TESTS FOR GRADE OF BINOCULAR VISION AND SENSORY

1. TESTS FOR GRADE OF
BINOCULAR VISION AND
SENSORY FUNCTIONS
OPTO.ASKAR.PK

2. 1.WORT FOUR-DOT TEST
• For this test patient wears goggles with red lens in front
of the right and green lens in front of the left eye and
views a box with four lights - one red, two green and one
white.

3. Interpretation
• If the patient sees all the four lights in the absence of manifest squint, he has
normal binocular single vision
• In abnormal retinal correspondence (ARC) patient sees four lights even in the
presence of a manifest squint.
• If the patient sees only three green lights, he has right suppression
• When the patient sees only two red lights, it indicates left suppression
• When he sees three green lights and two red lights, alternately, it indicates
presence of alternating suppression.
• If the patient sees five lights (2 red and 3 green), he has diplopia

7. 2. Test for fixation.
• It can be tested with the help of a visuoscope or fixation star of the
ophthalmoscope.
• Patient is asked to cover one eye and fix the star with the other eye.
• Fixation may be centric (normal on the fovea) or eccentric (which may
be unsteady, parafoveal, macular, paramacular, or peripheral

8. VISUOSCOPY

14. CENTRALFIXATION
FIXATION
PARAFOVEOLARECCENTRICFIXATION
FIXATION

15. 3. After-image test.
• In this test the right fovea is stimulated with a vertical and left with a
horizontal bright light and the patient is asked to draw the position of
after-images.

16. Interpretation
• A patient with normal retinal correspondence will draw a cross
• An esotropic patient with abnormal retinal correspondence (ARC) will
draw vertical image to the left of horizontal
• An exotropic patient with ARC will draw vertical image to the right of
horizontal

18. After Image Tests
Interpretation with central fixation
• First assess with visuoscope
direction, sees
• In px with NRC, two fovea have a common visual
the gap superimposed

19. • In ARC. two fovea no longer have a common
visual direction with right esotropia sees vertical
after Image displaced to the left
• Patient with ARC and right exotropia .vertical
after image is displaced to the right

21. 4. Sensory function tests with synoptophore
• Synoptophore (major amblyoscope) consists of two tubes, having a right-
angled bend, mounted on a base.
• Each tube contains a light source for illumination of slides and a slide carrier
at the outer end, a reflecting mirror at the right-angled bend and an eyepiece
of +6.5 D at the inner end
• The two tubes can be moved separately or together by means of knobs
around a semicircular scale.
• Synoptophore is used for many diagnostic and therapeutic indications in
orthoptics.

22. Synoptophore tests for sensory functions
include:
• Estimation of grades of binocular vision

23. Detection of normal/abnormal retinal
correspondence (ARC).
•It is done by determining the subjective and objective angles of the
squint.
• In normal retinal correspondence, these two angles are equal.
•In ARC, objective angle is greater than the subjective angle and the
difference between these is called the angle of anomaly.
•When the angle of anomaly is equal to the objective angle, the ARC is
harmonious.
•In unharmonious ARC angle of anomaly is smaller than the objective
angle.

24. 5. Neutral density filter test.
• In this test, visual acuity is measured without and with neutral density
filter placed in front of the eye.
• In cases with functional amblyopia visual acuity slightly improves while in
organic amblyopia it is markedly reduced when seen through the filter.