision anomalies by conventional orthoptic
method but also meets the requirements of
modern pleoptic method involving the use of
after images, automatic flashing & haidinger’s
brushes

3.  Based on the mechanical dissociation of two
eyes by means of two optical tubes.
 Eye piece consists of +6.50 lens, a slide carrier
which is situated at the focal point of the eye
piece.
 Parallel rays of light emerge which ensure
relaxation of patient’s accommodation

4. 1. Optical tube
2. Chin rest
3. Head rest
4. Handle for adjustment
of horizontal angle
between tubes
5. Scale for measuring
horizontal deviations
8. Slide carrier
11. IPD controls

5. 10. Vertical deviation scale
9. Vertical control
19. Lamp hosing
7. Horizontal vergence scale
20. Horizontal vergence control
24. Horizontal tube locks
12. Chin rest controls
21. Selector switch
23. Dimming rheostats
22. Hand flashing switches
15. elevation/ depression scale
26. Torsional deviation scale
13. Torsional deviation controls
14. elevation/ depression
controls
6. Central lock
27. IPD scale
28. Mains
29. haidinger’s brushes
30. Reversing switch
18. Speed controls

6.  It is necessary to position the patient’s
eye correctly by accurate adjustment of
the chin rest, the head rest & IPD
 Horizontal angle b/w the tubes can be
increased or decreased by moving the
handles which are sloped downwards.
 The angle through which the tubes are
moved are recorded in degrees on
outer edge & in prism diopters on the
inner edge of the scales present on the
roof of the base
 The tubes are locked together by
central lock & allow vergence exercises
to be given, so that each tube slowly
converges or diverges to an equal
extent.
 The amount of vergence is recorded on
the scale in degrees

7.  The slide carrier can be
moved upwards or
downwards to an extent
of 10 prism diopters by
controls & vertical
deviation & vergences
are recorded on scales
 If it is necessary to
measure a vertical
deviation greater than 10
prism diopters then
elevation & depression
controls may be used to
augment the movement
 Degree of deviation (15)
is converted into prism
diopter.

8.  Torsional deviation is measured &
corrected by the rotating slide
carrier around the optical axis of
the tube


9.  This is operated by the
two on/off switches, two
speed controls & two
reversing switches
present on the base in it.
 An iris diaphragms fitted
on to the tube helps to
restrict the field of vision
& helps to stimulate the
target point
 The brushes can be
appreciated more easily if
blue filters are inserted in
slots

10.  Include different pair of slides used to perform
various diagnostic & therapeutic tests.
 Simultaneous perception slides:
 Two dissimilar slides having two different
pictures which can be overlapped
 Each slide is presented separately to each eye
 Graded by their size into 3 groups

11.  Simultaneous foveal
perception slides (SFP):
 Consists of small sized
pictures, the images of
which do not exceed
size of fovea
 Simultaneous macular
perception (SMP):
 The pictures are slightly
larger than SFP slides
 Simultaneous
paramacular slides
(SPP):
 Largest pictures & form
image that extend in
paramacular area

12.  Consists of two
similar pictures each
of which is incomplete
in 1 small detail.
 In the presence of
suppression either of
the pots will be
missing in the
respective eye
 Graded according to
the size

13.  Consists of two pictures
of same object taken from
slightly different angles
 Picture of one eye is
slightly different from
other eye.
 These dissimilar parts are
imaged on disparate
retinal areas in the two
eyes & when the entire
picture fuses the disparity
gives rise to perception of
stereopsis of dissimilar
positions

14.  These are special
slides for after image
test, to detect ARC.

16. 1. Measurement of objective angle of deviation:
 Simultaneous perception slides are placed
 Synaptophore is set to patient's height & IPD
 Arm controlling the picture in front of
deviating eye is moved in opposite direction
till there is no movement on cover test of
either eye

17. 2. Measurement of subjective angle of deviation:
 After measuring objective angle, patient is
asked about position of objects
 If patient sees lion in the cage then objective
angle= subjective angle.
 If not then arms are moved back to zero &
patient asked to move handle controlling cage
picture in front of non fixating eye till 2
pictures are superimposed
 At this point cover test is performed to make
sure that change of angle between visual axis
has not occurred

18. Problems :
1. Small children may not cooperate
2. Suppression may prevent superimposition of
pictures
3. Patient may never be able to put lion in the
cage

20. 3. Measurement of deviation in cardinal direction
4. Measurement of IPD
5. Detection of retinal correspondence
 Objective angle= subjective angle ( normal
retinal correspondence)
 If objects are separated at the objective angle
then ARC is present & in this case objective
angle is greater than subjective angle
 Difference b/w angles is angle of anomaly
 ARC is harmonious if angle of anomaly =
objective angle ( subjective angle=0)
 Unharmonious ARC, angle of anomaly is
smaller than objective angle

23. 6. Estimation of grades of binocular vision
7. To detect presence & type of suppression:
 1st simultaneous foveal perception slides are
used, if present then simultaneous macular
suppression slides are used & then
simultaneous paramacular suppression slides
are used
 One arm of the synaptophore is rotated &
points are noted at which the target appears or
disappears
8. Measurement of range of fusion

24. 9. Measurement of angle kappa
 Normally visual axis crosses the cornea in the
nasal side of optic axis
 Positive angle when visual axis cuts cornea on
nasal side
 Negative angle when visual axis cuts cornea on
temporal side
 Slide consists of row of numbers & letters
( 4 3 2 1 0 A B C D) placed at 1º interval
 If right eye is tested & reflex is central when
patient looks at number 2 the patient has 2º
negative angle kappa

25.  Suppression
 Paramacular perception slides are used
 Fixate the target viewed by dominant eye
 target in front of suppressed eye is moved from
periphery to suppression scotoma
 It will disappear when it reaches suppressed area &
reappear on other side of scotoma
 Back & forth movement continues till area has
decreased to an extent that patient can simultaneously
perceive both targets & can superimpose both images
 To improve fusional amplitude in heterophorias &
intermittent heterotropias
 ARC
 Eccentric fixation