Effects of induced anisometropia on the loss of

stereopsis

A thesis Submitted by
KhansaHamid (BSOP-F19-011)
Abtisam Ahmad (BSOP-F19-009)
Maryam Shabbir (BSOP-F19-013)

In the Partial Fulfilment for the Award of

BS Optometry

Supervisor:
Ubaidullah Jan
M. Phil. Optometry

Department of Optometry and Vision Sciences

Faculty of Allied Health Sciences
Superior University Lahore
(2019 – 2023)
 UNDERTAKING BY STUDENT

We Khansa Hamid (BSOP-F19-011), Abtisam Ahmad (BSOP-F19-009), and

Maryam Shabbir (BSOP-F19-013) for BS-Optometry (2019-2023) declare
that the contents of my research project entitled “Effects of induced
anisometropia on the loss of stereopsis” are based on our own research findings
and have not been taken from any other work except the references and has not
been published before.

Khansa Hamid
Abtisam Ahmad
Maryam Shabbir
 Superior University Lahore
Faculty of Allied Health Sciences
Department of Optometry and Vision Sciences

SUPERVISORY CERTIFICATE

We, the Supervisory Committee certify that the contents and the form of thesis
submitted by Khansa Hamid (BSOP-F19-011),Abtisam Ahmad (BSOP-
F19-009),Maryam Shabbir (BSOP-F19-013)have been found satisfactory and
recommended for the award of degree of BS Optometry (2019 – 2023).

Date
_______ ___
Ubaidullah-jan
Lecturer Optometry
M-Phil OPTOMETRY
Department of Allied Health Sciences
The Superior University Lahore
Dedicated to
Our families
 ACKNOWLEDGEMENT

We would like to take this opportunity to express our gratitude to the Department
and staff of the Department of Optometry and Vision Sciences at the Faculty of
Allied Health Sciences at Superior University Lahore, particularly our esteemed
Supervisor Sir Ubaidullah Jan

Student’s Name
KhansaHamid
Abtisam Ahmad
Maryam Shabbir
 ABSTRACT
INTRODUCTION
Involving a significant difference in refractive power between the two eyes, can have a
negative impact on stereopsis, the ability to perceive depth and three-dimensional structure.
Previous studies have suggested a correlation between induced anisometropia and the loss of
stereopsis, highlighting the need for further investigation into this relationship. Understanding
the effects of induced anisometropia on stereopsis can provide valuable insights for clinical
interventions and visual correction strategies for individuals with anisometropia.

OBJECTIVE:
The objective of the study is to examine how induced anisometropia affects the ability to
perceive depth and three-dimensional structure (stereopsis), providing insights into the
relationship between anisometropia and the loss of stereopsis, and potentially informing
clinical interventions for individuals with anisometropia.

METHODOLOGY:
Firstly, the visual acuity of the participating individuals will be examined using log MAR to
determine if the person is emmetropic or not. The natural stereoacuity of the emmetropic
individuals will then be tested to determine if it is normal. Next, all emmetropes with normal
stereoacuity will be divided into three groups: 'myopic anisometropic amblyopia', 'hyperopic
anisometropic amblyopia', and 'astigmatic anisometropic amblyopia'. These groups will
undergo artificial induction of astigmatism by ±3.00D, ±4.00D, or ±5.00D.

RESULTS
These results imply that the Frisby test's measurement of stereoacuity was significantly
affected by the amblyopia that was induced. To further understand the underlying mechanisms
determining stereoacuity outcomes and to investigate the long-term impacts of these
experimental interventions, more research is required.
 CONCLUSION
The Frisby test's results for stereoacuity before and after experimentally produced myopic,
Hypropic and astigmatic anisometropic amblyopia and experimentally induced hypropic
anisometropic amblyopia show that people kept or may not kept their stereoacuity levels. There
were very slight differences in the distribution of the stereoacuity measurements between the
two experimental settings. These results imply that the Frisby test's measurement of
stereoacuity was significantly affected by the amblyopia that was induced. To further
understand the underlying mechanisms determining stereoacuity outcomes and to investigate
the long-term impacts of these experimental interventions, more research is required.

Key Words:
Stereoacuity, astigmatism, Hypropia, Myopia, Refraction, Amblopia.
 TABLE OF CONTENTS
Page#
DEDICATION -------------------------------------------------------------------------------- iv
ACKNOWLEDGEMENT------------------------------------------------------------------- v
ABSTRACT----------------------------------------------------------------------------------- vi
ABBREVIATION LIST--------------------------------------------------------------------- vii
TABLE OF CONTENTS-------------------------------------------------------------------- viii
LIST OF TABLES --------------------------------------------------------------------------- ix
LIST OF FIGURES--------------------------------------------------------------------------- x
CHAPTER-I---------------------------------------------------------------------------------- 01
INTRODUCTION---------------------------------------------------------------------------- 01
Objectives-------------------------------------------------------------------------------------- 05
CHAPTER-II-------------------------------------------------------------------------------- 18
LITERATURE REVIEW------------------------------------------------------------------- 18
1. Hypothesis --------------------------------------------------------------------------------- 31
2. Operational Definition-------------------------------------------------------------------- 32
CHAPTER-III------------------------------------------------------------------------------- 34
METHODOLOGY--------------------------------------------------------------------------- 34
1. Research Design--------------------------------------------------------------------------- 34
2. Clinical Settings---------------------------------------------------------------------------- 34
3. Sample Size--------------------------------------------------------------------------------- 34
4. Sampling Technique----------------------------------------------------------------------- 34
5. Duration of Study ------------------------------------------------------------------------- 34
6. Selection Criteria--------------------------------------------------------------------------- 34
6.1. Inclusion Criteria --------------------------------------------------------------------- 34
6.2. Exclusion Criteria -------------------------------------------------------------------- 34
7. Ethical Consideration---------------------------------------------------------------------- 35
8. Data Collection Procedure---------------------------------------------------------------- 37
9. Data Analysis------------------------------------------------------------------------------- 38
CHAPTER-IV-------------------------------------------------------------------------------- 39
RESULTS ------------------------------------------------------------------------------------- 39
CHAPTER-V--------------------------------------------------------------------------------- 43
DISCUSSION -------------------------------------------------------------------------------- 43
CHAPTER-VI-------------------------------------------------------------------------------- 48
CONCLUSION ------------------------------------------------------------------------------- 48
REFERENCES-------------------------------------------------------------------------------- 49
APPENDICES--------------------------------------------------------------------------------- 53
Appendix 1------------------------------------------------------------------------------------- 53
Appendix 2------------------------------------------------------------------------------------- 53
Appendix 3------------------------------------------------------------------------------------- 53
Ethical Consideration ------------------------------------------------------------------------ 54
 LIST OF TABLES
Chapter Description Page

IV-1 Table 1 Crosstab of Myopia ------------------------------------------------------- 22

IV-2 Table 2 Crosstab of Hypropia------------------------------------------------------ 23

IV-3 Table 3 Crosstab of Anisometropia ----------------------------------------------- 24

IV-4 Table 4 ANOVA---------------------------------------------------------------------- 25

IV-5 Table 5 Effect------------------------------------------------------------------------ 26

 LIST OF FIGURES
Chapter Description Page

IV-1 Figure 1 Bar Chart of Myopia ------------------------------------------------------ 27

IV-2 Figure 2 Bar Chart of Hypropia ---------------------------------------------------- 28

IV-3 Figure 3 Bar Chart of Anisometropia---------------------------------------------- 29

 CHAPTER-I
INTRODUCTION

The medical name for an imbalance between the two eyes' refractive powers is anisotropia. It
expressly implies that there is a significant clinical difference between the way light is refracted
in the right and left eyes. Anisotropic amblyopia, a condition that permanently lowers visual
acuity in one or both eyes, is caused when the difference in refractive strength between the eyes
is not rectified in certain individuals with anisometropia. For there to be a difference, the
spherical equivalent (SE) between the eyes must vary by at least one diopter. The brain's failure
to properly synthesize visual information from the two eyes results in this visual impairment,
which can eventually lead to a loss of depth perception and other visual issues. It is important
to note that anisometropia can occur without any other ocular issues, and it is not invariably
related to amblyopia(1). Reduced visual acuity in childhood, especially in one eye, is a defining
feature of amblyopia. It is believed to be the main reason why children's monocular vision
impairment occurs. Amblyopia can only be effectively treated and prevented if it is discovered
early in development. Any interruptions to the regular visual experience can have a long-lasting
impact on a child's ability to see clearly since during this time, children's visual systems are
particularly sensitive to change. An aberrant visual experience during a crucial stage of visual
development results in amblyopia. Early diagnosis and treatment are essential since, if left
untreated, amblyopia can result in long-term vision impairment. In order to urge the brain to
use the weaker eye, treatment for lazy eye in children typically involves treating any underlying
vision problems and employing a number of strategies, such as eye drops or patches.(2) It is
crucial to stress that elderly people may not respond well to treatment because the crucial
window for visual development has passed. Amblyopia is a disorder where one eye performs
worse than the other and is caused by a problem with the region of the brain that helps with
vision. Early detection and treatment are therefore crucial for the correct management of
amblyopia. As a result, one eye no longer sees as clearly as the other. One in six people have
both of these conditions, with one eye having variable strength in 50% of instances and one
eye not pointing in the appropriate direction in 25% of cases. Other factors, such as having a
hazy lens in one eye since birth, are less frequent. A person may be more prone to developing
amblyopia for a variety of causes, including eye abnormalities, early birth, a family history of
the disorder, or other health issues.(3).
Anisotropia is the medical term for an imbalance in the two eyes' refractive abilities. It shows
a clinically significant difference in the way light is refracted by the right and left eyes. For
there to be a difference, the spherical equivalent (SE) between the eyes must vary by at least
one diopter. Anisotropic amblyopia, a condition that permanently lowers visual acuity in one
or both eyes, is caused when the difference in refractive power between the eyes is not rectified
in certain patients with anisometropia. The brain's failure to properly integrate visual
information from both eyes, which results in this visual impairment, may be the cause of the
loss of depth perception and other visual problems. Amblyopia is a common condition
characterized by decreased visual acuity in childhood, typically in one eye. It should be
underlined that anisometropia can develop without any other ocular disorders and is not always
related to amblyopia. It is thought to be the primary cause of monocular vision impairment in
children. Only when amblyopia is detected early in development can it be adequately treated
and prevented. Since the developing visual system is particularly open to change, any
disruptions to the normal visual experience can have an adverse effect on visual acuity.
Amblyopia is brought on by an unusual visual encounter during a critical period of visual
development. Because amblyopia can produce persistent vision impairment if left untreated at
this time when the visual system is still developing and more vulnerable to changes in visual
input, early detection and intervention are crucial. Treatment for lazy eye in children frequently
involves treating any underlying vision problems and utilizing various methods, such as eye
drops or patches, to encourage the brain to utilize the weaker eye. It is important to stress that
elderly individuals may not benefit from treatment because the critical window for visual
development has passed. As a result, effective treatment for amblyopia hinges on prompt
diagnosis and intervention. (4) Amblyopia is a condition that causes one eye to function worse
than the other and has an impact on the part of the brain that facilitates vision. One eye no
longer sees as clearly as the other as a result. One eye has changeable strength in 50% of cases,
one eye doesn't point in the right direction in 25% of cases, and one in six people has both of
these disorders. Other causes are less common, like having a cloudy lens in one eye since birth.
Amblyopia can be caused by a variety of factors, including eye issues, early birth, a family
history of the condition, and other health issues(5). Amblyopia is a condition where the part of
the brain that aids in vision does not develop normally. As a result, it may be challenging to
see well with one or both eyes, as well as to differentiate between various color tones and
determine distances. It happens when something goes awry when the brain is still growing. It
might be caused by problems with how the eyes work or how they connect to the brain. Doctors
can use tests to identify whether a patient has amblyopia. The earlier you start learning, the
better, as treatment is more successful when it is started while a person is younger. Treatment
involves covering the "good" eye so that the brain can become more adept at using the other
eye. There may occasionally be a need for additional therapies or eyewear. It is essential to
maintain the medication until the brain has finished maturing in order to ensure that the problem
does not reoccur. (6)An eye ailment where one eye perceives items more clearly than the other
is more common in older people. This problem, known as anisometropia, appears as people get
older. The goal of this study was to establish whether anisometropia in older people worsens
with early cataract formation and how it changes over time.
The evaluation of a person's stereoacuity, or capacity to see in three dimensions, is an essential
component of an eye exam. The results of this examination help medical practitioners choose
the most effective course of treatment for a patient's vision problems. Many facets of life
require the capacity to see in 3D, yet occasionally persons who are unable to take the exam
incorrectly think they can. This can be due to the way the test is administered. Researchers
looked at all of the potential ways to conduct the 3D test in this study in order to assess its
effectiveness for patients. Moving targets having a brightness contrast high enough to create a
visual image with a velocity of at least 600 degrees per second can be used to create a stereo
depth sense. They also talked about the flaws in the tests as they are now and how to fix them.
The fastest speed at which this perception can take place is constrained by the high-temporal
frequency cut-off of the eye, which is roughly 30Hz. How well one can distinguish depth from
stereo disparity of moving targets depends on the eye's adaption condition, not the speed of the
target. In a horizontally moving grating, it is the spatial shift as a constant proportion of the
grating's period that is essential for depth perception rather than the separation between the
matching brightness points in spatial units of arc min. Accordingly, stereoacuity is governed
by the difference in phase angles between the two eyes, which is also true for gratings that are
fixed and oriented obliquely. Phase discrepancies also contribute to the classic Pulfrich
stereophenomenon and its dynamic equivalent.(7) Binocular vision, or the ability to utilize both
eyes simultaneously, offers both benefits and drawbacks. Even though it enhances contrast
sensitivity and allows us to see beyond obstacles, it also makes it difficult to merge two
different points of view into a single convincing image. One advantage of binocular vision is
stereopsis, a method for extracting depth information from images by comparing those from
both eyes. This essay looks at the many applications of stereopsis and binocular vision, as well
as how different species employ them. Stereopsis, the ability to see objects in three dimensions,
is frequently thought to need a complex brain. We can learn more about the brain underpinnings
of stereopsis and uncover novel details about its potential manifestations outside of human
vision by studying a number of species. The fact that even insects have this ability disproves
this theory. It is believed that insect stereopsis evolved to assist basic behaviors like recognizing
and responding to nearby objects or potential prey. Simple methods are used for insect
stereopsis, which may or may not consider contrast or velocities.(8) Additionally, depth
mapping or binocular fusion may not always be necessary. Although it may look poorly built
from an engineering perspective, this works well for insects in their natural environments and
could have significant ramifications for autonomous technology. This article is a part of a larger
discussion on cutting-edge approaches to 3D vision.(9)
People can feel depth and three-dimensionality while viewing an image of a three-dimensional
scene or by closing one eye. When looking at a real scene with both eyes, the depth perception
is different, giving a clear sensation of solid shape and empty space. This phenomenon—known
as "stereopsis"—has been a significant perplexity in perception since the time of Leonardo da
Vinci. The common definition of stereopsis is that it is a consequence of binocular vision or
visual parallax. This theory, however, is called into question by the ability to produce stereopsis
in a single image while only viewing it with one eye. Another explanation claims that stereopsis
is a visual occurrence associated with the impression of egocentric spatial size. Stereopsis'
primary feature, the experience of "real" separation in depth, is connected to how accurately
egocentrically scaled depth is formed. Stereopsis's secondary features of interactability and
realness, which can also help with motor activity planning, can be functionally explained. By
linking stereopsis to a generic perceptual characteristic rather than a specific cue, it provides a
more thorough explanation of the diversity in stereopsis in real scenes and photographs as well
as a basis for understanding how we can sense depth in pictures despite competing visual
inputs. (10)
Because of the lateral spacing of the eyes in primates, each eye perceives objects slightly
differently. Due to this, there is disparity, which is characterized as a little variation in the
positioning of specific features in the retinal images of each eye. Stereopsis is the term for the
depth perception based on the resulting discrepancy. When other clues are present, stereopsis
is particularly useful for determining the relative depth of things. One of the monocular signals
that helps people perceive depth is stereopsis. The majority of research has been on
stereoacuity, or the capacity to recognize even minute differences in depth, but there is
evidence that stereopsis generally improves eye-hand coordination. Even coarse stereopsis is
preferable to none, according to a previous study with individuals who had central field loss as
a result of macular degeneration (MD). Those that still retained stereopsis in their peripheral
vision performed peg placement tasks more accurately. We evaluated the largest disparity that
healthy control participants could encode at a certain eccentricity in order to determine the
upper limits of stereopsis in the periphery. In this study, we examine the relationship between
the maximum behavioral disparity and the physiological measurements of the coarsest disparity
units at various eccentricities. (11)
Clinical dentistry procedures are becoming more and more demanding on the doctors' vision
as new treatments are created that call for close attention to small details. Sharp eyesight is
necessary for good hand-eye coordination, but so are a number of psychological and
neurological abilities, including the ability to perceive depth. The ability to perceive three-
dimensional depth based on the difference between images formed on the retinas of both eyes
is known as stereopsis, which is the highest level of depth perception. It is believed to offer
useful benefits in everyday tasks including hand-eye coordination. Although stereopsis' role in
depth perception has been thoroughly studied, little is known about its importance in dentistry.
The goals of this review are to provide an overview of stereopsis' role in daily life and to look
at the research on its importance in dental procedures. (12)
Uncommonly, given the same genetic make-up and environmental influences, a person's two
eyes may develop asymmetrically, resulting in visibly separate refractive abnormalities.
Anisometropia is the term for this condition. Myopic anisometropia, also known as
anisomyopia, is commonly caused by an interocular asymmetry in axial lengths and is typically
identified by a difference of at least 1.00 D in the myopic spherical equivalent refractive errors
between the eyes. In this unusual refractive condition, the person's eyes have grown to two
quite different ends. (13)
Anisotropia is a frequent risk factor for the development of strabismus and amblyopia. If left
untreated throughout the critical period of visual development, it may hinder the normal
maturity of the visual system. Both eyes' signals are often unbalanced as a result of diminished
visual acuity and a hazy image in the eye with a higher refractive error, which harms the
neurons in the visual cortex (14). Studies suggest that hypermetropic anisometropia may be a
bigger risk factor for amblyopia than myopic anisometropia because it can lead to fixation
instability and imitate microstrabismus (15). Myopic anisometropia is frequently thought of as
a mild form of anisometropia that is curable, even in older children. However, little is known
about how it might impair the growth of stereopsis. A key component of the visual system that
influences one's quality of life and employment prospects is stereoscopic vision(16).
Stereoscopic vision problems may affect gripping, depth perception, and precision movements
(17), which may restrict participation in both personal and professional activities and heighten
frustration or even despair (18, 19). Strong links have been shown between anisotropic amblyopia
and poor stereoscopic vision (20). In the medical literature, there is still disagreement on the
relationship between the degree of anisometropia and the loss of stereoacuity. It is currently
unknown which type of anisometropia—myopia, hyperopia, or astigmatism—is most likely to
interfere with the visual system. Patients who are already anisometropic and frequently
amblyopic are used in the bulk of population-based studies looking at the connection between
anisometropia and stereoscopic vision (21). Refractive error can vary in severity during a
person's first few years of existence, as is common knowledge. Therefore, measurements taken
while a patient was young could not accurately reflect the highest amount of anisometropia
they previously possessed. By experimentally inducing myopic anisometropia and assessing
stereopsis in healthy individuals, we set out to find the answer to this. Identifying the myopic
anisometropia threshold values for sphere and cylinder, which in young people can result in a
loss of binocularity for both near and far vision, was the main objective of our study. (22)

Amblyopia is a neurodevelopmental condition that impairs vision in one eye, less usually in
both, and physiologically alters the visual pathways. It illustrates the wide range of
neurological, perceptual, oculomotor, and clinical issues that may develop when trauma during
infancy impairs healthy vision development. Other than refractive error, amblyopia is the most
common cause of visual loss in infants and young children. It causes a number of perceptual
impairments in the amblyopic eye's vision, including an increase in internal noise and longer
manual and saccadic reaction times. It also causes a loss of visual acuity, position acuity, and
contrast sensitivity, especially at high spatial frequencies. Additionally, the strong eye has
perceptual limitations, such as particular types of motion perception, which are mirrored in
different neural responses and functional connections in the visual cortex (Ho et al., 2005). The
cornerstones of treatment for young children are correcting any refractive defect and patching
the strong eye. A considerable portion of children who are amblyopic do not regain normal
acuity or stereopsis, even after extensive periods of therapy. Patch compliance is challenging.
Several intriguing experimental treatments, like playing action video games while donning a
safety patch, may improve adherence and outcomes. Evidence suggests that even though there
may be a sensitive window for the optimum results, people with amblyopia may still benefit
from treatment. There is currently no consensus on the best way to handle adults who have
amblyopia. (23)
In actual practice, ophthalmologists, optometrists, and patients routinely fail to correct
anisometropia that ranges from 0.25 DC to 1.00 DC or even more. However, our research has
shown that anisometropia, which affects stereopsis, the third degree of binocular single vision,
might be detrimental if left untreated. Due to their poor stereopsis, professionals who have
untreated anisometropia or amblyopia run the danger of making mistakes at work. In order to
avoid any potential negative effects on visual function and professional performance, we wish
to underline how important it is to address anisometropia and ensure that the right correction
is carried out.With the help of this study, we can ensure optimum vision and prevent such
errors.
 CHAPTER-II
LITERATURE REVIEW
2020 will see Flitcroft I, Saunders K, and Mccullough S. conducted a study on 362 participants
aged 6-7 from the Northern Ireland Childhood Errors of Refraction project. Axial length and
corneal curvature were measured using a Zeiss IOLMaster, and cycloplegic autorefraction was
determined using a Shin-Nippon open-field autorefractor. Interocular differences of less than
0.50 D were seen in 257 of the individuals (ISO group) and 105 (29%) of the subjects (ANISO
group). There were 9 people (2.5%) and 25 (6.9%) with anisometropia greater than 1.50 D,
respectively. The ANISO group showed positive skew, a hyperopic shift, and a bi-Gaussian
distribution, whereas the ISO group showed a virtually Gaussian distribution. The refractive
distributions of the two groups, ISO and ANISO, were dissimilar (p 0.001). The weak link
between refraction and corneal curvature exhibited in older children is a symptom of
emmetropization. Refraction and each eye's corneal curvature did not significantly correlate in
the ISO group (r=0.09, p=0.19), whereas they did in the ANISO group (r=0.28, p=0.004). (24)
In 2013, Barrett BT, Bradley A, and Candy TR launched a study to better understand the
connection between anisometropia and amblyopia as well as potential developmental pathways
that could result in the appearance of both illnesses. When the refractive defects in the two eyes
differ, this condition is known as anisometropia. An isotropia prevalence of 20% is related with
an inter-ocular variation in spherical equivalent refraction of at least 0.5D. The incidence falls
to 2-3% with an inter-ocular difference of three dimensions or greater. The study also found
that between one-half and two-thirds of amblyopes have anisometropia, either alone or in
combination with strabismus (misaligned eyes), and that amblyopia, a condition where the
brain and eye do not work together properly and cause vision loss, is present in 1-3% of
humans. As shown in animal models of the disorder, the conjunction of anisometropia and
amblyopia during a child's initial clinical assessment supports the theory that anisometropia
produced amblyopia. The literature analysis on humans and monkeys, however, reveals that
there may be additional causes for the co-occurrence of anisometropia and amblyopia in
addition to the classic one. The study underlines the requirement to know the causes that cause
anisometropic amblyopia to develop in order to prevent this problem. For instance,
anisometropia usually develops following the development of amblyopia secondary to either
deprivation or strabismus. The beneficial benefits of refractive correction on anisometropic
amblyopia provide significant evidence in favor of the idea that anisometropia caused
amblyopia. To directly prove the cause of anisometropic amblyopia, however, extensive
surveillance of neonates at risk will be required, which poses enormous ethical and scientific
challenges.(25)
A 2021 study in Portugal's central region involved 749 children and teens between the ages of
3 and 16. The study's objective was to determine the prevalence of anisometropia and the
relationships between it and factors including gender, study cycle, and location. Anisotropia is
a condition where the refractive capabilities of the eyes differ. The researchers used a specific
kind of device to measure the refractive power of the eyes without using eye drops to dilate the
pupils. 6.1% of children and adolescents had anisometropia, with the third study cycle having
the highest incidence. The most common kind of anisometropia was myopia, and neither
gender nor location revealed any statistically significant differences. The study also found that
the degree of anisometropia increased with each study cycle, with myopic anisometropia being
the primary contributor to this increase.(26)
In 2015, Levi DM, Knill DC, and Bavelier D published a brief review on stereopsis and the
potential for amblyopia recovery. Amblyopia provides an ideal case study for understanding
brain plasticity and how it may be employed to restore function, according to the scientists.
The authors next go into how poor stereoscopic depth perception affects visuomotor skills,
athletic participation, and safe mobility in senior citizens. In the past 20 years, there has been
a resurgence in interest in creating more potent amblyopia treatments and prolonging their use
past the critical window. They further underline that persons with amblyopia may have fewer
work possibilities due to reduced stereopsis. The authors describe several strategies of healing
amblyopia, including patching, perceptual learning, and videogames. They point out that
stereopsis is more significantly influenced in strabismic amblyopia than in anisometropic
amblyopia. They believe that both anisometropic and strabismic amblyopes can benefit from a
number of unique new ways for restoring stereopsis. They do point out that strabismic
amblyopia may require more intensive treatment than anisometropic amblyopia to recover
stereoacuity. Additionally, they point out that dichoptic training and direct stereo training are
more effective for people with strabismic amblyopia, who have a limited chance of improving
with monocular training. Overall, the authors argue that stereopsis in amblyopia may improve
and that novel therapeutic approaches have the potential to produce superior results. (27)
A study conducted in 2020 by Wang X, Pan J, Zhang Y, Lan Y, Zuo J, and Jiang Z, which
aimed to investigate the associations between myopic anisometropia and various factors such
as age, gender, spherical ametropia, astigmatism, and axial length (AL) in Chinese refractive
surgery candidates with myopia.A total of 3,791 participants with myopia were recruited for
the study, and all underwent a standardized ophthalmological examination. According to the
study, there was a statistically significant correlation between age, a larger interocular AL
difference, and higher cylindrical power and the prevalence and severity of myopic
anisometropia (all P0.001). The prevalence of myopia anisometropia (defined as myopic
anisometropia 1.00 D) was 29.62%, and the mean myopic anisometropic level was 0.96 D.
Additionally, spherical equivalent (SE) refractive error and myopic anisometropia showed U-
and V-shaped associations with AL, J0, and J45. Surprisingly, the study found that myopic
anisometropia had a statistically significant connection (P0.001) with the interocular AL
difference. This demonstrates that the AL difference may have a big impact on how myopic
anisometropia develops in this population. The study provides important new data about the
occurrence and correlates of myopic anisometropia in Chinese patients undergoing refractive
surgery who are myopic in general.(28)
In a 2013 study, Lee JY, Seo JY, and Baek SU compared the degree of stereopsis in people
with anisometropia wearing glasses to people with isoametropia. The study included 106 non-
amblyopic participants with anisometropia and 56 people with isoametropia. The level of
stereopsis was classified as normal (40 seconds of arc), equivocal (40-100), and subnormal
(100-400). The researchers investigated whether the amount of interocular difference in the
lens power of the glasses, the type of anisometropia, a history of amblyopia, and the age at the
time of the first prescription of glasses were related to the level of stereopsis. The results
showed that the mean level of stereopsis in patients with anisometropia was 77.52 seconds of
arc in the Titmus-fly test and 52.78 seconds of arc in the Randot stereotest. According to the
study, people with isoametropia had better stereopsis than people with anisometropia (52.86
and 39.20 in both tests; P.05). In the Titmus-fly test and the Randot stereotest, the proportion
of normal and equivocal stereopsis was 87.7% and 96.9%, respectively. Additionally, the
spherical myopic form of anisometropia had a higher degree of stereopsis than the spherical
hyperopic type (P.05). However, it was not found that any of the other factors looked at, such
as the amount of interocular variation in the lens power of the glasses, a history of amblyopia,
or age at the time the first pair of glasses were prescribed, were related to the degree of
stereopsis.(29)
A retrospective study was done in 2017 by Zedan RH, El-Fayoumi D, and Awadein A to look
at the changes in visual acuity, cycloplegic refraction, and cylindrical error in children with
anisometropia. The study was carried out for a minimum of five years, and every three to six
months, the children under the age of thirteen underwent a thorough ophthalmologic
examination that included measuring their visual acuity and cycloplegic refraction. Children
younger than 13 who had myopia greater than 4.00 diopters (D) in the more ametropic eye and
a difference in spherical equivalent refraction of 4.00 D between the two eyes were included
in the study. The researchers measured changes in the difference in spherical equivalent
refraction between the two eyes as well as changes in the spherical equivalent and cylindrical
error for both eyes for each patient at each visit. The regression line that had the highest R2
value after the researchers tried a range of fitting models, including linear, polynomial,
logarithmic, and exponential models, was found to be the best match. There were 63
participants in the study. According to the research, the more ametropic eye developed
normally for the first two years of life before abruptly slowing down and being practically
stable by the end of the fourth year. The myopia rise was best characterized by a third-degree
polynomial (cubic) model (R2 = 0.98), whereas the less ametropic eye only minimally
increased its myopia throughout the investigation. The anisometropic difference between the
two eyes significantly increased during the first two years before settling. In general, the
evidence suggests a predictable pattern in the growth of the more ametropic eye, which may
have implications for controlling and treating childhood anisometropia.(30)
In 2022, a study was conducted by Liu J, Wang Y, Huang W, Wang F, Xu Y, Xue Y, Wu M,
Yu F, and Gao R. The aim of the study was to compare the ocular biometry of eyes with
different axial lengths belonging to individuals with a spherical equivalent greater than -6D. In
order to be eligible for the trial, patients required to have at least one eye with an axial length
greater than 26 mm and a binocular axial length difference greater than 2 mm. The axial length
difference between the eyes was used to group the patients. Patients were further divided into
Group S1 (shorter eye) and Group L1 (longer eye) if there was a binocular axial length
difference of greater than 4 mm. The study analyzed a number of ocular biometric parameters,
including central corneal thickness, corneal curvature radius, axial length, anterior chamber
depth, lens thickness, white-to-white corneal diameter, and the radius of the anterior and
posterior lens capsules in patients with shorter eyes (axial length less than 26 mm). The eye
with a significantly shorter axial length was assigned to Group S, while the other eye was
assigned to Group L. The researchers compared these factors between Group S and Group L,
Groups S1 and L1, and Groups S2 and L2 among the study's 64 participants, including 26 in
Group S1 and Group L1 and 34 in Group S2 and Group L2. The findings revealed no noticeable
differences between Group S and Group L, Groups S1 and L1, or Groups S2 and L2 in any of
the ocular biometric measurements, with the exception of axial length. The study suggests that
eyes with different axial lengths may have similar ocular biometry aside from the axial length
difference. (31)
Saleem AA, Siddiqui SN, Wakeel U, and Asif M conducted a study. did. published in the
Taiwan Journal of Ophthalmology's 2018 issue. The age range of the 124 CNLDO children in
the study was 2 months to 8 years, with a mean age of 29.69 21.12 months. The study's
objective was to assess the refractive errors in kids with unilateral congenital nasolacrimal duct
obstruction (CNLDO) and compare those errors between the affected eye and the unaffected
eye. According to the researchers, cycloplegic refraction was performed on each child with
CNLDO before the required treatment. With a significance threshold of P 0.001, the study
found that hypermetropia was more common in the damaged eyes than in the normal eyes
based on spherical equivalent (SE). Anisotropia of at least 1.5 diopters (D) was present in 17
of the children (13.7%). The results showed a significant difference between the afflicted and
normal eyes for spherical error and SE but not for cylindrical errors, and that hypermetropia
was more common in the affected eyes of children with CNLDO. In summary, the study found
that children with CNLDO had hypermetropia more frequently in their affected eyes. The
management and treatment of CNLDO in children may be affected by the findings of this study.
(32)

In a 2016 study, Pärssinen et al. studied the relationship between anisometropia and a number
of ocular features in female twin participants between the ages of 66 and 79. The study
comprised 117 monozygotic (MZ) and 116 dizygotic (DZ) twin people. The refractive status
of the subjects was measured by an auto-refractor and controlled by subjective refraction. The
absolute values of anisometropia of spherical refraction (AnisoSR), anisometropia of
astigmatism (AnisoAST), and anisometropia of spherical equivalent (AnisoSE) were
calculated and compared with the ocular features. The axial length, anterior chamber depth,
and corneal refraction were measured with a Zeiss IOL Master. The associations between these
anisometropia values and spherical error (SR), astigmatism (AST), spherical equivalent (SE),
corneal refractive power (CR), corneal astigmatism (CAST), anterior chamber depth (ACD),
axial length (AL), and interocular variations were also examined. Astigmatism, spherical
equivalent, and spherical error all had mean values of anisometropia of 0.67. Anisometropia
more than 1.0 D was present in 14.7%, 4.2%, and 17.7% of cases for anisoSR, anisoAST, and
anisoSE, respectively. AnisoSR, AnisoAST, and AnisoSE were shown to be higher when the
values of SR or SE were more negative. In addition, there was no statistically significant
correlation between anisoSR and anisoSE and the absolute values of interocular differences in
CR and AL. These anisometropia values were not increased by hyperopic ametropia. When the
actual values of the interocular discrepancies were taken into account, the relationships were
still significant. AnisoSR and AnisoSE (emmetropization) decreased as a result of the
combined effect of the true interocular differences in CR and AL, according to the study. The
mean values of anisometropia for astigmatism, spherical equivalent, and spherical error were
0.67, 0.67, and 0.67 respectively. Anisotropia greater than 1.0 D was found in 14.7%, 4.2%,
and 17.7% of cases for anisoSR, anisoAST, and anisoSE, respectively. When the values of SR
or SE were more negative, it was discovered that AnisoSR, AnisoAST, and AnisoSE were all
higher. The absolute levels of interocular differences in CR and AL did not show any
statistically significant connection with anisoSR or anisoSE. Hyperopic ametropia had no
effect on these anisometropia levels. The associations were still significant when the interocular
differences' real values were taken into account. Participants who had their eyes operated on
for glaucoma or a cataract were excluded from the study, but the degree of nuclear opacity was
not documented. The study found that the real interocular differences in CR and AL together
had the effect of reducing AnisoSR and AnisoSE (emmetropization), as showed the inverse
relationship (r = -0.258, p 0.001).(33)
During a 12-year period, elderly people's refractive error increased, according to a 2014 study
by Haegerstrom-Portnoy et al. The study, which included 118 patients with healthy ocular
lenses in both eyes throughout the experiment and who were aged 67.1 and 79.3 years at the
two test dates, calculated anisometropia, which is defined as a difference in refractive power
between the two eyes. The prevalence of anisometropia nearly tripled for all refractive
components, the study found. Spherical error, primary astigmatism, and oblique astigmatism
all underwent comparable alterations. The study also discovered that many individuals who did
not at first display anisometropia later did. For instance, spherical equivalent anisometropia
increased from 16.1% to 32.2%. Within the tested age range, anisometropia began to manifest
at every age, with no particular age showing a preference. A small percentage of the subjects
did, however, gradually lose their anisometropia. Individual analyses of increases in refractive
error and nuclear lens modifications suggest that a significant amount of anisometropia (40%)
may be due to early nuclear sclerosis abnormalities in the two eyes. The study emphasizes the
significance of routine eye exams, especially for older people, because anisometropia can
happen at any age and can have a significant impact on visual function. It was shown that an
unequal hyperopic shift in the two eyes' spherical components was the main culprit behind
anisotropia. It also implies that the development of anisometropia in elderly people may be
influenced by changes in nuclear sclerosis and an unequal shift in the spherical component's
hyperopia. (34)
Pang Y, Allen M, Robinson J, and Frantz KA conducted a clinical study in 2019 that included
the participation of 20 amblyopic youngsters who also had myopic anisometropia. The control
group consisted of 16 patients who had high myopia but did not have amblyopia. Using linear
sine-wave gratings at a variety of spatial frequencies (1.5, 3, 6, 12, and 18 cycles per degree),
the researchers wanted to determine the contrast sensitivity function (CSF) of amblyopic,
fellow, and control eyes in order to draw conclusions about the differences between the groups.
The findings of the research indicated that there was a statistically significant difference in
logCS (contrast sensitivity) between the three groups of eyes at all frequencies (with the
exception of 1.5 cpd), which was one of the frequencies that was investigated. It was found
that the CSF of the amblyopic eyes was significantly lower than that of the control myopic eyes
at 3, 6, 12, and 18 cpd, but not at 1.5 cpd. This was the case at all other concentrations. There
was no statistically significant difference in the logCS between the control myopic eyes and
the fellow eyes. According to the findings of the study, the degree of anisometropia was found
to have a correlation with a lower CSF in amblyopic eyes when measured at middle
frequencies. There was not a significant relationship between the co-variables (age and race)
and the logCS. To put it another way, the degree of anisometropia, also known as the
differential in refractive error between the two eyes, is directly proportional to the contrast
sensitivity of the amblyopic eye at middle spatial frequencies. This discovery is crucial because
it highlights the role of anisometropia in the process of diminishing contrast sensitivity in
amblyopic eyes and emphasizes the requirement of early detection and anisometropia
correction in order to prevent or treat amblyopia (35).
The problem of severe anisometropia-induced amblyopia in older children, as well as the
necessity of early detection and treatment for the condition. Anisometropia is a condition in
which one eye has a different refractive defect from the other eye. This condition can lead to a
variety of visual difficulties, including amblyopia. The Eye Department at Aalborg University
Hospital has recently been given many recommendations for older children and adolescents
who suffer from anisometropia-induced severe amblyopia. Recent studies have revealed that
older children and some older persons with amblyopia caused by anisometropia can still
respond favourably to treatment, and some may see a substantial improvement in their vision.
This is the case even though they are considered to be older. An examination of one eye only
is necessary to diagnose anisometropia because the condition cannot be seen by the other eye
alone. However, because it is presently impossible to predict who would react favorably to
therapy, it is recommended that treatment be made available to all children, regardless of age,
if a child and their parents are motivated for it. This is because it is currently impossible to
predict who would react well to treatment. When anisometropia is identified at an earlier stage,
there is a greater possibility that treatment will result in a positive outcome (36).
In this article, the clinical investigations that Sharma P. conducted in 2018 on restoring
alignment and stereopsis in the management of amblyopia, esotropia, exotropia, and
complicated strabismus are evaluated from the perspective of the author's published work as
well as the author's own personal experiences. Amblyopia is a condition in which one eye turns
in a different direction than the other eye. Medical treatment and perceptual training with
monocular or binocular video games have been proved to be more effective than earlier
techniques of treating amblyopia, which included occlusion, penalization, or optical
rehabilitation. This has been demonstrated via multiple studies. According to the findings of
study, in order to successfully restore stereopsis, early treatment of esotropia and alignment
must be initiated within 8 weeks of the onset of symptoms. In this particular experiment, the
Frisby-Davis distance stereopsis was utilized. When it comes to the surgical treatment of
intermittent exotropia, individuals whose preoperative distance stereopsis was 70 arcsec are
less likely to improve after surgery. This is something that may be predicted by the distance
stereotest. Several different surgical procedures can be used to realign the eyes and restore
binocular vision in patients who have had their eyesight impaired. In situations of exotropic
Duane syndrome and lateral rectus palsy, some of these operations include periosteal fixation
of the globe or of the lateral rectus muscle, medial transposition of the split lateral rectus
muscle, and adjustable, partial vertical rectus muscle transposition. The surgeon's toolkit
should include all of these different surgical techniques (37).
For participants to be considered for participation in the study that Gawcki M worked on in
2019, they needed to have anisometropia of 0.25 D or less in a spherical equivalent, full
stereoscopic vision both near and distance, and neither a functional nor morphological
ophthalmological impairment. The individuals' right eyes were used to inflict myopic
anisometropia in order to assess the subjects' stereoscopic vision via the Randot and Titmus
tests for near and far, respectively. The objective of this was to determine how well the patients
could see in three dimensions. They were able to determine the thresholds for the loss of
stereopsis in patients whose myopic anisometropia was greater than fifty percent. myopia
anisometropia of more than 2 D has the potential to considerably impair binocular vision. The
findings indicated that stereoacuity at a distance is more susceptible to myopia anisometropia
than stereoacuity at a close distance. It was found that myopic anisometropia with "against the
rule" astigmatism may have a higher influence on binocularity than anisometropia with
conventional astigmatism does. This was a surprising discovery. An anisometropia of more
than two diopters needs to be treated as quickly as possible, as the researchers came to the
conclusion that this is the best way to prevent children from developing amblyopia. (38)
Myopia, hyperopia, and astigmatism at both 90° and 45° were induced by placing trial lenses
over the dominant eye, ranging in diopter (D) power from 3 to 1. In the subsequent
investigation, sixty adult volunteers were gathered, and four different types of anisometropia
(myopia, hyperopia, and astigmatism at both 90° and 45°) were induced. The Titmus, Randot,
and TNO tests were employed in order to measure stereopsis. In 2019, Nabie R, Andalib D,
Khojasteh H, and Aslanzadeh SA compared the results of the various tests. The findings of all
three stereo acuity tests showed that stereopsis decreased as anisometropia rose for all types of
anisometropia (P 0.001); this was the case regardless of the kind of anisometropia. The greatest
reduction in stereopsis, as measured in arc seconds, was associated with three-dimensional
myopic anisometropia in Titmus circles, Randot circles, and TNO, respectively. These
measurements were as follows: 6.51 2.10, 6.59 2.35, and 7.36 1.89. At 45 degrees, however,
there was not much of a shift in the stereopsis of 1 D astigmatism. (39)
In addition, 39 ophthalmology residents with stereopsis and normal vision participated in a
separate study that was conducted in 2021 by Singh P, Bergaal SK, Sharma P, Agarwal T,
Saxena R, and Phuljhele S. The purpose of this study was to investigate the influence that
induced anisometropia had on surgical performance and near stereopsis. Through the use of
trial lenses that were both spherical and cylindrical, anisometropia ranging from +1D to +5D
was successfully induced. During the evaluation of the residents, an EYES simulator was
utilized, and surgery scores were kept track of according to the degree of produced
anisometropia. With the help of the Randot and TNO tests, near stereopsis was analyzed both
at the beginning of the study and after each level of induced anisometropia. The findings
indicated that induced anisometropia had a considerable negative impact on surgical
performance as well as near stereopsis. The stereoacuity on the Randot and TNO tests both
decreased from baseline after the induction of anisometropia to varying degrees depending on
the degree of anisometropia that was caused, with the greatest loss occurring at +5D Sph. The
surgical score dropped considerably with each additional degree of induced anisometropia,
with the biggest change happening at +5D Sph. There was a statistically significant inverse
connection between the results for surgical tasks and stereopsis. A similar pattern of results
was observed when anisometropia was produced with cylindrical powers. (40)
In a different study, ten people with normal binocular vision were given synchronized shutter
glasses and shown McGill-modified random dot stereograms through them. This was done so
that their stereoacuities could be evaluated using a forced-choice approach with four different
alternatives. Atchison DA, Lee J, Lu J, Webber AL, Hess RF, and Baldwin AS. On the Effects
of Simulated Anisotropia and Aniseikonia on Stereopsis in 2020. Atchison DA, Lee J, Lu J,
Webber AL, and Hess RF. Anisotropia and aniseikonia were produced as well as their effects
on stereopsis assessed by positioning test lenses in front of the right eye that varied in their
powers as well as the axis that they were on. The loss of stereopsis due to anisometropia
increased when the cylindrical axis was rotated from 180 degrees to 90 degrees, with the
greatest loss for two-dimensional meridional anisometropia being recorded at the 90 degree
position. Either the positive or the negative lenses that were employed to generate
anisometropia had a deleterious impact on the stereopsis of the subject. On the other hand, the
axis did not have any effect on the stereopsis loss that was linked with induced meridional
aniseikonia, which was around 64 percent lower than that of a similar degree of overall
aniseikonia. In addition, the threshold was affected in the same way by each 6% of induced
aniseikonia as well as each D of produced anisometropia. 107 children were found to have
anisometropia, with 35 of those children having amblyopic anisometropia (AA) and 72 of those
children having non-amblyopic anisometropia (NA). (41)
2017 research conducted by Jeon HS and Choi DG featured 107 young persons with
anisometropia who were divided into two groups (n = 72 for non-amblyopic anisometropia and
n = 35 for amblyopic anisometropia). Additionally, a control group of healthy individuals (n =
73) who did not have anisometropia was included in the study as well. 107 children who were
diagnosed with anisometropia and were separated into two groups: non-amblyopic
anisometropia (NA, n = 72) and amblyopic anisometropia (AA, n = 35). In addition, 73 children
who were considered to be healthy and did not have anisometropia served as a control group.
The control group consisted of 73 individuals who were in good health and showed no signs
of anisometropia. The degree of stereopsis and sensory fusion was evaluated with the help of
the Titmus stereotest and the Worth 4-dot test, both of which were carried out with
anisometropic glasses. These tests served as the key outcome measures. Anisotropic glasses,
the Titmus stereotest, and the Worth 4-dot test were utilized during the course of the research
in order to determine the level of stereopsis and sensory fusion present in each of the groups.
The relative levels of anisometropia in the NA, AA, and control groups, respectively, were 2.54
D, 4.29 D, and 0.30 D, respectively (P = 0.014). According to the data, the stereopsis in the
AA group was significantly worse than that of the NA group and the control group (P 0.001
for each comparison; 76.25 arcsec and 54.52 arcsec, respectively). There was no noticeable
difference in stereopsis between the groups receiving NA and the control group. When
compared to the control group, the rate of fusion was significantly lower in the NA group
(65.3% vs. 80.6%, P = 0.001), and when compared to the NA group, the AA group's rate of
fusion (14.3%) was significantly lower (P 0.001). (42)
In the cross-sectional study conducted by Elamurugan V, Shankaralingappa P, Aarthy G,
Kasturi N, and Babu RK, 222 children and young adults between the ages of 5 and 18 who had
been wearing eyeglasses for at least a month were examined. All of the participants had been
wearing their glasses for at least a month. Their current need for corrective lenses was
determined with the use of an auto lensmeter, and their visual acuity was evaluated with the
help of a Snellen visual acuity chart. In order to determine the level of stereopsis, the Randot
and Titmus fly stereo tests were carried out. After the data were processed with IBM-SPSS
version 20, the researchers explored the links that existed between stereopsis and the various
categories of refractive errors, as well as visual acuity, age, and gender. The degree of
agreement between the Randot and the Titmus fly tests was determined with the help of Kappa
statistics. Myopia was the most common form of the three different types of refractive errors,
followed by astigmatism (60.4%), and then hypermetropia (1.4%). Anisometropia was present
in 13.5% of the children. It was not abnormal for children with hypermetropia to have
stereopsis. The sequence in which astigmatism, anisometropia, and stereopsis improved in
children and adolescents with spherical myopia was significant (P = 0.036). Children whose
anisometropia was less than 1.5 D showed superior stereopsis than those whose anisometropia
was greater than 1.5 D. At the time of the test, the child's age, the age at which they first started
wearing glasses, or their visual acuity had no bearing on whether or not they exhibited
stereopsis. The findings of the Randot and Titmus fly stereo tests showed that there was a
moderate amount of agreement with a Kappa value of 0.581 (43).
In a study that was conducted in July of 2022 by Atchison DA, Nguyen T, Schmid KL, Rakshit
A, and Hess RF, a four-circle (4-C) paradigm was established. As a result of the crossed or
uncrossed discrepancy, one of the circles may appear in front of or behind the others. This
stereotest was utilized for the following investigations: comparing it to the McGill modified
random dot stereogram (RDS); comparing it to anisometropia caused by +2 D spheres and
cylinders; comparing it to aniseikonia caused by 6% overall and 6% meridional (180, 90)
magnifiers before the right eye; comparing it to 6% lens-induced and 6% screen-induced 6%
overall and meridional magnifications; and determining whether In conditions that were
anisometropic as well as aniseikonic, the 4-C test produced stereo-thresholds that were 0.5–0.2
log units higher than those that were produced by the RDS test. In spite of this, the effects of
varying the power, meridian, and magnification on the two experiments were virtually
identical. According to the results of the pilot study, the use of surround masking was able to
more effectively neutralize screen and lens affects. Masking caused the stereo-thresholds to be
elevated both by lens-induced magnifications and screen-induced magnifications. When lens
and screen effects were in opposition to one another, stereo-thresholds returned to baseline for
overall and 180 magnifications in the majority of individuals, but they did not return to baseline
for 90 magnification. It was decided to develop a four-circle (4-C) paradigm, in which one
circle is placed in front of or behind the others depending on whether or not the discrepancy is
crossed. Only three out of the seven participants showed adequate compensation when viewed
at a magnification of 90. This stereotest was utilized for the following investigations:
comparing it to the McGill modified random dot stereogram (RDS); comparing it to
anisometropia caused by +2 D spheres and cylinders; comparing it to aniseikonia caused by
6% overall and 6% meridional (180, 90) magnifiers before the right eye; comparing it to 6%
lens-induced and 6% screen-induced 6% overall and meridional magnifications; and
determining whether In conditions that were anisometropic as well as aniseikonic, the 4-C test
produced stereo-thresholds that were 0.5–0.2 log units higher than those that were produced by
the RDS test. In spite of this, the effects of varying the power, meridian, and magnification on
the two experiments were virtually identical. According to the results of the pilot study, the use
of surround masking was able to more effectively neutralize screen and lens affects. Masking
caused the stereo-thresholds to be elevated both by lens-induced magnifications and screen-
induced magnifications. When lens and screen effects were in opposition to one another, stereo-
thresholds returned to baseline for overall and 180 magnifications in the majority of
individuals, but they did not return to baseline for 90 magnification. Only three of the seven
individuals showed appropriate compensation for the 90x magnification. (44)
In the study conducted by Atchison DA, Schmid KL, Haley EC, Liggett EM, Lee SJ, Lu J,
Moon HJ, and Baldwin AS, twelve subjects with normal binocular vision were shown McGill-
modified random dot stereograms using a forced-choice method with four different
alternatives. When trial lenses were placed in front of the eyes, the patient developed
astigmatism, and when magnifying lenses were utilized, the patient developed aniseikonia. The
research used a total of 23 different scenarios for each of the two types of induced astigmatism
and aniseikonia. These scenarios included different configurations of lens powers and axes
placed in front of the right and left eyes. According to the findings, the astigmatism axis exerted
a considerable influence on stereo acuity. Both monocular and binocular blur effects with
parallel axes resulted in the same amount of loss of stereopsis when compared to monocular
blur effects with the same axes. Binocular blur effects with orthogonal axes showed more
visible impacts than those with parallel axes, while the latter's axis combination had no effect
at all. Aniseikonia can be corrected by dividing the magnifications between the two eyes, and
while this does improve stereopsis, the advantages are not axis-dependent. (45)
1. Operational Definitions

Anisometropia:
The condition known as anisometropia is a singular illustration of how the eyes of an organism
can develop differently people, both in terms of their genetic origin and their apparent
susceptibility to identical environmental variables can cause asymmetrical growth, which can
produce drastically divergent results, mistakes caused by the refractive index.

Astigmatism:
The uneven focussing of light rays along distinct meridians is what gives rise to the condition
known as astigmatism. A prevalent type of refractive error, astigmatism is brought on by a
disparity in the relative refractive powers of the eye moving through a variety of meridians.
This results in two line foci, which cannot be remedied by modifying the position of the lines
either the viewing distance or the accomodation. It is impossible for the light beams to converge
as they travel through the eye at a certain focal point, but produce focal lines in the area around
it. To phrase it another way, astigmatism is a medical issue. when light beams that are parallel
and are traveling from the cornea do not converge to a location that is focused on the retina.
HYPEROPIA:
Light is concentrated behind the retina in people who have hyperopia.

MYOPIA:
Light is concentrated in front of the retina in those who have myopia.
REFRACTIVE ERROR:
The International Classification of Diseases, 10th revision, defines refractive error as defect
affects the focussing of the light on the retina, leading to eyesight that is unclear as a result.
Steropsis:
The perception of depth brought about by the brain's simultaneous reception of visual
information from both eyes; binocular vision.
2.Hypothesis
It is stated that
Null Hypothesis
There is no significant relationship between anisometropia and the grading of stereopsis,
suggesting that anisometropia does not impact depth perception or scoring in stereopsis tests.
Alternative Hypothesis
Anisometropia significantly impairs the grading of stereopsis, leading to reduced depth
perception and lower scores in stereopsis tests.
 CHAPTER-III

3.1: OBJECTIVE
To summarize current knowledge about the effect of anisometropia on the grading of steropsis.
 METHODOLOGY
1. Research Design: Interventional or Experimental study design will be
selected.

2. Clinical Settings: Data will be collected from Gulab devi Hospital,

Lahore.

3. Sample Size: Sample size for the research is 59 and is calculated by Raosoft.
N = Z2 P (1- P)/D2
Sample Size (n) = 45

4. Sampling Technique: Convenient non-probability sampling method.

5. Duration of Study: 3 months for Data Collection

6. Selection Criteria:
6.1. Inclusion Criteria:
 This study includes emmetropic individuals
 Between the ages of 4-30 years
 Having normal binocular single vision.

6.2. Exclusion Criteria:

 Individuals having squint will be excluded,
 Uncooperative individuals will be excluded
 Individuals with amblyopia or any ocular organic pathology will be
excluded.

7. Equipments:
 Frisbe
 Autoref.
 log Mar chart
 Trail box, Trial frame
7. Ethical Consideration
During the course of the research, both the norms and regulations that have been established
by the ethical committee of Superior University, Lahore, as well as the rights of the people who
are participating in the research, will be adhered to.

 All of the participants' written informed consent is included in the attached document.

 Every piece of information and the gathering of data is kept strictly confidential.

 Participants are not identified at any point during the course of the study.

 The participants in the study were told that there are no potential drawbacks or dangers
associated with the method being used in the research.

 participants were all informed that participants had the option to quit participating in the
study at any moment while it was ongoing.

 Please let us know if there are any known dangers that are going to be linked with this
research.

 Include this in your discussion if there are any advantages that will accrue to the participant
as a direct result of their involvement in this study.

 We will do everything possible to safeguard your privacy. Your anonymity will be

maintained in all publications that are the direct outcome of this research.

It is not required that you take part in this research study in any way. You are free to opt out of
the study at any time, and you are also free to revoke your agreement to do so if you change
your mind. In the event that you decide not to take part in this study or to withdraw from it
altogether, you will not be punished in any manner.
8. Data Collection Procedure
There are a few crucial stages involved in the process of collecting data in order to investigate
the impact that anisometropia has on the grading of stereopsis. In the first step of the process,
individuals with anisometropia and a control group that does not have anisometropia are
selected to take part in the study from the patient population at the hospital. Participants or their
legal guardians are asked for their informed consent before the study begins.
The patient's medical history is reviewed, and an eye exam is performed to acquire any
pertinent information, such as the patient's visual acuity, measurements of their refractive error,
and any ocular abnormalities. After the examinations, both groups will take standardized
stereopsis grading tests such as the Randot Stereo Test or the Frisby Stereo Test. These tests
will be given in order to determine their stereopsis scores. The exams are carried out in
accordance with standardized instructions, which guarantees that every participant will be
subjected to identical testing settings.
The stereopsis grading scores that were received from each participant in both the
anisometropic and control groups are recorded while the process of data collection is being
carried out. Additionally, data concerning the severity of anisometropia as well as other clinical
factors are gathered.
The gathering of exhaustive and precise information concerning the influence that
anisometropia has on the grading of stereopsis is the major objective of the approach that is
being used to collect data. The information that was gathered lays the groundwork for the
subsequent analysis and interpretation that will be done in order to identify the nature of the
link that exists between anisometropia and the grading of stereopsis.
The primary objective of this technique of acquiring data is to achieve a level of precision and
accuracy in the information that is gathered concerning the influence that anisometropia has on
the grading of stereopsis. In order to determine whether or not there is a correlation between
anisometropia and stereopsis grade, additional research and interpretation will be dependent on
the data that has been acquired.
9. Data Analysis
The data analysis procedure for summarizing the current knowledge about the effect of
anisometropia on the grading of stereopsis involves several key steps. Firstly, the collected
data, including stereopsis grading scores, anisometropia severity, and other relevant variables,
is organized and prepared for analysis.
To encapsulate the properties of the data, descriptive statistics like means, standard deviations,
and frequencies are produced. Subsequently, appropriate statistical tests are employed to
compare the stereopsis grading scores between the anisometropic and control groups. .
Depending on the data's distribution and the research questions, this step may involve non-
parametric tests, analysis of variance (ANOVA), or t-tests. Other relevant variables are also
organized and prepared for analysis.
In addition, statistical methods like regression analysis can be utilized to investigate the
connection between the degree of anisometropia and the stereopsis grading scores, while
controlling for potential confounding variables. Post-hoc analyses, such as pairwise
comparisons, may be conducted to further explore any significant findings.
The results of the data analysis are then interpreted, taking into consideration the statistical
significance and effect sizes. The findings are compared to existing literature and used to draw
conclusions about the effect of anisometropia on the grading of stereopsis. Limitations of the
study are discussed, and suggestions for future research or clinical implications may be
provided based on the results.
The data analysis procedure is crucial for providing empirical evidence and enhancing our
understanding of the relationship between anisometropia and stereopsis grading. It allows for
objective interpretation of the collected data, enabling researchers to make informed
conclusions and contribute to the current knowledge on this topic.
4.11: GANTT CHART
(In order to achieve the desired objectives of the study, divide your work plan into
different phases in a tabular form)

Months
(Divide the months according to your research duration)
Activity
01 02 01

Data Feb-March
collection

Data April
analysis
and
interpreta
tion

Thesis May
presentati
on and
submissio
n
 CHAPTER-IV
RESULTS
Induced PowerOf DS/DC * Streoacuity After Exprimantly Induced Myopic
Anisometropic Ambyopia On Frisby.

Crosstab
Count
Streoacuity After Exprimantly Induced Myopic Anisometropic Ambyopia On Frisby
.0 150" 450" 875" 1000" 2000 3000 Total
Induced +3 34 12 9 1 3 0 0 59
PowerOf +4 31 8 2 9 3 3 0 56
DS/DC +5 32 7 1 3 8 3 3 57
4.00 8 0 0 0 0 0 0 8
Total 105 27 12 13 14 6 3 180
 Induced PowerOf DS/DC * Streoacuity After Exprimantly Induced
hypropic Anisometropic Ambyopia On Frisby

Crosstab
Count
Streoacuity After Exprimantly Induced hypropic Anisometropic Ambyopia On Frisby
.00 150" 450" 875" 1000" 2000 3000 Total
Induced +3 35 12 7 4 1 0 0 59
PowerOf +4 31 11 3 7 2 2 0 56
DS/DC +5 32 9 2 3 7 2 2 57
4.00 8 0 0 0 0 0 0 8
Total 106 32 12 14 10 4 2 180

Induced PowerOf DS/DC * Streoacuity After Exprimantly Induced

astagmatic Anisometropic Ambyopia On Frisby

Crosstab
Count
Streoacuity After Exprimantly Induced astagmatic Anisometropic
Ambyopia On Frisby
.00 150" 450" 875" Total
Induced +3 50 2 5 2 59
PowerOf +4 50 1 4 1 56
DS/DC +5 50 2 3 2 57
4.00 0 0 4 4 8
Total 150 5 16 9 180
 ANOVA:

Results of the ANOVA test showing the statistical difference between all possible pairs
of measurements. Absolute differences between mean rank values are significant if
larger than 0.761599273516645 at a confidence level = 0.05.

ANOVA
Sum of Squares df Mean Square F Sig.
Streoacuity After Exprimantly Induced
Between Groups 23.879 3 7.960 3.176 .025
Myopic Anisometropic Ambyopia On
Frisby Within Groups 441.033 176 2.506
Total 464.911 179
Streoacuity After Exprimantly Induced Between Groups 16.290 3 5.430 2.646 .051
hypropic Anisometropic Ambyopia On Within Groups 361.154 176 2.052
Frisby Total 377.444 179
Streoacuity After Exprimantly Induced Between Groups 38.746 3 12.915 25.685 .000
astagmatic Anisometropic Ambyopia Within Groups 88.498 176 .503
On Frisby Total 127.244 179
Effect of anisometropia causing a loss of stereopsis in more than 50% of
subjects.

Type of anisometropia Sig.

myopic .025

hypropic .051

astagmatic .000
 CHAPTER-V
DISCUSSION

The majority of patients' loss of stereoacuity was the intended outcome of the study, which
sought to determine the specific types of anisometropia—myopic, hyproic, and astagmatic—
that were created. Despite the fact that there is a lack of consensus on the thresholds at which
stereoacuity is lost, population-based research have found that anisotropia is a significant
component that affects stereoacuity. Levi et al. conducted an analysis based on the loss of
stereopsis on 84 different kinds of pure anisometropes. Myopic anisometropes displayed
dramatically enhanced stereopsis as compared to analog anisohypermetropes. There was
shown to be a linear relationship between the loss of stereopsis and the degree of anisometropia
in cases with pure anisometropia (46). Dobson et al. , in their study, reported data on a group of
school-aged children who had a high astigmatism prevalence. In this particular study, a
hyperopic anisometropia of 1 D or more in sphere or 2-3 D or more in astigmatism was the
threshold for determining whether or not there was a substantial increase in the presence of
amblyopia.(47) However, it was shown that sphere or cylinder anisometropia as low as 0.5 D or
greater dramatically reduced stereoacuity. This was the case for all types of refraction defects.
Jeon and Choi (48) conducted research on 107 children diagnosed with anisometropia. The
children were divided into two categories: those who had amblyopia and those who did not
have the condition. In the group of people who did not have amblyopia, the average degree of
anisometropia was found to be 2.54 D, whereas in the group of people who had amblyopia, it
was found to be 4.29 D. In the amblyopic group, stereopsis was much worse than in the control
group, with a difference of 641.71 seconds of arch compared to 76.25 seconds of arch,
respectively. In the research carried out by Chen et al., pure anisometropes with three
dimensions or less were found to maintain some degree of stereopsis and fusion. It was
discovered that a degree of anisotropia of at least 6 D is required to bring about a complete loss
of binocularity (49). According to Yan et al. , stereopsis impairment is seen in children who have
myopic anisometropia that is more than one diopter in a sphere or cylinder.(50)
The previous research suggests that anisometropia diminishes stereoacuity; nevertheless, it is
difficult to determine the exact amount of anisometropia that substantially compromises
stereoscopic vision. This is because there are many different degrees of anisometropia. In
population-based studies, researchers commonly encounter stereoacuity defects due to a wide
variety of factors (anisometropia, microstrabismus, and deprivation), which makes it difficult
to conduct a study of this kind.
On the other hand, research that examines stereopsis in artificially created anisometropia is
able to precisely estimate the deficit in stereoacuity per 1 D of ametropia.
Oguz and Oguv were shown to cause anisometropia in healthy volunteers in laboratory
experiments (51). According to the findings of this study, spherical anisometropia and
astigmatism both caused a loss in stereoacuity that ranged from 51–56 seconds of arch to 57–
59 seconds of arch, respectively. At three dimensions, anisometropia hit its threshold, which
resulted in a significant reduction in stereoacuity for both the sphere and the cylinder. In their
respective studies (50,51), Dadeya et al. and Gawcki and Adamski reported findings that were
comparable. Kulkarni et al. (52) conducted research to investigate how experimentally induced
astigmatism affects one's ability to perceive stereo detail. The astigmatism values were
determined by the authors by using either 1 D or 2 D along a different axis. The dioptre power
of the astigmatism increased, resulting in decreased levels of stereoacuity. The effect of the
astigmatism along the 180 axis was the least noticeable to them, but the oblique astigmatism
had the most noticeable effect. Al-Qahtani carried out an inquiry on astigmatism that was
connected to this topic, and Al-Debasi provided support for these findings (53).
Analysis of myopic anisometropia is the primary emphasis of our current work. In contrast to
the findings of other studies, this one makes use of stereopsis grading and involves the
treatment of a significant number of patients. This study looked at the threshold values of
myopic anisometropia, which result in a complete loss of stereoacuity. The threshold values
varied across close and far distance assessments. In the close range, where values between 3
and 4 D cause a loss of binocularity, myopic anisometropia can be tolerated more easily. An
anisometropia value as low as 2 D has the potential to substantially diminish or even abolish
binocularity at a distance. In addition, we bring to your attention the possibility that "against
the rule" astigmatism may have a bigger influence on stereoacuity than normal astigmatism.
These findings are comparable with those of past study; however, this work also gives
intermediate values of anisometropia that lower stereoacuity but do not fully eradicate it. These
intermediate values of anisometropia are provided by this work. Patients with myopic
anisometropia who have lower threshold values run the risk of developing amblyopia; this fact
must be kept in mind at all times.
It has therapeutic implications, specifically for identifying the threshold values for the loss of
stereoacuity. Getting immediate medical attention is necessary for a child who has myopic
anisometropia that is greater than 2 D. When deciding on a course of treatment for amblyopia,
all relevant factors, including the presence of the sensitive phase for the treatment of the
condition, the availability of therapeutic methods, and the potential risks associated with the
use of those therapeutic approaches, need to be taken into account.
According to the findings of the vast majority of studies, the age range of 0–7 years old is the
most sensitive for visual development (54,55,56). On the other hand, there is evidence to suggest
that amblyopia in children less than 5 years old may be more amenable to treatment (57,58).

According to Donahue (59), amblyopia in anisometropic children younger than the age of 3 is a
somewhat rare occurrence. Amblyopia is a condition that normally appears in children with
anisometropia by the time they reach the age of three.
It is necessary to correct the refractive error, which includes anisometropia, in order to sustain
or regain binocular vision. The possibility of a normal development of the visual system in the
absence of such treatment is quite low. Anisotropia can be successfully treated with a reduced
degree of success when using spectacles and a greater degree of success when using contact
lenses (60). However, there are certain children who are resistant to the optical correction that
can be achieved using such approaches. Under these conditions, it is important to take into
consideration the possibility of laser refraction error correction. In the body of published
medical research, there have been reports of positive functional results following PRK in
anisometropic children. Autrata et al. report acceptable binocular function (61) in 13 children
between the ages of 7 and 15 who received photorefractive keratectomy (PRK) for severe
myopia anisometropia. These children had the procedure. Only six of the thirteen people
displayed stereopsis, but all thirteen had the ability to fuse together into a single entity. In a
follow-up study, the same researchers demonstrated that anisometropic children who had
received PRK or LASIK had better binocular function than anisometropic children who had
undergone treatment with contact lenses (fusion and stereopsis gain in 78% versus 33% of
cases) (62). Paysee et al. report similarly favorable outcomes for patients who had anisometropia
treated with PRK (63,64). Improvements in stereopsis were observed in 33 percent of cases (short
term) and in 55 percent of cases (long term) including children aged 2 to 11. Yin et al. (65)

conducted an examination on 32 myopic youngsters who had undergone LASIK surgery

because of myopic anisometropia. The percentage of patients who exhibited stereopsis rose
from 19% before surgery to 89% after it was performed. According to the findings of Astle et
al. (66), the percentages of stereopsis gain ranged from 39.4% to 87.9% across the full cohort of
children diagnosed with hyperopic and myopic anisometropia. The improvement in stereopsis
found in anisometropic persons after corneal refractive surgery can also be beneficial to adults
(67), who can also reap the benefits of this improvement.
Magli et al. presented data that were less than encouraging in nature. Only two out of eighteen
patients diagnosed with myopic anisometropia saw an improvement in their stereopsis as a
result of PRK.(68) Similar outcomes in young patients with myopic anisometropic amblyopia
who did not have stereopsis prior to femtosecond laser corneal surgery were described by
Zangh and Yu (69). There was an improvement in stereopsis observed in 21.2% of these patients.
Implantation of a phakic intraocular lens, often known as a p-IOL, is an alternate therapeutic
option for substantial anisometropia. The patient's native lens is preserved during the surgery,
which entails inserting an artificial lens either into the ciliary sulcus or the anterior chamber.
Tian et al. (70) performed a meta-analysis on the relevant body of research that was available.
They compared the functional vision improvement that occurred in children with myopic
anisometropia following the implantation of p-IOLs to that which occurred following corneal
refractive surgery. A greater than half of the patients in both study groups reported an
improvement in their ability to use both eyes together.
Implantable collamer lenses, often known as ICLs, have just recently become accessible for
use in the correction of serious forms of myopia and hyperopia. The p-IOLs are placed into the
patient's eye through the ciliary sulcus. ICL was used to correct myopia in 11 eyes of children
with unilaterally high myopia who were an average of 11 years old when the procedure was
performed. Zhang et al. The operation resulted in a significant improvement in BCVA;
however, none of the patients had a recovery of stereopsis for a considerable period of time
following the surgery (71), despite the fact that the surgery was performed. The same
authorreports the outcomes of ICL therapy in adult patients who had myopic anisometropia.
(72). Four of the thirteen individuals who received the treatment reported experiencing a
fundamental stereopsis gain for near after the procedure.
According to the findings of the research that were discussed, surgical treatment can only
deliver excellent outcomes under very certain conditions. It's possible that this is due to the
patients' advanced ages, as elderly patients are typically treated for amblyopia. In the same way
that the potential benefits and risks of any therapy must be evaluated in connection to one
another, the same is true for surgical procedures. Phakic intraocular lenses, and in particular
ICLs, may be beneficial for children who have severe anisometropia and for whom correcting
their vision with contact lenses or glasses is difficult or even impossible. This is especially true
for severe myopic anisometropia, as extreme myopia can be difficult to treat successfully with
corneal laser surgery. The refractive error known as myopia is one that the majority of people
willingly correct once they reach maturity. If there is a possibility of myopic anisometropia, a
choice about whether or not to have surgery should be made during the period of most
susceptible visual development.(76).
 CHAPTER-VI
CONCLUSION

The Frisby test's results for stereoacuity before and after experimentally produced myopic,
Hypropic and astigmatic anisometropic amblyopia and experimentally induced hypropic
anisometropic amblyopia show that people kept or may not kept their stereoacuity levels.
There were very slight differences in the distribution of the stereoacuity measurements
between the two experimental settings. These results imply that the Frisby test's measurement
of stereoacuity was significantly affected by the amblyopia that was induced. To further
understand the underlying mechanisms determining stereoacuity outcomes and to investigate
the long-term impacts of these experimental interventions, more research is required.
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 9.2: CONSENT FORMS
CONSENT FORM IN ENGLISH

Description of the Research and Your Participation

You are invited to participate in a research study conducted by Khansa Hamid (BSOP-
F19-011), Ibtasam (BSOP-F19-09), and Maryam Shabbir (BSOP-F19-012). The
purpose of this research is to evaluate the “Effects of induced anisometropia on the loss
of stereopsis”.

Protection of Confidentiality
We will do everything we can to protect your privacy. Your identity will not be
revealed in any publication resulting from this study.
Voluntary Participation
Your participation in this research study is voluntary. You may choose not to
participate, and you may withdraw your consent to participate any time. You will not
be penalized in any way should you decide not you participate or to withdraw from this
study.
CONSENT
I have read this consent form and have been given the opportunity to ask questions. I
give my consent to participate in this study.

Participant’s Signature Date:

 ‫ﺗﺤﻘﯿﻖ ﻣﯿﮟ ﺷﺮﮐﺖ ﮐﺎ ﺩﻋﻮﺕ ﻧﺎﻣﮧ‬

‫‪Title: “Effect of Contrast sensitivity in Proliferative Diabetic‬‬

‫”‪Retinopathy and Non-Proliferative Diabetic Retinopathy‬‬

‫ﻧﻘﺼﺎﻧﺎ ﺕ ﺍﻭﺭ ﺗﮑﻠﯿﻒ‪ :‬ﺍﺱ ﺗﺤﻘﯿﻖ ﺳﮯ ﮐﺴﯽ ﻗﺴﻢ ﮐﮯ ﻧﻘﺼﺎﻥ ﯾﺎ ﺗﮑﻠﯿﻒ ﮐﺎ ﺍﻧﺪﯾﺸﮧ ﻧﮩﯿﮟ ﮨﮯ ۔‬

‫ﻣﻤﮑﻦ ﮦ ﻓﻮﺍﺋﺪ ‪ :‬ﺁﭘﮑﻮ ﺍﯾﮏ ﺍﮦ ﻡ ﺗﺤﻘﯿﻖ ﻣﯽ ﮞ ﺣﺼﮧ ﻟﯿﻨﮯ ﮐﺎ ﻣﻮﻗﻌﮧ ﺩﯾﺎ ﺟﺎﮰ ﮔﺎ۔‬

‫ﺭﺍﺯﺩﺍﺭ ﯼ ﮐﺎ ﺗﺤﻔﻆ‪ :‬ﮦ ﻡ ﺁﭖ ﮐﯽ ﻣﻌﻠﻮﻣﺎﺕ ﮐﮯ ﺗﺤﻔﻆ ﮐﮯ ﻟﯿﮯ ﻭﮦ ﺳﺐ ﮐﭽﮧ ﮐﺮﯼ ﮞ ﮔﮯ ﺟﻮ ﮦ ﻣﮑﺮ ﺳﮑﺘﮯ ﮨﯿﮟ۔ ﺗﺤﻘﯿﻖ ﮎ ﮮ‬
‫ﻣﺘﻌﻞ ﻕ‬
‫ﺍﮐﭩﮩﯽ ﮐﯿﯽ ﮔﯿﯽ ﺗﻤﺎﻡ ﻣﻌﻠﻮﻣﺎﺕ ﮐﻮ ﺍﻧﺘﮩﺎ ﺋﯽ ﺧﻔﯿﮧ ﺭﮐﮫ ﺍ ﺟﺎﮮ ﮔﺎ۔ ﮈﯾﭩﺎ ﺍﻧﭩﺮﯼ ﺍﻭﺭ ﺗﺠﺰﯾﮯ ﮐﮯ ﺩﻭﺭﺍﻥ ﺁﭖ ﮐﮯ ﻣﺘﻌﻠﻖ ﻭﮦ‬
‫ﺗﻤﺎﻡ ﻣﻌﻠﻮﻣﺎﺕ ﺝ ﻥ ﺱ ﮮ ﺁﭖ ﮎ ﯼ ﺷﻨﺎﺧﺖ ﮦ ﻭﺳﮑﺘﯽ ﮨﻮ ﮐﻮ ﺧﺘﻢ ﮐﺮ ﺩﯾﺎ ﺟﺎﮮ ﮔﺎ ۔ ﺍﺱ ﺗﺤﻘﯿﻖ ﮐﮯ ﻧﺘﯿﺠﮯ ﻣﯽ ﮞ ﺷﺎﺋﻊ‬
‫ﮨﻮﻧﮯ ﻭﺍﻟﯽ ﮐﺲ ﯼ ﺑﮫ ﯾﺎﺷﺎﻋﺖ ﻣﯿﮟ ﺁﭖ ﮐﯽ ﺷﻨﺎﺧﺖ ﮐﻮ ﻇﺎﮨﺮ ﻧﮩﯿﮟ ﮐﯿﺎ ﺟﺎﮮ ﮔﺎ‬
‫ﺭﺿﺎﮐﺎﺭﺍﻧﮧ ﺷﻤﻮﻟﯿﺖ ‪ :‬ﺍﺱ ﺗﺤﻘﯿﻘﯽ ﻣﻄﺎﻟﻌﮧ ﻣﯿﮟ ﺁ ﭖ ﮐﯽ ﺷﺮﮐﺖ ﺭﺿﺎﮐﺎﺭﺍﻧﮧ ﮨﮯ۔ ﺁﭖ ﮐﻮ ﺷﺮﮐﺖ‬
‫ﻧﮧ ﮐﺮﻧﮯ ﺍﻭﺭ ﮐﺴﯽ ﺑﮭﯽ ﻭﻗﺖ ﭘﻐﯿﺮ ﻭﺟﮧ ﺑﺘﺎﻧﮯ ﺍﺱ ﺗﺤﻘﯿﻖ ﻣﯿﮟ ﺷﻤﻮﻟﯿﺖ ﮐﻮ ﭼﮭﻮﮌﻧﮯ‬
‫ﮐﺎ ﺍﺧﺘﯿﺎﺭ ﮨﮯ۔ ﺷﺮﮐﺖ ﻧﮧ ﮐﺮﻧﮯ ﯾﺎ ﺍ ﺱ ﻣﯿﮟ ﺷﻤﻮﻟﯿﺖ ﮐﻮ ﭼﮭﻮﮌﻧﮯ ﮎ ﯼ ﺻﻮﺭﺕ‬
‫ﻣﯿﮟ ﺁﭖ ﮐﮯ ﺧﺎﻟﻒ ﮐﻮﺋﯽ ﮐﺎﺭﻭﺍﯾﯽ ﻧﮩﯿﮟ ﮎ ﯼ ﺟﺎﮮ ﮔﯽ‬

‫ﺩﺭﺟﺬﯼ ﻝ ﻣﻌﻠﻮﻣﺎ ﺕ ﺗﺤﻘﯽ ﻕ ﻣﯽ ﮞ ﺷﺎﻡ ﻝ ﮨﻮﻥ ﮮ ﻭﺍﻟﻮ ﮞ ﮎ ﮮ ﻟﯽ ﮮ ﭘﮍﮬﯽ ﮞ ﺍﻭ ﺭ ﺍ ﻥ ﮎ ﺍ ﺟﻮﺍﺏ ﺩﯾﮯ ﮔﯽ‬
‫ﮮ ﺧﺎﻧﻮ ﮞ ﻣﯽ ﮞ ﺩﺭ ﺝ ﮐﺮﯾﮟ‬

‫ﻣﯽ ﮞ ﻧﮯ ﻣﻌﻠﻮﻣﺎﺗﯽ ﺷﯿﭧ ﺟﻮ ﮐﮧ ﺗﺤﻘﯿﻖ ﮐﯽ ﻭﺿﺎﺣﺖ ﮐﺮ ﺭﮨﯽ ﮨﮯ ﮐﻮ ﺳﻤﺠﮫ ﻟﯿﺎ ﮨﮯﺍﻭﺭﻣﺠﮭﮯ‬

‫ﮐﺮﻥ ﮮﮐﺎ ﻣﻮﻗﻊ ﺩﯾﺎ ﮔﯿﺎ ﺗﮭﺎ ۔‬ ‫‪‬‬ ‫ﺗﺤﻘﻘﯿﻖ ﮐﮯ ﺳﻮﺍﺍﻟﺖ‬
‫ﻣﯽ ﮞ ﺳﻤﺠﮫ ﮔﯿﺎ‪/‬ﮔﯿﯽ ﮨﻮ ﮞ ﮐﮧ ﻣﯿﺮﯼ ﺷﺮﮐﺖ ﺭﺿﺎﮐﺎﺭﺍﻧﮧ ﮨﮯ ﺍﻭﺭ ﯾﮧ ﮐﮧ ﻣﯽ ﮞ ﮐﺴﯽ ﺑﮭﯽ‬
‫‪ ‬ﮨﻮ ﮞ ﺍﻭﺭ ﺗﺤﻘﯿﻖ ﺳﮯ ﺩﺳﺘﺒﺮﺩﺍﺭ ﮨﻮ ﺳﮑﺘﺎ‪/‬ﺳﮑﺘﯽ‬ ‫ﻭﻗﺖ ﺍﭘﻨﺎ ﺍﺭﺍﺩﮦ ﺑﺪﻝ ﺳﮑﺘﺎ‪/‬ﺳﮑﺘﯽ‬
‫ﻣﯽ ﮞ ﺳﻤﺠﮫ ﮔﯿﺎ‪/‬ﮔﯿﯽ ﮨﻮ ﮞ ﮐﮧ ﻣﯿﺮﮮ ﺟﻮﺍﺑﺎﺕ ﺧﻔﯿﮧ ﺭﮐﮭﮯ ﺟﺎﺀﯼ ﮞ ﮐﮯ۔ ﻣﯽ ﮞ ﻣﺤﻘﯿﻘﯿﯽ ﻥ ﮐﻮ‬
‫ﻭ ﮦ ﺟﻮﺍﺑﺎﺕ ﮐﻮ ﺟﺎﻥ ﭺ ﺳﮑﯿﮟ ۔‬ ‫ﺍﺱ ﺑﺎﺕ ﮐﯽ ﺍﺟﺎﺯﺕ ﺩﯾﺘﺎ‪/‬ﺩﯾﺘﯽ ﮨﻮ ﮞ ﮐﮯ ‪‬‬
‫ﻣﯽ ﮞ ﺳﻤﻤﺠﮫ ﮔﯿﺎ‪/‬ﮔﯽ ﮨﻮ ﮞ ﮐﮯ ﻣﻌﻠﻮﻣﺎﺕ ﻣﯿﺮﮮ ﻧﺎ ﻡ ﮐﮯ ﺑﺠﺎﮮ ﻧﻤﺒﺮ ﮐﯽ ﺻﻮﺭﺕ ﻣﯽ ﮞ ﻣﺤﻔﻮﻁ ﮐﯽ ﺟﺎﺋﯽ ﮞ ﮔﯽ۔ ﺗﺎ ﮐﮧ ﻣﯽ ﮞ‬
‫ﻧﺘﺎﺉ ﺝ ‪‬‬
‫ﮎ ﯼ ﺍﺷﺎﻋﺖ ﮐﮯ ﺩﻭﺭﺍﻥ ﮐﺴﯽ ﺑﮭﯽ ﻃﺮﺡ ﺳﮯ ﺷﻨﺎﺧﺖ ﻧﮧ ﮐﯿﺎ ﺟﺎ ﺳﮑﻮﮞ۔ ﻣﯿﮟ ﺍﺱ ﺑﺎﺕ ﺳﮯ ﺭﺿﺎﻣﻨﺪ ﮨﻮﮞ ﮐﮯ ﺟﻮ‬
‫ﻣﻌﻠﻮﻣﺎﺕ ﻣﺠﮫ ﺳﮯ ﻟﯽ ﺟﺎﺋﮩﯿﮟ ﮔﯽ ﻭﮦ ﺗﺤﻘﯿﻖ ﻣﯽ ﮞ ﺍﺳﺘﻌﻤﺎﻝ ﮨﻮ ﮞ ﮔﯽ۔ ﻣﯽ ﮞ ﺍﻭﭘﺮ ﺑﺘﺎﯾﯽ ﮔﯽ ﺗﺤﻘﯿﻖ ﻣﯿﮟ ﺷﺎﻡ ﻝ ﮨﻮﻧﮯ‬
‫ﮐﮯ ﻟﯿﮯ ﺭﺿﺎﻣﻨﺪ ﮨﻮﮞ ﺍﻭﺭ ﻣﺤﻘﯿﻘﯿﻦ ﮐﻮ ﺍﭘﻨﺎ ﭘﺘﮧ ﺗﺒﺪﯼ ﻝ ﮨﻮﻧﮯ ﮐﯽ ﺻﻮﺭﺕ ﻣﯿﮟ ﻣﻄﻞ ﻉ ﮐﺮﻭ ﮞ ﮔﺎ‪/‬ﮔﯽ‬

‫ﺭﺿﺎ ﻣﻨﺪﯼ‪:‬ﻣﯿﮟ ﻧﮯ ﯾﮧ ﺍﺟﺎﺯﺕ ﻧﺎﻣﮩﭙﮍﮬﺎﮨﮯ ﺍﻭﺭﻣﺠﮭﮯ ﺳﻮﺍﻝ ﭘﻮﭼﮭﻨﮯ ﮐﺎ ﻣﻮﻗﻊ‬

‫ﺩﯾﺎ ﮔﯿﺎﮨﮯ۔ ﻣﯿﮟ ﺍﺱ ﺳﭩﮉ ﯼ ﻣﯿﮟ ﺷﺮﮐﺖ ﮐﮯ ﺭﺍﺿﯽ ﮨﻮﮞ ۔‬
‫ﺗﺎﺭﯾﺦ‬ ‫ﺩﺳﺘﺨﻂ‬ ‫ﺷﺮﮎ ﺕ ﮐﻨﻨﺪﮦ ﮐﺎ ﻧﺎﻡ‬

‫ﺗﺎﺭﯾﺦ‬ ‫ﺩﺳﺘﺨﻂ‬ ‫ﺍﺟﺎﺯ ﺕ ﻟﯿﻨﮯ ﻭﺍﻟﮯ ﮐﺎ ﻧﺎﻡ‬

 PROFORMA

The Superior University Lahore

Department of Allied Health Sciences

1.Experimentally induced ‘Anisometropic amblyopia’:

Name Age Gander Visual Stereoacuity POWER Stereoacuity

acuity before myopic OF DS After myopic
Anisometropia Anisometropia
induced on
frisby test
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
2.Experimentally induced ‘Hypropic Anisometropic amblyopia’:
 Name Age Gander Visual Stereoacuity POWER Stereoacuity
acuity before myopic OF DS After myopic
Anisometropia Anisometropia
induced on
frisby test
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
3.Experimentally induced ‘Astigmatic Anisometropic amblyopia’:

Name Age Gander Visual Stereoacuity POWER Stereoacuity

acuity before myopic OF DS After myopic
Anisometropia Anisometropia
induced on
frisby test
1
2
3
4
5
6
7
8
9