The document focuses on the synaptophore, a device used in ophthalmology to measure various visual parameters such as interpupillary distance (IPD), angles of deviation, and fusion capabilities of the eyes. It details its components, types of slides used for different assessments, and the methodologies for conducting tests, including subjective and objective angles of deviation. Additionally, it outlines specific tests like the after image test and Haidinger’s brushes for treating amblyopia.

1. SYNAPTOPHORE
PRESENTER - BABLI SHARMA (B.OPTOM , M.OPTOM )
DHIR HOSPITAL & POST GRADUATE INSTITUTE OF OPHTHALMOLOGY

2. SYNAPTOPHORE
• Also known as major amblyoscope
• It is haploscopic device based on mechanical dissociation of the two
eyes , by the means of two optical tubes
• Strength of the lenses with eyepiece +6.50D
OPTICS OF SYNAPTOPHORE
• Consist of :
 Light source
 Slide of focal length of lens
 Plane mirror
 +6.50D eyepiece

3. SLIDES
• Range of slides
• Size of picture on the slides subtends , visual
angles of different degrees at nodal point .
• Simultaneous macular perception (SMPp slides
• Fusion slides
• Stereopsis slides
• After image slides
• Haidinger brushes

4. • SMP SLIDES :
 Ability to perceive simultaneously and to superimpose two
dissimilar images
 Slides are red in color used to measure ipd , angle of deviation and
assessing SMP
SLIDES SIZE ANGLE SUBTENDED
FOVEAL SP 1 DEGREE
MACULAR SP 1-3 DEGREE
PARAMACULAR SP 3-5 DEGREE
PERIPHERAL SP > 5 DEGREE
SMP slides

5. • FUSION SLIDES
 Ability of the eyes to produce a composite
picture from two similar picture each of which
is incomplete in small details
 Black in color and used to measure sensory
and motor fusion
• STEREOPSIS SLIDES
 Ability to obtain and impression of depth by
superimposition of two pictures of the same
object which have been taken from slightly
different angle
 Green in color
 Gives only the idea of presence or absence of
stereopsis
 Doesn’t gives the details about the
stereoacuity
Fusion slides
Stereopsis slides

6. RED BINDING SMP SLIDES
BLACK BINDING FUSION SLIDES ,
(SENSORY AND MOTOR
FUSION )
GREEEN BINDING STEREOSCOPIC SLIDES
YELLOW BINDING AFTER IMAGE SLIDES
BLUE BINDING SPECIAL PURPOSE SLIDES
HB SLIDES

7. PARTS OF SYNAPTOPHORE
Forehead rest control Chin rest Rotates tube
vertically
Central lock
Horizontal
deviation control
IPD
adjuster
On / off
switch
Chin height
control
Dimming
rheostates
Tube light
control
H.B motors
Slide box
Fusion / vergence
control
Torsion control
Vertical deviation
control (rotates slides
vertically)
Slide holder ,
H.B holder

8. USES OF SYNAPTOPHORE
Measurement of IPD
• IPD is measured
• Distance between the two
pupil called IPD
• Average of adult IPD is 60-65
mm when the eyes are fixing
at the distance .
• Average IPD for child is 40-
45mm.
• Must be measure before the
any procedure
IPD SCALE

9. USES OF SYNAPTOPHORE
Measurement of angle of
deviation
• Performed either subjectively and
objectively
• Both should be done with or
without correction
• Done with SMP Slides
• Tubes can be rotated horizontally
or vertically
• Horizontal , vertical and torsional
angles of deviation are obtained
HORIZONTAL
DEVIATION SCALE
VERTICAL
DEVIATION

10. USES OF SYNAPTOPHORE
Measurement of angle of deviation
• Tube is locked before the fixating eye and
alt CT IS Performed by extinguishing the
light in each tube to acts as an occlude
• With ESO deviation tubes are converged
before the deviating eye
• With EXO deviation tubes are diverged
• Alt CT is performed and the procedure
continued until no further movement to
take up fixation is seen
• This will give the objective angle of
deviation
• When assessing subjective angle of
deviation pt is asked to move the tube
before the deviating eye so that images
overlap
TORSIONAL
DEVIATION SCALE

11. USES OF SYNAPTOPHORE
SMP
• SP slides are dissimilar
• Subjectively pt moves the tube
before the non fixating eye
• And attempts to overlap the
images
• SP is absent if pt is unable to see
two images at the same times or
if one image repeatedly
disappears .
• If SP is not achieved with small
slide , it is useful to reassess with
peripheral slides before assuming
lack of SP
SMP SLIDE

12. USES OF SYNAPTOPHORE
Fusion
• Sensory fusion is present if
patient perceives single image of
two incomplete but similar
images
• Assessment should be done at the
subjective angle of the patient
• Motor fusion range is assessed by
converging and diverging the
tubes whilst asking the patient to
state when fusion breaks.
VERGENCE SCALE

13. USES OF SYNAPTOPHORE
Stereopsis :
• Both tubes are locked at fusion
angle
• Gross stereopsis slides inserted
and pt is asked whether or not
there is stereoscopic effect
• It will give qualitative analysis of
presence or absence of stereopsis
STEREOPSIS SLIDE

14. USES OF SYNAPTOPHORE
After image test
• Used to check presence of ARC or NRC
• RE fovea is stimulated with vertical line
and LE eye is stimulated with horizontal
line
• Pt is asked draw the position of after
image
• If patient with NRC will draw complete
cross
• If pt is having ET with ARC pt will draw
vertical line image to the left of horizontal
line
• If pt is having XT with ARC pt will draw
vertical line image to right of horizontal
line
AFTER IMAGE TEST

15. USES OF SYNAPTOPHORE
Haidinger’s brushes
• Used in pleoptic treatment for
eccentric fixation
• Entoptic phenomenon caused by
the effect of polarised light at the
fovea
• Consist of polarised and blue filters
• Background of blue light enhances
this effect which may be prolonged
by rotating the axis of polarization
so that brushes also rotate.
• Used for amblyopic patient fixate
with fovea or not
• Training technique in amblyopia to
improve fixation
HAIDINGER BRUSH

16. USES OF SYNAPTOPHORE
IPD measurement
Subjective and
objective angle of
deviation
Macular function
with H.B
Angle of deviation in
9 gazes
Measurement of
vertical and cyclo
deviation
After image test for
NRC and ARC
Fusional exercises
Convergence
insufficiency exercises
Anti suppression
exercises in ARC
Relaxation exercises
Pleoptic treatment

17. REFERENCES
• Clinical orthoptics by Fiona J. Rowe ,3rd
edition
• Simplifying strabismus by Saurabh Jain

18. Thank you