REVIEW
Thoughts on Ocular Dominance—Is It Actually a Preference?
Daniel M. Laby, M.D., and David G. Kirschen,
Background: Ocular dominance has been studied for many years, and there
have been many attempts to correlate eye dominance with athletic perfor-
mance. Although many reports have failed to show a correlation, some
reports have shown a relationship between sports performance and eye
dominance.
Methods: This report reviews some of those studies and the tests of eye
dominance used in the reports. Additionally, we review the physical basis of
eye dominance and the role of the binocular visual system in its de-
termination. Lastly, a review of common facts and fallacies relating to ocular
dominance is provided.
Results/Conclusion: It is suggested that the visual system is designed as
a binocular system, and only tests that allow for maintenance of binocular
vision during the determination of ocular preference should be used if an
accurate evaluation is to be made.
Key Words: Ocular dominance—Eye dominance.
(Eye & Contact Lens 2011;37: 140–144)
O cular dominance was initially described by Porta1 in 1593 in
his work entitled De refractione. Since that time, much has
been written concerning the detection and importance of ocular
dominance patterns.
Thus, the concept of ocular dominance is not new, as is the
controversy surrounding its usefulness. Many thorough review
articles have already been published regarding the existence and the
measurement of ocular dominance and will not be repeated here.2–7
This review will present a slightly different perspective on ocular
dominance, questioning its very existence and its usefulness in eye
care in general and sports vision in particular.
Ocular Dominance has become a commonly measured phenom-
enon in many different fields, including sports vision, education,
and manufacturing and the military. Many different reports regarding
the value of ocular dominance and the correlation between per-
formance or education have been published8–13—without any
consensus as to its value.
Additionally, many different tests to determine ocular dominance
have been described,14–17 and published reports have shown that
From the Department of Ophthalmology (D.M.L.), Massachusetts Eye
and Ear Infirmary, Harvard Medical School, Boston, MA; and Department
of Ophthalmology (D.G.K.), Jules Stein Eye Institute, David Geffen School
of Medicine, University of California at Los Angeles and the Southern
California College of Optometry, Fullerton, CA.
The authors have no funding or conflicts of interest to disclose.
Address correspondence and reprint requests to: Daniel M. Laby, M.D.,
Suite 592, 95 Washington Street, Canton, MA 02021; e-mail:
drlaby@drlaby.com
Accepted December 31, 2010.
DOI: 10.1097/ICL.0b013e31820e0bdf
140
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O.D., Ph.D.
different tests performed on the same individual provide different
ocular dominance results. Simple logic would suggest that there is
a problem with either the diagnostic test used or the underlying
phenomenon itself, if different results are obtained on the identical
subject simply based on which test is used.
Finally, ocular dominance directly contradicts the critically
important phenomenon of binocular vision and ocular fusion. The
visual system is designed to fuse and join the images presented by
the right and left eyes into a single visual precept that contains,
as a result of this fusion, stereoscopic depth information. The
notion of a single eye dominating this binocular construct
contradicts long accepted understandings of how the human visual
system is wired.
In this review, we will analyze each of these areas, presenting
current literature, and reviewing older citations, to understand the
concept of ocular dominance and its place in normal visual function.
If ocular dominance is a measure of visual ability as it relates to
performance in sports, we must ensure that we measure that ability
consistently and precisely and understand the pros and cons of each
test used. Additionally, we must ensure that our test does not change
or disturb the property we are measuring, because this will invalidate
any result we obtain. Unfortunately, the current tests, described in
the scientific literature, do not meet these criteria. The reports using
these tests of eye dominance must be considered in this light.
CLINICAL PERSPECTIVE
The advantage that ocular dominance provides in sports
performance and education is controversial. Most of the published
studies have addressed the role of the combination of hand and
eye dominance in the performance of a task. The comparison is
made between same-sided eye and hand dominance versus crossed
or opposite side hand and eye dominance. Although several studies
have described a benefit to certain patterns (e.g. same or crossed) of
hand/eye dominance, many have been repeated with differing
results.
In the field of baseball, perhaps the most visually challenging
sport, there has been controversy among coaches, athletes, and eye
care practitioners regarding the role of same or crossed hand–eye
dominance patterns on baseball performance. Some of the con-
troversy originates in the tests used for determining ocular
dominance (this area of controversy will be addressed in the next
section) although for the purposes of this discussion, the most
common test, a sighting test, was used.
In a publication in 1996, Classe et al.8 studied 215 members of
the professional Southern Baseball League. In their report, they
used a sighting test to determine the ocular dominance of each
player. In addition, each player reported which his dominant hand
was for hitting, pitching, and fielding. With this information, the
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authors were able to determine the same or crossed hand and eye
dominance pattern for each player. The study showed that 66% of
the players were right eye dominant in the sighting test and that 60%
of the players demonstrated same-sided eye and hand dominance.
When comparing these results with each player’s onfield
performance, the authors did not find any statistically significant
differences between the players with the same or crossed hand and
eye dominance in hitting ability, pitching success, or fielding.
Another report,9 in 1998, studied the effect of ocular dominance
on the performance of professional baseball players. In this report,
Laby et al. evaluated the eye and hand dominance patterns of 410
major and minor league members of the Los Angeles Dodgers
Professional baseball team. Also using a sighting test to determine
ocular dominance, and subject reported handedness, they found no
statistically significant difference between eye/hand dominance
pattern and batting average for hitters and earned run average for
pitchers in either the major league or minor league groups.
Lastly, in a sport similar to baseball in visual requirements,
Thomas et al.10 found that cricketers were not more likely to have
crossed hand–eye dominance patterns when compared with
controls. This suggests that same or crossed hand–eye dominance
patterns are not important in cricket.
One task in which ocular dominance may play a role is
marksmanship and using a rifle. In shooting a rifle, one eye is used
to align the site with the target. This task is inherently monocular,
and both eyes cannot be used together to be successful. Jones et al.11
evaluated a cohort of novice riflemen and found that the learning of
rifle marksmanship is influenced by the hand–eye dominance
pattern. In their study of 308 military recruits, they found that same
eye–hand dominance was preferred to crossed eye–hand dominance
in learning marksmanship skills. In fact, they suggest that trainees
who show crossed hand–eye dominance patterns should be trained
to employ same hand–eye dominance to achieve greater success.
The role of eye dominance has been evaluated for the ability to
perform a laparoscopic surgical procedure. In 2010, Suleman
et al.12 reported on a study they performed to determine if hand–
eye dominance and depth perception defects affected an
individual’s ability to perform laparoscopic procedures. In their
study of 104 medical students, they found that although depth
perception defects did affect a student’s ability, differences in
hand–eye dominance did not correlate with performance differ-
ences in basic laparoscopic skills.
In 1985, Newman et al.13 described the results of a study they
performed to evaluate the role of ocular dominance in reading and
spelling. In this study, they evaluated 298 children aged 7 to 11
years. Ocular dominance was determined by an Orthoptist, who was
blinded to the child’s spelling and reading abilities. The Dunlop test
of ocular dominance was used in this study. The test was applied 10
times, and if either side, right or left, was identified as the dominant
side eight or more times, then dominance was assigned there. If
neither eye was picked as the dominant eye eight or more times,
then dominance was considered ‘‘unstable or unfixed.’’ As we will
note below, it is precisely this fact that dominance need not be
100% left or right that is missing from many of the tests used to
evaluate dominance in the literature. In their report, Newman et al.
note that of their 298 subjects, 99 (33%) were right eye dominant,
52 (17%) were left eye dominant, and 147 (49%), almost half,
exhibited ‘‘unstable or unfixed’’ dominance. Is it possible that these
147 subjects demonstrated an intermediate form of ocular
q 2011 Lippincott Williams & Wilkins
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Thoughts on Ocular Dominance
dominance (e.g., not purely right or left) that could not be captured
and measured by the test of ocular dominance used?
OCULAR DOMINANCE TESTING
Walls,14 in 1951, described at-least 25 different ways to test and
measure ocular dominance. Interestingly, Walls described dominance
as ‘‘any sort of physiological preeminence, priority or preferential
(emphasis added) activity of one member of any bilateral pair of
structures in the body.’’ The use of the terms preeminence, priority,
and preference seem to be critical in understanding the role of ocular
dominance in the visual system. None of these terms suggest or imply
the exclusive use of one eye over the other or the inability of the
visual system, under normal conditions, to use both eyes
simultaneously and cooperatively. Instead, they suggest a situation
that when forced to choose between one eye or the other, that one eye
may be preferred. As we will describe below, many of the tests for
ocular dominance, in common usage, do not preserve the spirit of
a preference and instead force the subject under abnormal and
nonphysiologic conditions to chose between one eye or the other
when determining ocular dominance.
Perhaps the most common test for ocular dominance is the
‘‘sighting test.’’ The sighting test, perhaps the easiest test of eye
dominance to perform, does not require any special equipment or
expertise. In this test, the subjects are asked to hold their hands
together, with their palms facing away at arm’s length, in such a way
that a small space remains between the thumbs and fingers of the two
hands. The subjects are then asked to extend their arms fully and sight
a target, through the small space between their fingers. The examiner
then covers one eye of the subject, followed by the other eye and asks
in which eye the target is no longer seen when the eye is covered.
That eye is identified as the dominant eye. There are many variations
of the sighting test, with some requiring that only one hand be used to
sight the target and the other making use of a small card with a hole in
the center that is used to sight the distant target. Regardless of the
specific technique, all of the sighting tests share one characteristic,
specifically, that the test only allows a single eye to be identified as
the dominant eye. As a result of the laws of Physics, it is physically
impossible to sight the target with both eyes equally and
simultaneously or with a combination of both eyes at the same
time (e.g., mostly one eye with a smaller contribution from the other
eye). Thus, the sighting test is only able to provide a result of 100%
right eye dominance or 100% left eye dominance. The results of this
test can be influenced by various factors, including confounders
ranging from a difference of visual acuity in one eye or the other not
related to eye dominance and orthopedic issues that could influence
the subject to favor one side over the other, again not related to ocular
dominance. As noted by Newman et al. above, when the sighting test
is repeated, the same result is not always found; almost half of their
subjects did not demonstrate a result that could be repeated more than
80% of the time.
Mapp et al.2 in a review article in 2003 reviewed ocular dominance
and described the basis for many of the clinical tests for ocular
dominance. In that review, the authors note four main criteria that
have been used to test eye dominance. In reviewing the literature,
they note that ‘‘which eye has been identified as the dominant one by
different criteria has not necessarily been the same.’’ Each of the
different criteria, ranging from concepts that ‘‘eye dominance is
related to handedness or hemispheric dominance’’ to ‘‘the sighting
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 D. M. Laby and D. G. Kirschen
dominant eye is the egocenter’’ does not hold up to careful review
and scrutiny, and tests in these areas do not agree. Intuitively, if
different tests give differing results when attempting to measure the
same property, there must either be a problem with the test or with the
understanding of the physical entity. In an ideal state, all tests
measuring the same property must give the same answer.
Portal and Romano4 and Purves and White15 reported a variation
of the alignment technique. This difference not only allows for left,
right, or central ocular dominance, but in addition, intermediate
forms can be assigned (i.e., moderately left or moderately right). In
their series, Purves and White found 23% of the subjects to be left-
side dominant, 16% to be ambiocular, and 59% to be right-side
dominant
The strength of this technique lies in the fact that it does not force
the subject to choose completely between one eye or the other when
performing a sighting task. This test, commonly known as a ‘‘pointing
test,’’ is performed by asking the subject to point a single finger
toward the camera lens of the examiner. A photograph is taken, and
the placement of the finger in relation to the eyes and face is
evaluated. In some individuals, the pointed finger will be placed
directly below the right eye, indicating complete right eye
dominance. In other individuals, the finger will be placed at a point
between the midline and the right eye, suggesting a preference for the
right eye but some use of the left eye as well to complete the viewing
task. In other individuals, the finger will be placed precisely in
the midline between the two eyes suggesting equal input from both
the left and right eyes. Additionally, the finger can be located midway
between the midline and the left eye or under the left eye suggesting
varying degrees of left eye preference. This test has several
advantages over the more commonly used sighting test. Most
importantly, it does not force the use of one eye or the other but
instead allows for varying degrees of eye preference to be identified.
In fact, the range is complete from total right eye preference to total
left eye preference with infinite points between. The ability to
simultaneously use both eyes is the strength of this test and more
closely simulates normal viewing conditions as compared with the
sighting test. This test can be confounded by various factors, most
importantly the use of the extremities to perform the test. Again,
orthopedic factors in arm and finger extension could certainly
influence the placement of the finger as the subject uses their visual
system to view the target.
In contrast to our work9 showing no relationship between the same
or crossed hand–eye dominance patterns in professional baseball
players using a sighting test to determine eye dominance, Portal and
Romano16 performed a similar study using the pointing technique. In
their report in 1998, the authors tested 25 members of the University
of Florida varsity baseball team. Using the pointing technique, they
were able to identify intermediate forms of eye dominance and not be
limited by only the possibility of left and right. Interestingly, they
noted, ‘‘players with central eye dominance, whether right or left
handed, were the most successful players in both hitting and
pitching.’’ These results suggest that the sighting test does not allow
a complete measure of eye dominance, and when given the
opportunity to use both eyes, in some combination, many subjects
prefer that to using only one eye or the other.
In a study presented to the American Association for Pediatric
Ophthalmology and Strabismus in 1998,17 we compared the sighting
technique to the pointing technique in determining ocular dominance
and evaluating the test–retest repeatability of the newer pointing
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Eye & Contact Lens  Volume 37, Number 3, May 2011
technique. Our results obtained after testing 30 members of the Los
Angeles Dodgers Professional baseball team showed that ocular
dominance testing by the sighting technique identified 73% of the
subjects (22/30) to be right eye dominant and 27% (8/30) to be left
eye dominant. The pointing technique determined this same group to
be 63% (19/30) right-side dominant (either pure right or center right),
13% (4/30) centrally dominant, and 24% (7/30) left-side dominant.
Comparison of a single subject’s results on each test showed a 63%
agreement between the two techniques. Further evaluation of the
pointing test revealed that 67% of the subjects gave different answers
after being retested with their second hand, whereas 56% of the
subjects switched their dominant side when tested with their left or
right hand. These data suggest an inherent disagreement between the
tests and in test–retest reliability. They also suggest that the pointing
test is a more complete description of how a given subject uses his or
her eyes under more physiologic conditions.
OCULAR DOMINANCE AND
BINOCULAR VISION
Walls,14 in his work entitled ‘‘A theory of ocular dominance’’
described five main types of ocular dominance phenomena. Type 1
assigned the dominant eye as that whose image is perceived for
a greater period in a situation of rivalry. Type 2 dominance
encompasses the alignment tests that require the subject to align one
eye with a target under binocular viewing conditions (i.e., the sighting
test described above). Type 3 phenomena assign the nondominant
eye to be that which despite misalignment does not affect the
binocular perception (up to the point of diplopia). Type 4 phenomena
describe the dominant eye as the ‘‘preferred’’ eye. Examples of this
include the eye more difficult to monocularly close (wink) or the eye
preferred most often for near work. The final group (type 5) includes
subjective phenomena, such as the eye with better visual acuity or the
eye in which an after-image persists longer.
Because of the dichotomy in function of the extremities, we have
been led to assume that there must be a similar segregation in the
use of the eyes. Although we normally use our extremities
separately, we normally use our eyes together. In fact, barring any
abnormality or interference, binocular vision is the epitome of
function for the visual system.
To properly measure eye dominance, and if we are to assume we
are measuring a property as is normally used, we must test that
property under normal conditions. Tests of eye dominance that do
not allow the subjects to maintain their normal state of binocular
cooperation therefore do not accurately assess eye dominance under
those conditions. Tests that do not meet this criterion, therefore,
should not be used when attempting to explore the relationship
between eye dominance and sporting performance, normally
performed binocularly. Interestingly, the only sport in which there
seems to be a consistent result regarding the role of eye dominance
in sporting ability is shooting, in which the task itself required for
success in the sport is being monocular!
Crowley and Katz,3 among others, describe the development of
ocular dominance in their article entitled Ocular Dominance
development revisited. In this report, they describe both the structural
development and the temporal plasticity of the ocular dominance
areas of the lateral geniculate nucleus and the visual cortex.
Specifically, they describe that ocular dominance development can
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be divided into two phases: In the initial phase, likely well before
birth, the ocular dominance columns of the lateral geniculate nucleus
are formed without any input or signal from the eyes. Second, and
with visual input, these dominance columns are remodeled, ordered,
and developed according to the visual experience of the individual.
Clinically, in the development, evaluation, and treatment of
amblyopia, we note individuals who initially demonstrate equal
vision, develop visual loss in one eye (because of a variety of factors
including strabismus, anisometropia, and obscuration of the visual
axis to name a few) and favor the better seeing eye—a form of eye
dominance (type 4 or 5 above). With treatment, this initial dominance
is reversed, allowing for more equal use of both eyes (as noted by
normal stereoscopic vision) and a loss of the developed eye
dominance.
In a presentation in 1999,18 we described the development of
a binocular test of eye dominance (preference) that is not affected
by handedness or the extremities. This computer-based test
provides a binocularly disparate image to each eye. By fusing
the images and aligning them with a nondisparate square on
a computer screen (achieved by pressing a keypad), it is possible to
determine to what extent one eye, the other eye, or both eyes are
used at any given time. This test creates a ‘‘preference index’’ to
quantify this phenomenon, allowing for the development of a linear
scale between a complete left eye preference and a complete right
eye preference and every value in between. Additionally, we noted
that by adding a stressor to the binocular system, by means of
a prism, we increased the subject’s fixation disparity. We could
force the subject to increasingly favor one eye over the other, until
finally choosing one eye completely. In normal subjects under
conditions of binocular viewing, there is little preference for either
eye over the other. In fact, only when forced to choose between the
two eyes does an ocular preference pattern develop. Only when it
becomes impossible to use both eyes together does an individual
chose one eye over the other. The effect of these results on
questions relating to the creation of monovision, the selection of
which eye to operate on first in cataract surgery and the relationship
between ocular preference and athletic performance should be
reconsidered in light of these findings.
HOW IT ALL FITS TOGETHER—FACTS
AND FALLACIES
Thus far, we have described the inconsistent literature related
to eye dominance and sports performance. In addition, we have
reviewed the most common test for ocular dominance used in these
reports and have identified possible reasons why the test may not be
designed to provide the information needed to properly assess the
role of eye dominance in sports. In addition, we have described
the role of the binocular visual system in sports performance and
the notion that under normal binocular conditions the visual system
uses both eyes and does not allow one eye to dominate.
Following are several common fallacies and some facts regarding
eye dominance and its role in sports performance:
Fallacy 1: The Anatomic Presence of Ocular
Dominance Columns Shows That There Is
a Dominant Eye
Fact #1: Many studies have shown that ocular dominance
columns in the visual system develop well before birth and well
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Thoughts on Ocular Dominance
before there is any visual input. In addition, these anatomic
structures can adapt and change significantly during the ‘‘sensitive
period’’ of visual development based on patterned neural input
through the visual system. Some reports suggest that they also may
change after this period (albeit not as significantly). Although
anatomically each eye is represented in the nasal and temporal
visual field (in layer 4 of the visual cortex), there is extensive
integration between the eyes in layers 2,3, 5, and 6, all of which
receive input from both eyes.
Fallacy 2: Eye Dominance Is Related to Handedness
or Hemispheric Dominance
Fact #2: Although both the eyes and the limbs are paired
structures, their similarity ends there. The eyes are receptor organs,
whereas the limbs are effectors. The limbs are lateralized in the
brain, whereas the eyes are not. Each limb has a specific localization
to one hemisphere of the brain, whereas the eyes are segregated in
nasal or temporal visual perception—representing input from both
eyes. In other words, each limb projects to a single hemisphere,
whereas each eye projects to both hemispheres. Thus, there is
a basic, fundamental, structural difference between motor domi-
nance and sensory visual dominance.
Fallacy 3: Sighting Dominance Is the Best Test for
Determining Eye Dominance
Fact #3: As described above, the sighting test, although the most
common test used in the literature to determine eye dominance, is
likely the test least able to determine accurately an individual’s use
of the visual system. The sighting test does not allow normal use of
the visual system, can be influenced by several extraneous factors,
does not give the same answer when repeated, and differs from the
results provided by other more physiologic tests. In fact, the reason
why the literature differs in the role of eye dominance in sports may
be wholly because of the widespread use of this test.
Fallacy 4: The ‘‘Preferred Eye’’ Is the Dominant Eye
Fact #4: Studies have shown (e.g., Tong et al.) that there is
a constant rivalry between the right and left eyes for dominance of
vision. In fact, which eye predominates may be a constantly
changing phenomenon and may depend on image size, direction of
gaze, and other factors.
In reviewing this topic, one fact becomes clear, that is, the topic
of ocular dominance is far more complex than simply being right or
left. In fact, there may not be actual eye dominance but instead an
eye preference determined by testing conditions and the extent of
binocular vision. Clinically, it likely makes more physiologic sense
to consider how the eyes are working together (binocularly) as
opposed to one eye dominating over another when measuring their
effect on sports performance.
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