1 & 2. Intro To Binocular Vision & BV problems Flashcards

1
Q

Benefits of binocular vision

A
  1. Increased field of view.
  2. Compensation for the phycological blind spot.
  3. Binocular summation
  4. Stereopsis (depth perception)
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2
Q

What is the term used to describe double vision?

A

Diplopia

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3
Q

What causes double vision?

A

When the eyes are not lined up, different images fall on each fovea in both eyes (this is called confusion). This 2 images are superimposed leading to double vision- because the 2 images are seen together at the same time.

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4
Q

How is alternating vision caused? And it can lead to ?

A

Due to double vision, the brain uses image from 1 eye at a time causing an alternation between the 2 images, leading to loss of peripheral vision.

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5
Q

What is stereopsis?

A

Depth perception or 3D vision

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6
Q

What do we need to have binocular vision?

A

Two eyes with overlapping visual field

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7
Q

What 4 factors are important for optimal binocular vision?

A

Good VA
Roughly equal VA
Roughly equal sized images
Clear media- no cataracts

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8
Q

Where does binocular visual processing take place pathway and why does it need to be intact?

A

Processing takes place in the cortex (brain) hence needs to be intact.
BV processing takes place in the brain and not they eye.

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9
Q

What ocular conditions are caused if binocular vision pathway isn’t intact?

A

Albinism -not all information cross optic chiasma it stays on the same side of the brain.

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10
Q

What motor aspect is important for BV?

A

Positioning of the eyes to look at an object and maintaining alignment at the object

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11
Q

What voluntary and involuntary muscles play a role in motor aspects of BV?

A

Voluntary- extraocular (extrinsic) muscles
Involuntary- ciliary muscles (Accommodation) and pupils (sphincter and dilatory)

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12
Q

Is binocular vision present at birth?

A

NO

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13
Q

Binocular vision develops at what age?

A

It first rapidly develops over the first 6 months of life and continues for 8/9 years of life

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14
Q

At what age is binocular vision the most malleable?

A

Up to 5/6 years, maybe up until 8/9 years, very difficult to change after this

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15
Q

Where does binocular vision processing occur?

A

In the brain (in V1 of the occipital cortex and subsequently in the higher centre) and this route is provided by the retina to co-ordinate information

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16
Q

Describe how binocular vision processing occurs in relation to ganglion cells and the cortex

A

Info from ganglion cells at corresponding points in each eye are processed together in the cortex to extract binocular information. Decussation of nerve fibres at chiasm allows this.

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17
Q

Define principal visual direction/ visual axis/ line of sight?

A

(When looking at an object), the image falls on the fovea and lies on the visual axis.

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18
Q

Define secondary visual direction

A

Image does not fall on the fovea. (Surrounding objects)

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19
Q

Define oculocentric localisation

A

Position of objects relative to principal visual direction in monocular vision.

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20
Q

Define egocentric localisation

A

Understanding position of objects relative to our bodies. (using both eyes and proprioceptive clues).

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21
Q

Define primary visual direction and it is determined by?

A

It is determined by the eyes rotation. Image will fall on the fovea even if that object is not at the centre of the scene.

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22
Q

Multiple objects in the same visual direction are perceived as?

A

Being behind or in front of each other.

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23
Q

Difference in images between 2 eyes is called?

A

Retinal Disparity

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24
Q

Define Horopter

A

Imaginary plane for a fixation point. All objects on this plane perceived as single.

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25
Define Panum's area
Region behind and in front of horopter where objects can still be fused, but are seen in depth.
26
We don't see images as diplopic because?
Our brains suppress the image from the non-dominant eye. This is called as physiological diplopia.
27
Can patients with diplopia drive?
No
28
What is congenital or infantile BV problems?
Either present at birth or develop within the first 6-12 months
29
Childhood BV problems onset?
Typically 2-5 years onset
30
How are BV problems acquired in life?
Trauma, cranial nerve palsy or decompensation of existing heterophoria
31
What are complains reported by adults with non-specific BV problems?
Eye strain when using computers
32
Squint synonyms?
Strabismus or heterotropia
33
What are congenital BV conditions? what kind of deviations do they produce?
This conditions are present at birth however, may not be diagnosed until later. They often produce INCOMITANT deviation.
34
What are incomitant deviations?
This are deviations that change in size in different direction of gaze.
35
What are comitant deviations?
This is when deviations are same in all direction of gaze
36
What are potential BV issues?
Problems with convergence, accommodation and extra-ocular muscles, convergence insufficiency (unable to maintain convergence)
37
What is gaze palsies?
This is BV potential issue, this is a lesion in the brain that causes eye movement problems
38
How is recovery tested in cover test?
It is assessed on how well fusion is restored.
39
Describe the recovery of eyes with a tropia
The eye doesn't recover, since the eyes are unable to fuse at the end of the cover test.
40
What is the purpose of cover test and why is it done at distance and near?
Purpose: to assess ocular alignment. It is done at both distances cause it may vary.
41
Why is cover test done with glasses on and off?
To identify if glasses are making vision better, worse or same. This also helps identify existing BV problems
42
What target is used for cover test?
1 line above normal V/A on snell chart and if vision is poor use of spot light
43
Can cover test be useful for highly myopic eyes?
No, target needs to be visible by both eyes
44
What is Nystagmus?
If the patients eyes can remain still- involuntary eye movement
45
Before cover test is performed what observations are made?
1. Are the eyes straight? 2. Is the head straight? 2. Are the eyes still?
46
What will be seen in patients with unequal Rx in both eyes?
Unequal phoria
47
What are the preliminary observations taken before performing cover test?
1. Mobility/ navigation 2. One eye covered? 3. Facial structural characteristics? 4. Abnormal head posture? 5. Ocular alignment? 6. Nystagmus? 7. Does the patient have an existing Rx?
48
What is suspected in patients with one eye higher then the other?
Vertical deviation
49
What is suspected in patients with high interpupillary distance?
Exotropia
50
What is suspected in patients with a small PD?
Esophoria
51
How can epicanthic folds mislead into BV problems?
If folds are large, it can give the illusion of esotropia
52
What can be determined by eyelids: Angle of lid fissure?
Abnormal slope may indicate high astigmatism. Asymmetry might indicate unilateral high astigmatism
53
What is proptosis?
Forward bulging of the globe, e.g Grave's disease
54
What is pseudoproptosis?
Retraction of the upper eyelid causing the appearance of ptosis. e.g, graves disease
55
What is ptosis?
Dropping of eyelids e.g, myasthenia gravis, 3rd nerve palsy. OM can be affected
56
What is pseudoptosis?
False appearance of drooping eye lids of eyes.
57
Describe Abnormal Head Posture (AHP)? what kind of deviation does it produce?
Usually found in incomitant deviation. It develops to improve BV problems. And occasionally this condition increases diplopia
58
What are the common face movements caused by AHP?
Head/ face turn Head/ face tilt Chin up/ down
59
How do you know if your patient has AHP?
Sit directly in front of the patient and ask the patient to fixate on a target. Assess heterotropia with and without AHP
60
What conditions can give the appearance of AHP?
1. Nystagmus null point 2. Homonymous hemianopia 3. Musculo- skeletal issues affecting the back and neck
61
What is the optometrists responsibility to the patient?
1. Identify any problems 2. Resolve any problems or refer (Recognize your own limits) 3. Communicate effectively with your patients
62
Which ocular pathology can be presenting as BV problem?
Retinoblastoma - can be represented as a convergent squint
63
Is it true that the target in the cover test needs to be seen by both eyes?
Yes
64
Is phoria or tropia alternating?
Tropia
65
If a patient has a phoria, what is being observed about the movement between the 2?
The equality between the movements
66
Asymmetry in angles of lid fissure may indicate? And patients with this are at high risk of?
Unilateral astigmatism- high risk for amblyopia
67
Importance of corresponding points?
They send information to the brain
68
Retinoblastoma can be represented as?
Convergent squint
69
What is binocular visual field?
Combination of right and left visual fields.
70
Define confusion in terms of diplopia
Differing images falling on the fovea seen simultaneously, overlying each other.
71
Fusion of images from both eyes leads to extraction of information related to?
Depth perception
72
Images fall on which part in the retina?
Fovea