Tests for Stereopsis

Presenter
Dr. Syed Nabil Bin Maruf
FCPS Course Student
NIO&H
 Chairman
Dr. Shovona Alam
Associate Professor
Department of Paediatric Ophthalmology
NIO&H

Moderator
Dr. Chandan Kumar Paul
Registrar
NIO&H
 Terminology
 Retinal Corresponding Points
 Retinal areas in the 2 eyes sharing a common subjective

visual direction
 Their simultaneous stimulation results in the subjective

sensation that the stimulating target or targets come from

the same direction in space
 Terminology
 Horopter
 Imaginary band containing all those points in
space off which, images fall on corresponding
points of the retinas of the two eyes
 Terminology

 Panum’s Fusional Space

 Zone around the horopter in which objects stimulates

slightly non-corresponding retinal points giving rise to

single vision despite retinal disparity
 Terminology
 Binocular Single Vision (BSV)
A common single perception of the object of regard by

simultaneous usage of both the eyes

It is based on Normal Retinal Correspondence
 Terminology
 Depth Perception aka Bathopsis
 Perception of relative distance between two objects relying

on monocular cues
 Monocular Cues: Motion, Shadow, Size, Aerial Perspective,

Defocus Blur, Interposition

 Terminology
 Stereopsis
Binocular sensation of relative depth produced by

horizontal disparities of the retinal images in the two

eyes
 Basis of Stereopsis
 Simultaneous Perception
Ability of the two eyes to visually perceive an object simultaneously at any given
time individually
 Development of Fusion
Ability of the brain to fuse the simultaneously perceived two images into one
complete image
 Stereopsis
Ability of the brain to analyse the dissimilarities of the two images and generate a
three-dimensional perception of the object in our visual cortex
 Grades of Binocular Vision
Different steps in the development of stereopsis
during visual maturation, graded using
Synoptophore as:
 Grade 0 – No BSV
 Grade 1 – Simultaneous Perception
 Grade 2 – Fusion
 Grade 3 – Stereopsis
 Stereoacuity
 A qualitative aspect of binocular vision
 A patient’s stereo performance
 The least angular difference in depth that an
individual can perceive binocularly
 Stereoacuity

 Quantified as Seconds of Arc / arcsec

 Lesser the value, better the stereoacuity
 Normal range <40 arcsec
 Tests for Stereopsis
 Qualitative Tests
• Lang Two Pencil Test
• Synoptophore
 Quantitative Tests
• Random Dot Test
 Random Dot E Stereotest
 TNO Anaglyph Stereotest
 Lang Stereotest (without glasses)
• Frisby Stereotest
• Stereo Fly Test
 Lang’s 2 Pencil Test
 Determines gross stereopsis
 Method:
• Examiner holds a pencil infront of the patient
• Patient is asked to place the tip of another pencil on top of
the examiner’s pencil tip
 Patient with gross stereopsis easily performs the
test binocularly, but faces difficulty monocularly
 Synoptophore
 Also referred to as
Amblyoscope
 Orthoptic instrument
used for various
diagnostic and
therapeutic purposes
 Synoptophore
 Based on Haploscopic Principle
Division of the physical space into two seperate areas of visual
spaces, each of which is visible to one eye only
Synoptophore
 Random Dot Test
 There are several types of random dot stereotests
 The stereoacuity is measured from the patient's
ability to identify forms from random dot
backgrounds, as presented on several plates or
pages of a book.
 Random Dot E Stereotest
 Designed to rapidly test for amblyopia and strabismus
using stereopsis in early & non-readers and non-verbal
children & adults.
 Wearing the polarized viewers, an individual with normal
depth perception should be able to correctly identify the
Raised letter E
 Random Dot E Stereotest
 Test consists of:
• 3 cards
 Model E Card
 Blank Card
 Raised E Card
• 1 pair pediatric polarized
viewers
• 1 pair adult polarized
viewers
 Random Dot E Stereotest
 Test subject is shown the Model E Card to identify
the figure
 At 50cm from the test subject both Blank &
Raised E Card is held up facing the subject, and
asked to identify E Card
 Random Dot E Stereotest
 Cards are then shuffled behind the back of the examiner
and presented to the subject again to identify the Raised E
 Repeated atleast four times
 Examiner then moves further away and repeat the process
again
 Random Dot E Stereotest
Disparity
Distance (cm)
(arcsec)
50 504  The Test can measure
100 252 stereoacuity ranging
150 168 from 500-50 arcsec over
200 126 a distance upto 16 feet
300 84
400 63
500 50
 TNO Anaglyph Stereotest
 Designed primarily for screening pre-school children (age 2½ to 5
years) for defects of binocular vision
 It consists of seven plates, viewed with red-green spectacles at
40cm distance
 Each carry figures that can be seen only when both eyes co-operate
to give stereoscopic vision
 TNO Anaglyph Stereotest
 Plates I - III enable the examiner to establish
whether stereoscopic vision is present at all
 Plates V – VII used for exact determination of
stereoscopic sensitivity
TNO Anaglyph Stereotest
 Plate I
• Two butterflies can be seen,
but one of them is hidden,
which is visible only when
both eyes are used.
• The child is asked to point at
each butterfly they can see
TNO Anaglyph Stereotest
 Plate II
• Four discs (balls, saucers), that
differ in size, are present.
• Two of these, the largest and
second smallest, are visible only
stereoscopically.
• First ask for the smallest disc -
this one always being visible -
then for the largest.
 TNO Anaglyph Stereotest
 Plate III
• Four hidden test items - a disc, triangle, square and diamond are
arranged around a central cross of different texture
• The child is first asked to look at one of the examples on the opposite
page and then instructed to find the corresponding figure in the test
plate.
 TNO Anaglyph Stereotest
 Plate IV
• This is a suppression test, showing a small disc flanked by two large discs
• If the child sees only two discs, ask for the largest
• The position of that disc (left or right) indicates which is the dominant eye.
• If the child shows a tendency to fuse the small disc with one of the larger
ones, the book should be rotated over 90° so as to present the discs in a
vertical row.
TNO Anaglyph Stereotest
 Plate V-VII
• Here the test figures (discs with a sector
missing) are presented at six different depth
levels (two at each level).
• The corresponding retinal disparities (binocular
parallax) range from 15 to 480 seconds of arc.
• When instructing very young children it may be
helpful to tell the child to put a finger in the
hole where the piece of “cake” or “pie” is
missing.
Plate V
Plate VI
Plate VII
 Lang Stereotest
 The LANG-STEREOTEST is an easy-to-use screening-test
designed for early detection of problems with stereoscopsis in
children without use of any glasses
 Two versions of the test plates are available, which differ only
according to the 3D objects shown.
 Lang Stereotest
 Lang Stereotest I displays a star, a cat and a car.
 Lang Stereotest II displays a moon, a truck and an
elephant, each of them appearing on a different
level.
 In addition, the Lang Stereotest II contains a star
that can be seen with only one eye.
 Lang Stereotest I

 Disparities:
• Car: 550 arcsec
• Star: 600 arcsec
• Cat: 1200 arcsec
 Lang Stereotest II
 Disparities:
• Moon: 200 arcsec
• Truck: 400 arcsec
• Elephant: 600
arcsec
• Star: always visible
 Frisby Stereotest
 Simple and easy to administer
 No need for special glasses
 Tests for stereopsis even if amblyopia is present
 Ideal for babies and young children
 Repeat testing possible without the patient learning
how to pass for the wrong reasons
 Pre-test training possible to ensure test
understanding
Frisby Near Stereotest
 Frisby Near Stereotest
 The target is a cluster of randomly
arranged arrowheads of differing sizes
 It is printed on one side of the plate in
one of the four quadrants; on the other
side of the plate similar pattern elements
are printed around the target and in the
other three quadrants.
 Frisby Near Stereotest
 An observer with normal BSV can readily detect the target
because it appears to stand out from the background or to
recede from the background, depending which way round the
plate is shown.
 An observer lacking normal BSV or viewing monocularly fails
to detect the target as long as the plate is shown correctly
 Frisby Near Stereotest
 Correct Positioning
• Stationary, viewed square-on,
• Placed about
5-10cm
infront of a
clear
background
 Frisby Near Stereotest
 Do not hold the plate flat
against the box when
measuring stereoacuity
as this can introduce
shading cues revealing
the target monocularly
Frisby Pocket Stereotest
 Frisby Stereotest
Viewing Distance Plate Thickness
cm (in) 6mm 3mm 1.5mm

30 (12) 600 300 150

40 (16) 340 170 85
50 (20) 215 110 55
60 (24) 150 75 40
70 (28) 110 55 30
80 (32) 85 40 20
100 (40) 55 25 15
120 (47) 40 20 10
150 (60) 25 10 5
STEREO
FLY
TEST
STEREOTEST
HOUSEFLY
FLY WINGS
59 Minutes of Arc
3552 Seconds of Arc
STEREOTEST
CIRCLES
 STEREOTEST
ANIMALS

Test Correct Answers Angle of Stereopsis at 16 inches

A Cat 400 arcsec
B Rabbit 200 arcsec
C Monkey 100 arcsec
 Conclusion
 An ideal Stereotest should include:
1. Measure fine stereopsis
2. Be glasses-free
3. Be an easy task
4. Have no monocular cues
5. Have large and high contrast dots
6. Measure a wide range of disparities with small step sizes
7. Have good repeatability and sensitivity
 Conclusion
 Of all the commercially available tests, none of them meets all
these criteria
 Each test has its own advantages and disadvantages
 It is recommended to use more than one test and combine
Frisby with a random dot stereotest like TNO or Random Dot
E to measure fine stereopsis in the absence of monocular cues
 Conclusion
 The poor sensitivity of all available stereotests
means that a stereotest should never be used as a
sole instrument for screening for amblyopia or
strabismus, but should be complemented by other
(binocular) vision tests and clinical examinations
 Conclusion
 Fine stereopsis is a prerequisite for the following occupations:
 Pilot (Passenger Airline/Air Force)

 Captain or Sailor of a Ship or Boat

 Locomotive Engineers

 Driver of any vehicle

 Surgeons (esp. Microsurgeon)