LECTURE

STEREOPSIS

Natnael L.
May /2017
OBJECTIVES
 At the end of this chapter, you will be able to:
 Define stereopsis
 Differentiate b/n monocular and binocular stereopsis
clues
 Write the advantage and disadvantage of the different
stereopsis tests
 Demonstrate to screen patients for the presence of
stereopsis
STEREOPSIS
 Definition:

It is the ability to perceive space as three dimensional solely

through slight difference between the right and left retinal

image

Or it could be said to be the ability to perceive depth

Or relative localization of visual object in depth

PANUM’S AREA
Despite the term corresponding points, the correspondance is not point to point relation but

gather of a point to an area after panum

The horizontal extent of these area is small (6to10min) near the fovea and increase towards

the periphery around (30 to 40min at 12˚ from the fovea)

Due to panum’s fusional area the horopter is not a surface but a solid

Point located within the region of single binocular vision form image within the Panum’s

areas for the two eyes

If an object is located in front or behind the region of single binocular vision double vision

occurs and this is known as physiological diplopia

THEORY OF DEPTH PERCEPTION
1.Monocular clue
It is also called Experimental clue

A person with only one eye is able to judge relative

distance of objects using monocular clue

They play an important role in estimation of relative

distance of visual object and the ability to use it is learned

The clues are active in monocular as well as binocular

vision
1.size
A large object interpreted as being closer than a small object
 The size of the retinal image varies directly with the angular substence
of the object and is also inversely proportional to the object distance
 In normal circumstances an image decreasing in size is not interpreted
as a shrinkage object but as an object constant size moving away (a
phenomenon known as size constancy)

2. Overlap
 Nearer objects obstructs the viewing more distance objects
 An objects that blocks another is interpreted as closer than the two
3. Aerial perspective
 Scattering of light in the atmosphere makes distance objects
appear less clearly defined and often tones them with blue
4. Parallax
 As the observer moves nearer objects appear to move in the
opposite direction further objects in same direction as the
observer
 Parallax and apparent size are probably the most important
element in driving
5.Accommodation and convergence
 Although accommodation is adjusted to focus upon a near
object , it is of little help in judging distance
 Convergence although a binocular function is of little aid
BINOCULAR CLUES FOR PERCEPTION OF DEPTH
 This is the ability to judge the relative distances of objects
from the observer by means of binocular vision only
 This ability depends on very small disparities between the
retinal images in the two eyes
Stereoscopic vision:
This is the ability to judge the relative distances of
objects from the observer by means of binocular vision
only
This ability depends on very small disparities between
the retinal images in the two eyes
Stereoacuity
 Stereoacuity depends on many factors and greatly
influenced by the method employed in understanding it
 In refined lab examination stereoacuity is lower than 2-
7sec of arc
 No standing clinical stereoscopic test compared to VA
test
 No result of mass examination test comparable to VA
test
 Generally speaking 15 to 30 secs of arc obtained in
clinical test may be regarded as excellent
 Visual acuity has some relation to stereoscopic acuity.
 Decreases from center to periphery

 Stereoacuity and visual acuity is expected to have some

correlation in normal observer
 There are 3 anatomical and physiological requirements for
stereoscopic vision:
 Large binocular over lap of the visual fields

 Partial decussation of the afferent visual fibres

 Co-ordinated eye movements

 Stereoscopic vision is absent in patients with strabismus and is

either poor or absent in patients with amblyopia
 Any abnormality in development might retard level of
stereoacuity
TNO TEST FOR STEREOSCOPIC VISION
 Was designed primarliy for screening pres-school
children (2.5-5 years) for defects of binocular vision
 It consists of seven plates
 Viewed with the red-green spectacles
 Plates I-III -Enable the examiner to quickly establish
whether stereoscopic vision is present at all
 Plates V-VII -Used for exact determination of
stereoscopic sensitivity
 When used for screening purposes, plate V should be
used as a pass-fail criterion
 Various studies, indicate that at the level of 240 sec of arc at least 95% of the
amlyopes are unable to see the test figures
 If an increase in the number of over referrals is acceptable, one may increase
the sensitivity of the test still further, by using the next step as pass-fail
criterion(120 sec of arc)
 When presenting the test, the plates should be well illuminated and presented
at a distance of approximately 40 cm
 Spectacles should not removed
 The plates may also be presented up side down. in that case items will be
seen in reversed depth , an effect that also may be obtained by reversing the
red-green spectacles
Determine if the following can be seen

Plate 1:
Ask the Px how many butterflies can you find on this page?

Can you point to them ? There are two butterflies one is

seen monocularly and the other is seen only if stereopsis is

present

Plate 2:
Ask the patient how many circles?which is the biggest?

There are 4 discs of which two are seen with stereopsis

Plate 3:

Ask the patient can you find a



cross/square/triangle/circle/diamonds?
Can you point to it? 4 hidden shapes (circle, square, triangle,


diamond) are arranged around a centrally easilly visible cross

This plate is very useful with children as they like to find and name


shapes
Plate 4:
Ask the patient how many circles can you see this page?


Can you point them? This is a suppression test , there are 3 discs


one seen with the right eye, one seen by the left eye and one seen
binocularly
Plate 1-4 are completed correctly proceed to

Plate 5 to 7:
Which represent graded stereo acuities from 480 to 15
seconds of arc
 Ask the Px in each of these squares there is a cake hidden
with a piece missing
Can you find the cake and point to the piece that is missing?
For each test level, two discs with a sector missing are
presented in different orientations.
If patient is hesitant about an answer allow plenty of time to
view the test plate. If only one of the two tests for each acuity
level is stated correctly , allow the patient a second attempt at
the incorrect one, but if called incorrectly again , or if the
Patient can not see a shape, record the Stereoacuity as the
previous correctly identified level.
RECORDING
 If the stereo shapes are identified in plates 1-3 but not 5-7
record gross stereopsis
 If plate 4 is identified incorrectly, record which is the
suppressing eye
 For plates 5-7 record the stereoacuity as at least the highest
level where both responses were correct eg stereoacuity is
less or equal to 15.
 Factors that could affect stereoacuity are a small
misalignment, a small suppression scotoma, small amounts of
blur(binocular, monocular) and / or aniseikonia
MOST COMMON ERRORS
 Allowing the Px change the working distance without altering the
results accordingly
 Measuring stereopsis before the refraction with the Px’s own
spectacles which may not be optimal.
 Instructing the Patient in such a manner that leads the Px to the
answers
 Not allowing sufficient time for the Px to perceive the stereo figure

 Excessive glare on the page

 Not adjusting the instructions to the Patient’s age and capabilities

CLINICAL TESTS FOR STEREOACUITY
1. Titmus test
o This consists of three different tests which are:
 Stereo housefly test
 Stereo circle
 Stereo animal

Procedure:
 The patient wears polarising spectacles provided an easily
administered check of stereoscopic depth perception at any age
level
Purpose
 To measure how minutely the two eyes can discern difference in
the distance of objects from the observer.
 To administer: hold the picture straight before the patient to
maintain the proper axis of polarisation
 Provide good light but avoid reflections on the shine surfaces

 Polaroid viewers must always be worn over glasses if used.

 For bifocal wearers position the test properly for near points
viewing.
Stereo house fly test
 The fly is universally known and understood even by young
children
 The large centered mass and translucent wings make it an ideal
stereoscopic subject
HOW TO USE
 Patients needs to wear polarizing spectacles
 Place the test at 40cm distance

 Since there is stereoscopic threshold it follows that stereopsis

can not work beyond & certain critical distance
 This distance has being computed differently by various books
depending on the threshold used for computation
 It is somewhere between 125 and 200cm

 If the image from one eye is used by the mind the fly will
appear as an ordinary flat photograph
 If both eyes are functioning well the response of the individual
leaves little doubt as to his ability to interpret what he sees
stereoscopically.
DEMONSTRATE
 Have the patient try to pinch the tip of a wing between the
thumb and four fingers.
 Note whether the fingers remain above the plane of picture or
not.
 Waggling or moving the picture back and forth assist some
whose stereoscopic appreciation is sluggish
Stereo circle
 Design: a graded series which is used for testing depth
discrimination consists of nine squares each containing 4
circles
 Only one of the circle has a degree of crossed circle disparity

 It appears forward of the plane reference for those having

normal vision.
DEMONSTRATE
 Starting from the first square
 Tell the patient to look on the test

 Ask the patient to point a circle that seems too out closer to
him
 Continue through the test until patient gives up trying or
makes two successive mistakes
 If the patient makes one mistake and gets the next one right
go back and have him try the missed one if he can achieve
this level of stereoscopic discrimination or just passed the
more difficult one
Test correct answer range of stereo @40cm
1 bottom 800secs
2 left 400sec
3 bottom 200sec
4 top 140 sec
5 top 100sec
6 left 80 sec
7 right 60 sec
8 left 5sec
9 right 40sec
SUMMARY

 Stereo fly and other stereo-tests used in:

 Stereopsis

 Strabismus

 Amblyopia testing
The NEW Distance Randot Stereotest®
 Finally, a test for distance stereopsis for patients as young as
4 years of age.
4 tests in 1 booklet (400 sec of arc to 60 sec of arc)
1 pair of Standard 3-D Viewers and 1 pair of Pediatric 3-D
Viewers
 Affordable

 Portable and readily available

Stereo Fly SO-001
STEREO-FLY

 Recognized as the standard for Stereo Depth Perception testing,

the Stereo Fly SO-001 allows for easy administration and

evaluation of both gross and fine stereo vision

 This test is designed so that it is easy to administer

 All items of the Stereo Fly test are manufactured with high quality

materials, ensuring sharp long lasting images

Stereo Butterfly SO-005
 The Stereo Butterfly SO-005 tests and evaluates random dot
stereo depth perception for both gross stereopsis (2500 to 1200
seconds of arc) and fine depth perception
 The figures present on the test cannot be identified without
viewing glasses
 The test includes:
Graded circle test (800 to 40 seconds of arc)

Animal test for children (400 to 100 seconds of arc)

One pair of standard 3-D viewers

Stereo animals
 Design : present 3 levels of testing young children.
 in each row there are 5 animals one of the animals appears
forward from others ,when seen with polaroid spectacle
 How to use:
 place the test at 40cm

 The patient wears polarising spectacle

 Demonstrate: tell him to point animal that seem to come out forward

 If he misses one and gets the next go back and have him try the

missed once again

CLINICAL SIGNIFICANCE

 Response depends on the age and intelligence of the

examiner

 positive, partial doubtful and negative results must be

distinguished

A clear positive result can be corrected by correct localization

and naming of the object or trying to grasp

Titmus fly test (polaroid vectograph)
 This is a popular clinical test which uses crossed polarised
filters to present slightly different aspects of the same object
to each eye
 When the patterns are viewed through a polaroid visor, the
patterns are fused and seen in depth
 The test has 3 sections;
The circle patterns section:
 Provides the most sensitive assessment of stereopsis and should be used
when possible
 The house fly which manifest very large disparity and should be seen in
depth by most people. This part is particularly useful for young
children,since they can be asked to touch the wing of the fly and their
reaction noted
Circle patterns:
 This section consists of a series of patterns each containing 4 circles. One of the
circles in each group contains a graded disparity (crossed) so that when viewed
binocularly ,the circles range from 800sec of arc to 40sec
 The patient is asked to indicate which one of the four circles stands out towards them

Animals :
 There are 3 rows of animals ,one animal in each row having a crossed disparity has
to be identified by the patient
 The disparities range from 400- 100sec.
 This section of the test is useful for young children
Advantage
 Most common available test

 The titmus is a memorable test for all ages and popular (useful) with children

Disadvantages
 The test contains potent monocular clue because all the disparities are

crossed, the only possibility is that one circle will appear to lie in front of
others
 The patient really only has to decide which circle is different

 An intelligent person could do this monocularly by observing which of the

circles is slightly displaced

 Requires the use of a polaroid visor
Randot® SO-002
 The Randot SO-002 tests and evaluates stereo depth

perception by requiring patients to identify six geometric forms

from random dot backgrounds (500 to 20 seconds of arc).

 The test includes:

 Graded circle test (400 to 20 seconds of arc)

 Animal test for children (400 to 100 seconds of arc)

 One pair of standard 3-D viewers

Randot® Preschool Stereoacuity SO-007
RANDOT
 The Randot Preschool Stereoacuity Test SO-007 tests stereopsis
from 800 to 40 seconds of arc on patients as young as two years of
age
 This StereoTest is designed as a matching game in which the
patient matches the pictures on the left side with those on the right
 To eliminate guessing, figures cannot be seen without viewing
glasses
 The test includes:
One pair of pediatric 3-D viewers
Three tests in one booklet:
Test #1: 200 and 100 seconds of arc
Test #2: 60 and 40 seconds of arc
Test #3: 800 and 400 seconds of arc
Random Dot "E" SO-003
RANDOM DOT E
 The Random Dot "E" SO-003 StereoTest is designed specifically for use
with children as young as three years of age and up
 The patient is asked to distinguish between a "raised E" and a non-
stereo target
 Figures cannot be identified without the viewing glasses to discourage
guessing
 his product is recommended by the American Academy of
Ophthalmology and the American Academy of Pediatrics
 The test includes:
 One demonstration card
 One blank card
 One pair of standard 3-D viewers
 One pair of pediatric 3-D viewers
Lang stereo test
 This is a test used for the assessment of binocular vision
 This test is based on two principles: Random dots and
cylindrical gratings
 The test is a single card which can be held easily by the
clinicians or the patient
 It has only three levels of stereopsis which allow only gross
stereopsis to be detected
 With the test presented at 40cm the patient has to locate the
arc of the moon(200sec), a star(200 sec), a car (400sec) and
an elephant (600sec)
 The star can also be seen monocularly to help attract the
attention of young children
 Pre verbal children respond by reaching for the images , an action
which indicates that some stereopsis is present
 This is a useful test to have available as it is easy to use ,
provides valuable information and is relatively inexpensive
Advantages
 No goggles required

 Appropriate for young children and infants (age 6 months or older)

 For very young children eye movements should be observed as

they can be used to indicate if the child is fixing a pattern in the
same way as preferential looking is used to determine acuity level.
Disadvantages
 Gross stereopsis is only measurable
FRISBY STEREO TEST
 The test uses sheets of perspex on to which are printed at
random pattern of shapes .
 A circle within the pattern is printed on one face and the
remainder of the pattern on the other face.
 The patient has to select the pattern which contains the circle in
depth.
 The sheets of perspex are 1mm, 3mm and 6mm thick and are
presented at a range of fixation distances to achieve the
necessary disparity.
 The test is usually used at 40cm to start with, which allows a
best stereoacuity of 85 inches to be measured.
 In theory any disparity can be introduced by changing the
fixation distance.
Advantages
 Uses real depth rather than simulated depth
 Goggles not required better for children
 Infinite variation of stereo levels can be tested
 Durable test

Disadvantages
 Monocular clues with Px movement of the plate or patient’s head .
 Having to change working distance lenses for presbyopes.
Thank u!!!