DEPARTMENT OF OPTOMETRY & VISUAL SCIENCE

Madonnna University
Elele Campus, Rivers State

OPT 314 Physiological Optics II

Binocular Vision & Spatial Perception

E. Owusu, OD, MSc, M.Optom, PhD

SECOND SEMESTER, 2022

Objectives
 To provide a basic understanding of the oculomotor system in health

 Introduce normal binocular vision and show how an understanding of this

foundation is essential to the diagnosis and treatment of patients in many
clinical areas including binocular vision, traumatic brain injury, and
aniseikonia.
Introduction to Binocular Vision (BV)
 Two-eyed vertebrate vision comes in two main varieties:
 Utrocular: eyes function separately. e.g., the panther chameleon
 See an example at https://www.youtube.com/watch?v=KaNzChBiOLM
 Or humans with trained ability for independent eye movement
https://www.youtube.com/watch?v=02iuafVA_N4 or https://www.youtube.com/watch?v=4IcncAcOJgA

 Ambiocular: eyes work together (true binocular vision)

Binocular Vision: the coordinated behaviour of the two eyes in the perception of
space
 BV implies simultaneous vision, which is achieved by the coordinated use of both eyes, so
that separate and slightly dissimilar images arising in each eye are appreciated as a single
image by the process of fusion.
Major Characteristics
 Utrocular Vision
 independent eye movements
 complete crossing of the optic nerves
 usually present in lower vertebrates
 Ambiocular Vision
 coordinated eye movements (Hering’s Law of equal innervation applies).
 partial decussation of the optic nerves
 Usually present in mammals
Placement of eyes in head
 Frontal eyes facilitate ambiocular vision (but frontally-placed eyes are not required
for ambiocular vision
 animals such as horses have lateral eyes but still have ambiocular vision.
 Predator animals tend to possess ambiocular vision
 frontal eyes provide better depth perception and visual acuity for offensive behaviour
 Prey animals tend to possess utrocular vision
 Lateral eyes provide safety through panoramic view (like the rabbit’s almost 360 degree field of
view
Binocular fields of vision: visual fields of animals with lateral eyes

CAT
DOG
RABBIT
HORSE HUMAN
Why ambiocular vision?
 For stereopsis (stereoscopic vision): the specific sensation of depth characteristic of
ambiocular vision.
 Made possible by coordinated eye movements and retinal correspondence
 For better Visual Acuity: from better optics of the way ambiocular vision is set up

Binocular Vision: how does monocular vision differ from binocular vision in
humans? Sensory summation
 Depth Perception.
 Monocular vs binocular cues: depth judgement is usually monocular, but
binocular depth perception (stereopsis) is superior
 Stereopsis (Seeing in 3-D): heightened depth perception arising from
slight retinal disparity
Monocular vs binocular views

 Light adaptation
 The eyes dark adapt independently of each other (reason for pirate
patches).
 Patching one eye will allow that eye to dark adapt without affecting the
other eye.
 In transient light adaptation, the two eyes are not totally independent of
each other
Importance of BV
 Binocular Single Vision enhances the quality of vision that we have with each eye
alone:
 Stereopsis: the pinnacle of binocular single vision
 However, stereopsis is not the only way of judging depth
 In some cases (beyond 1.5m), monocular cues may be superior to
stereopsis
 Monocular vs Binocular cues: personal, peri-personal & extra-
personal spaces
 Binocular summation(synergy of visual function): VA and contrast sensitivity:
 E.g. right VA: 6/9; left VA: 6/9; binocular VA: 6/6.
 Summation also exists for contrast sensitivity, form recognition, flicker
perception, etc
 Expanded visual fields: consider the prey animals
 Compensation for blind spot and other interocular differences
Disadvantages of BV
 More complex system to deal with: more problems likely with binocular vision that
would be the case with cyclopean (Cyclops had one eye in the middle of the forehead,
between where the eyes are) vision
 BV anomalies frequently symptoms such as eyestrain, headaches or difficulty reading.
 Many of these problems would not exist if we had only one eye. For example, binocular
stress can be caused by:
 Incorrect refractive balance
 Dissimilar images between the two eyes due to anisometropia or retinal disease
(aniseikonia)
 Over- or under convergence: Convergence insufficiency is one of the commonest
causes of poor performance in school, and reduced quality of life

 Conflicts between accommodation and convergence

Conditions for normal BV
 Clear ocular media in each eye
 Identical visual direction (retinal correspondence):
 Eyes must point in the same direction, fixate and focus on the same object
 The need for eye movements such as convergence and accommodation
 Retinal correspondence: the image points on the two retinas must have identical
visual direction
 Not point-to-point correspondence; a little non-correspondence (within a
limit) is allowed - Panum’s fusional areas
 Retinal disparity: slight misalignment which still falls within Panum’s
fusional areas is necessary to keep the eyes fixated
 fixation disparity: purposeful error necessary for stereopsis and to
maintain fixation
 Conditions for BV

 Binocular fusion –
 Motor fusion: eyes must move together to point on the object being fixated
 Lack of motor fusion: diplopia (double vision)
 E.g. from strabismus
 Sensory fusion: higher centres in the visual system (such as primary and secondary visual
cortices) must be able to integrate images from both eyes
 Consequences of abnormal sensory fusion:
 Diplopia
 Superimposition/confusion
 Adaptations to prevent these consequences
 suppression
 binocular rivalry (alternating suppression)
 Anomalous retinal correspondence
 amblyopia (“lazy eye”)
Worth’s “Levels” of fusion:
The degree of fusion is sometimes classified according to “levels” attributed
to Worth:
 Level 1: First degree fusion – Simultaneous perception

 Level 2: Second degree fusion – Flat fusion (motor fusion of simultaneously

perceived images)

 Level 3: Third degree fusion – Stereopsis (stereoscopic depth perception)

Conditions that impede BV: these must be identified quickly and removed
 Impediments to clear retinal image formation
 Ptosis
 Congenital cataract
 High refractive errors
 >6D myopia, >4D hyperopia, >1.5D astigmatism
 Anisometropia
 >2D hyperopic anisometropia
 >1.5D astigmatic anisometropia
 > 2.5D myopic anisometropia
 Epiretinal membrane
 Retinal myelination (neurones in the retina are not myelinated – myelin is
insulating material; it will impede the passage of light in the retina
 Impediments to BV
 Impediments to bifoveal fixation

 Strabismus with normal or abnormal retinal correspondence

 Diplopia: lack of fusion

 Eye movement defects: e.g., poor convergence

 Inter-ocular dominance

 Motor dominance: the sighting eye

 Sensory eye dominance

Introduction to Eye Movements
 INTRODUCTION TO EYE MOVEMENTS
 Why do we move our eyes? And why is it necessary to co-ordinate eye
movements?
 The retina does not have the same sensitivity across
 The fovea is the most sensitive for seeing details (spatial resolution):
ability to see details decreases as one moves away from the retina
towards the periphery
 Peripheral retina more sensitive to some motions
 Therefore, there must be a system to point both foveae at the object of
regard, and to prevent images of moving objects from slipping away from
the fovea
 Thus, the eyes are moved to:
 Focus images of objects on the fovea
 Whether at far, intermediate or near distances
 At far, there should be no refractive errors, otherwise the eyes will
do what they can to focus the images on the retina
 At near, it is necessary for the eyes to accommodate, if they can
 Maintain the images of moving objects on the fovea
 Otherwise the retinal images would move away from the fovea, and
lose focus
 Explore visual space & increase the visual fields
 For very large visual fields, head movements are usually necessary in
addition to the eye movements
Normal fundus
Normal fundus – light-
skinned patient
Visual Acuity (VA) and Retinal Eccentricity
From Schwartz textbook on
Visual Perception
Eye movement disorders:
L: strabismus, R & middle:
Graves disease (dysthyroid
orbitopathy)
 And here?
What do you think is wrong here?
Introduction to Eye Movements

Categories of Eye Movements

Categories of Eye Movements
 All the eye movements that occur in human may be placed under 2 main
categories
 Gaze holding (Image stabilizing) during body movement: fixation, Vestibulo-Ocular Reflex
(VOR), Optokinetic Reflex (OKR)
 Gaze shifting (gaze tracking) of moving objects: e.g. smooth pursuit, saccades, vergence

 No matter the category, eye movements may also be considered as

 Voluntary: fixation, some types of vergence & accommodation, voluntary gaze shift
(saccades)
 Involuntary (Reflex): reflex saccades, VOR, OKR,

 Eye movements may also be considered as fast or slow

 Fast: no feed-back from retinal image; e.g. VOR, saccades
 Slow: feed-back from retinal image required for correction of movement if necessary
Categories of Eye Movements
 Gaze-Holding Eye Mov’ts
 VOR/OKR
 The visual system performs best when images are held steady on the retina; visual
clarity, recognition of objects, localization of objects.

 Head motion causes images of the world to “slip” on the retina if there is no
cancelling eye movement.

 To counteract this “retinal slip” from head movements, gaze-holding movements

developed.
 Vestibulo-Ocular Reflex (VOR): for brief head movements
 Optokinetic Reflex (OKR): for sustained head movements

 VOR/OKR are controlled from the inner ear – infection in the inner ear can lead to
problem with either VOR or OKR
 Dizziness, motion sickness
 Demo lack of VOR and/or OKN:
 Video record a scene with your phone’s camera as you walk (without
image stabilization technologies or a tripod).
 Later watch the video
 The “shakes” in the video demonstrate how the world would look to humans
without VOR and OKR

 VOR: during brief head movements when fixating an object, the eyes move
to counteract the effect of the head movements. Otherwise, the image on
the fovea will slip away to other parts of the retina.
 The direction of VOR is opposite the direction of head movement
 The speed of head movement is also exactly cancelled by VOR to maintain the image
on the fovea.
 VOR is a “reflex” – it is involuntary. It is quickly and reflexively activated to
counteract the retinal slip caused by head movement
VOR
 VOR Function:
 Image stabilization from head movements (gaze stability)
 Helps to maintain balance (postural stability)

Left video: no image stabilization; right- with image stabilization

 Failure of VOR
 Vestibular nystagmus
 Vertigo
 Oscillopsia during head motion: world appears to bounce/move due to failure of
VOR to keep the eyes still so images of objects do not remain still on the same
point on the retina
 Postural imbalance
 Photosensitivity: discomfort with bright light; discomfort with flickering light,
moving objects, text on a page, busy high contrast patterns such as polka dots or
sunlight filtering through mini-blinds
 Reading printed page may be challenging because small head movements
destabilizes gaze: text appear to shift or oscillate
 Reading text on computer screens may be challenging as increased sensitivity to
flickering or scrolling pages are uncomfortable
 Manually bracing heads during reading: arms in chin
Categories of Eye Movements
 Gaze-Holding Eye Mov’ts
 Fixational Eye Movements:
 Miniature eye movements that occur when one is fixating a stationary object

 Image stabilizing eye movements which occur when the eyes are supposed to
be completely still

 Eyes are never still- fixational eye movements happen as you fixate a stationary
object

 Occur when attempting to hold gaze steady on a stationary object.

 Nystagmus can be considered an abnormality of fixational eye movements.

  Nystagmus: disturbance to fixation

Full video available at https://www.youtube.com/watch?v=oQuvTgOcvb8

 Nystagmus is not always bad; it can be a normal, physiological response
 Optokinetic Nystagmus (OKN) is a normal, reflexive response to striped or
patterned objects
Categories of Eye Movements
 Gaze-Holding Eye Mov’ts
 Fixational Eye Movements:
 Three types of fixational eye movements are known:
 Tremor
 Drift
 Microsaccades

 These fixational eye movements are normal. You normally observe see them –
they are too small; they can be observed only with specialized equipment

 Questions have been raised about the usefulness of these fixational

 Some researchers think fixational eye movements are “noise” in the fixation
system
 However, there is evidence that suggests that some of the fixational eye
movements prevent images of objects being fixated from fading (Troxler
effect).
Demo of the Troxler Effect:
 Cover one eye and fixate on the
central fixation target
 Observe the grey target fade after a
few seconds
 Implication: when images being
fixated are not “refreshed” by
fixational eye movements, they may
fade.
 This fading of stabilized images
(called the Troxler effect) may be
due to neural adaptation
 Adaptation: the nervous system
becomes “used to” stimulus that
does not change
 E.g.: light adaptation: the visual
system becomes used to
constant light levels in the
environment.
Categories of Eye Movements
 Gaze Shifting Eye Mov’ts:
 Purposeful/voluntary shift in gaze angle to bring image of object of regard onto the
fovea or to maintain image on the fovea of a moving target.
 The need for gaze shifting eye movements arose with development of the
fovea.
 Vision is best at foveola
 Saccades, (or saccadic eye movements)
 Pursuits eye movements
 Pursuit is voluntary, saccades are either voluntary or involuntary
 Even occur in animals with huge fields of view (e.g. horses with laterally
placed eyes that can see almost all the way around head at the same time)
because they can’t see equally well everywhere (i.e. have region like our
fovea).
Categories of Eye Movements
 Gaze Shifting:
 Vergence
 Vergence eye movements developed to change gaze for different distances.
 To ensure the two eyes are used together at different distances (depths)

 One purpose of these vergence eye movements is to image the object of regard on
both foveae

 Vergence types
 Convergence: eyes coming together (left eye moves rightward, right eye moves
leftward) – as is the case when an object is moving closer to the observer
 Divergence: eyes move apart (left eye moves leftward, right eye rightwards) –
when an object moves farther away
 Categories of Eye Movements
 Gaze Shifting:
 Accommodation
 Changes in the shape of the crystalline lens brought about by contraction of the
ciliary body, changing the focal power of the eye.
 Accommodation interacts with vergence eye movements & pupillary constriction
(the near triad, synkinesis).
 Designed to bring targets at different distances into focus.
 Perception: people begin to lose accommodation around age 40 (presbyopia)- not
true!!!
 Accommodative ability decreases in a predictive fashion from childhood until around
age 60 years. It starts to catch up with us around age 40!
 Age-Expected AA = 18.5 D – (0.3 D/year) (age)
 Minimum Age-Expected AA =15-0.25(Age)
Accommodation
Presbyopia: what’s the deal?
 What is the expected amplitude of accommodation (AA) for a 45 year old?

 Age-Expected AA = 18.5 D –(0.3 D/year) (age)

 AA = 5 D

 So why would a 45-year-old be symptomatic if typical near

accommodative demand is only 2.5 D?
Eye Movement Terminology
 In this course, we will concentrate on angular eye rotations. This is distinctly different
than eye translations.

 Translations are linear motions of the eye whose effect on the eye rotation required to
fixate an object decreases as the distance of the fixation point from the eye increases.

 E.g.: If both eyes translate nasally the effect is a decrease of inter-pupillary distance
(pd).

 Translations have much less effect on eyes (especially if viewing distance is long)
compared to rotations.

 We will focus on rotations

Terminology for Eye Rotations
 Monocular eye movements

 Ductions

 Binocular eye movements:

 Two types

 Conjugate: Eyes go in same direction: Versions

 Disjunctive: Eyes go in opposite direction :Vergences

 Terminology for Eye Rotations
 Ductions: describe monocular movements

 Rotations about vertical axis (lateral movements)

 Abduction-rotate temporally; limit 45°

 Adduction-rotate nasally; limit 50°

 Rotations about horizontal axis (vertical movements)

 Sursumduction (supraduction, elevation) –rotate upward; limit about 35°

 Deorsumduction (infraduction, depression) -rotate downward; limit about 50°

 Rotations about line of fixation (anterior –posterior axis)

 Intorsion-12 o’clock position rotates toward nose

 Extorsion-12 o’clock position rotates away from nose

 Terminology for Eye Rotations
 Binocular Eye Rotations
 Conjugate –Versions (eyes go in the same direction)
 Rotations about horizontal axis (vertical movements)
 Sursumversion (supraversion, binocular elevation)-upward conjugate
eye movement
 Deorsumversion (infraversion, binocular depression) -downward
conjugate eye movement
 Rotations about anterior-posterior axis (torsion)
 Dextrocycloversion-12 o’clock position of both eyes rotating to right.
 Levocycloversion-12 o’clock position of both eyes rotating to left

 Disjunctive –Vergences (eyes go in opposite direction)

 Rotations about vertical axis (horizontal movement)
 Convergence: Inward rotation
 Divergence: Outward rotation
 Short description of EM terminologies
 https://www.youtube.com/watch?v=6GliSCGkpZ4
 Note: zero lateral vergence posture is when lines of sight are parallel such as when
viewing an object at infinity.
 Vergence angle –Angle between the lines of sight of the two eyes

 Vergence demand = ratio of interpupillary distance (pd) in centimetres

and object distance in metres
 PD (cm)/ Distance (m)
 Unit is prism diopters (Δ)
 E.g.: how much vergence is needed by person whose interpupillary distance is
60mm viewing an object located at 40cm?
 Vergence = PD(cm)/Distance(m) = 6cm/0.4m = 15 Δ
 How much vergence would be required by the same person looking at a target
at 100cm?
 Vergence = 6cm/1m = 6 Δ
 Just like accommodation, more vergence is required at shorter distances, and
vice versa
 While accommodation is only influenced by distance, vergence is influenced by both
distance and PD
 Terminology for Eye Rotations
 Disjunctive –Vergences(eyes go in opposite direction)
 Rotations about horizontal axis (vertical movement)

 Hypervergence (supravergence)-e.g. if right eye goes up and left eye goes

down, can call this a right hypervergence

 Hypovergence (infravergence)-e.g. if right eye goes up and left eye goes

down, can call this a left hypovergence

 Rotations about anterior-posterior axis (torsional movement)

 Incyclovergence: 12 o’clock position rotates in towards nose (both eyes)

 Excyclovergence: 12 o’clock position rotates out away from nose (both eyes)
Summary:
 For the two eyes to be co-ordinated for BSV, the central processing centre of
the brain does this co-ordination through retinal correspondence.

 The fact that the fovea is the most sensitive part of the retina means objects
being viewed in detail need to be co-ordinated so that the two foveae receive
the image of objects being viewed at the same time

 Eye movements are necessary to either ensure images of objects fall on the
fovea, or images remain on the fovea, whether the objects or the observer are
stationary or moving.

 Thus, some eye movements maintain images of stationary objects on the

fovea
 Fixational eye movements
 Other eye movements maintain moving images of objects on the fovea,
whether the moving image is due to movement of the object, the observer or
both
 VOR, OKN, pursuit, etc
 Yet other eye movements cause images at different locations or distances to
fall on the fovea
 Accommodation, vergence, saccades
 Eye movements are very important to ensure co-ordination of the two eyes
for BSV
 They ensure motor fusion which are necessary for sensory fusion
 Poor eye movements disturb binocular single vision
 Eye movement defects are a major cause of binocular vision anomalies

 It is essential for optometrists to know how to assess eye movements to

detect possible problems so they can be solved
 Some eye movement problems are solved entirely by optometrists, others are solved
entirely by other professionals while others are solved by collaborations among
different professionals
Reference:

 Prof Clifton M. Schor at UC Berkeley has some an excellent chapter on eye

movements which can be accessed at:

schorlab.berkeley.edu/passpro/oculomotor/html/chapter_2.html

 UChicago Online:
 https://www.youtube.com/watch?v=eb3h7oUqcTI