PRIMARY OPTOMETRY LABORATORY 6163, (Wensveen)

THE ADVANTAGE OF BINOCULAR VISION

EQUIPMENT
please bring:
calculator
pencil or pen
trial lens kit

supplied:
VHS video player and TV Howard-Dolman apparatus
Pulfrich effect videotape & viewers Verhoeff stereopter
Stereo effect videotape Titmus, Reindeer & Randot stereotests
TNO stereoscopic test
Plumb bobs Random-dot E
Table lamps Frisby test
Neutral density filters Lang stereo test

Stereoscopes (Brewster)
Stereograms demonstrating rivalry, luster, and stereopsis

Graph paper

INTRODUCTION
Binocular vision is the use of the two eyes in a coordinated manner so as to produce a
single mental impression. Normal binocular vision implies binocular single vision (fusion) and
a high level of stereoacuity.
In this laboratory we will examine several phenomena that cannot be appreciated
monocularly. Not all are necessarily an advantage of binocular vision as far as visual function
is concerned, but all have stimulated thought as to the mechanisms of binocular vision. We
will also learn about the threshold for stereopsis and utilize several tests for assessing
stereoacuity.
Binocular vision entails the integration of two monocular images into a single binocular
percept. The integration occurs at cortical levels and is therefore essentially a perception. The
formation of two suitable monocular sensations requires:

1. overlapping of the visual fields of the two eyes so that the same object can be seen by both
eyes

2. the simultaneous stimulation of corresponding retinal areas

3. the ability of the extraocular muscles to adjust the visual axes so that the corresponding
retinal areas are placed in a position to receive simultaneous stimulation by the same object.

Given that these requirements are met, the uniquely binocular phenomena of
physiological diplopia, Pulfrich effect, retinal rivalry and luster, Fechner's paradox and
stereopsis can be appreciated.

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Physiological Diplopia
When two images of an object fall on corresponding retinal areas, single vision is
attained. The extent of corresponding areas allows a certain amount of error; however, if the
images fall on widely disparate areas, diplopia results. Physiological diplopia is inevitable and
is always present. The double images are not noticed in everyday activities; we apparently
see only one view of the external world as if we possessed only one centrally placed eye.

Pulfrich Effect
The Pulfrich effect is the phenomenon whereby a moving object binocularly perceived
with unequal retinal illuminances appears to be displaced from its objective location. Swinging
a pendulum in a frontal plane and viewing it binocularly with a neutral density filter placed
before one eye usually demonstrates this effect. The resultant percept is of the pendulum
moving about an elliptical path. This effect has also been used to create stereoscopic effects
in broadcast television programs (Superbowl half-time show of 1989).
The Pulfrich effect occurs because the transmission time of signals from the retina to
the cortex depends inversely on retinal illuminance. At photopic levels, reducing retinal
illuminance by one log unit (a factor of ten) increases the transmission time by 15-20
milliseconds. If an image is moving across both retinae, a delay in one eye results in an
effective shift of the image in that eye relative to the other. If the motion is horizontal, this
effective disparity is perceived as depth when the signals from each eye are combined in the
cortex. The amount of depth depends on both the velocity of the moving image and on the
amount of delay produced by the filter.
Note that unequal retinal illuminances may also be produced by unilateral mydriasis or
by disease processes that effect neural transmission of the visual signal; a person in this
condition may experience potentially dangerous stereo percepts while driving.

Figure 1. Pulfrich
Effect
R L
Illustration of how a
swinging pendulum Plane of Pendulum
appears to follow an
elliptical path when
viewed with a neutral Apparent
density filter over one Path of
eye. The delay in Pendulum
visual processing due
to the filter causes the
central nervous
system to fuse images N.D. Filter
which originated at
different times,
resulting in an
effective disparity for
moving objects.

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Retinal Rivalry
Retinal rivalry or binocular rivalry (and rivalry suppression) occurs when images of
dissimilar targets presented to the two eyes cannot be fused. When images cannot be fused,
the visual system alternately gates signals from the left and right eyes, so that the two targets
appear to alternate in unpredictable ways. The classic demonstration uses targets of equal
size consisting of parallel diagonal lines arranged in opposite directions for the two eyes. The
direction of tilt seen in each part of the visual field reveals which eye is seeing and which is
suppressed at any instant. This suppression can be localized, resulting in a patchwork of left
and right eye signals, or it can be total so that only one or the other eye is represented.

Rivalrous patterns:
When presented to corresponding
areas in each eye, this pair of
images produces binocular rivalry.

Luster
Luster is a rivalry-like phenomenon which occurs when corresponding retinal areas
have dramatically different color or brightness, for example when viewing a matte white figure
outlined in black with one eye and a matte black figure of the same size outlined in white with
the other eye. The resultant perception differs from what one would expect if the images were
merely combined, i.e., a gray. The figure has a shiny, metallic appearance, which is called
luster. Although considered a limiting case of retinal rivalry, this phenomenon has not been
explained satisfactorily. Nevertheless, luster effects are useful in vision training of A.R.C.
(anomalous retinal correspondence). The strabismic (typically esotropic) patient (with ARC)
views a brightly illuminated wall while wearing red/green glasses. The patient should be able
to see luster over the entire surface of the wall as the red and green colors undergo rivalry. If,
on the other hand the patient sees a split field (i.e., red on one side and green on the other)
the prognosis for remediation of the ARC is poor and no further attempt at training is made.

Fechner's Paradox
Fechner's paradox is the phenomenon in which a monocularly viewed white surface
appears brighter than when it is viewed binocularly with one eye viewing the surface directly
and the other eye viewing it through a neutral density filter. The binocular brightness is less
than the brighter of the two monocular brightness. In the monocular viewing situation, one eye
sees zero brightness, so if left and right eye brightness are simply added then the image
should appear brighter when viewed binocularly, even if one eyes image is dimmed. The
paradox is that adding light to one eye has made the perceived brightness reduce. The
explanation for the phenomenon is that brightness averaging occurs when both eyes are
viewing, but suppression occurs when one eye is completely occluded.

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Stereopsis
Stereoscopic vision may be defined as the ability to see relative distances of objects on
the basis of visual information available only to a two-eyed observer. The two retinal images
(one in each eye) are slightly different due to the horizontal separation of the eyes, and it is
the horizontal retinal image disparities that provide the essential information for stereoscopic
depth perception. In the figure below, whether B is seen nearer or farther than A depends only
on whether the separation of the images of the two lines for the right eye is smaller or greater
than that for the left eye.
A Stereoscope is an instrument that separates the field of view of the two eyes so each
eye can view a different image. There are two basic forms of stereoscopes. The Wheatstone
stereoscope consists of two plane mirrors joined at one edge to form an angle of 90 degrees.
Targets placed to the left and right of the mirrors are viewed by the left and right eyes,
respectively. The targets can be moved laterally to induce convergence or divergence. The
Brewster stereoscope uses a pair of base out sphero-prisms as eyepieces to separate the
right and left eye fields of view. Targets are placed in front of the left and right eyes, and the
eyepieces allow the viewer to fuse them as if they were a single object at distance. The
amblyoscopes used in the clinic are examples of stereoscopes.
The threshold of stereopsis can be specified in terms of the minimum perceptible
binocular disparity. Binocular disparity refers to the difference in the angles subtended at the
eyes by two objects, one being the fixation point.

B Binocular disparity:
Linear
Depth Stereoscopic depth is
Interval perceived when images
A Angle B2 have different angular
separations on the two
Angle A1 Angle A2 retinae. Images of A and B
in this figure are closer
together in the left eye view
A B A B than in the right, resulting in
Angle
B1 a percept of depth.
Disparity is defined as the
Left Eye View Right Eye View
difference in subtended
angles (A1 - A2) or the
difference in target
B A B A vergence (B1 - B2).

Binocular disparity = a1-a2 or b1-b2 and is also called the stereopsis angle. Stereoacuity
corresponds to the threshold detection of this binocular disparity, usually expressed in
seconds of arc. This threshold angle of binocular disparity for a given subject is essentially
invariant with viewing distance. This indicates that the visual system utilizes angular
information in the disparity of the two retinal images and that the associated information
processing is independent of viewing distance.
Stereopsis requires fusion. If your patient has a history of a condition known to disrupt
fusion (strabismus or anisometropia) then it is unlikely that he will see the depth in screening
tests for stereopsis. When children fail screening tests, we suspect that they may not be using
their 2 eyes properly together and are alerted to look for the reason.

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BEHAVIORAL OBJECTIVES
Explain how we think these phenomenon occur: physiological diplopia, retinal rivalry,
luster, Fechner's Paradox, Pulfrich effect and stereopsis.
Define the threshold of stereopsis.
Recognize the differences between the tests of stereopsis: what the name of each is,
principal behind the test, how to administer the test properly, its advantages and
disadvantages, and special uses. Do not memorize the formulas given.
Know how anisometropia of increasing magnitude affects stereopsis, and how
measures of stereopsis with monocular blur compare to measures of stereopsis with
the same amount of binocular blur.

READINGS
Reading RW. Binocular vision. Butterworths, Boston, 1983: 25-26 50-52 151-190.
Bishop PO. Binocular Vision. In Moses RA. Adler's physiology of the eye. The C.V.
Mosby Co St Louis 1988: 619-689.
Heron G., Dutton GN. The Pulfrich phenomenon and its alleviation with a neutral
density filter. British J. Ophthal; 1989; 73:1004-1008.
Griffin JR. Binocular anomalies: Procedures for vision therapy. 1st Edition. Professional
Press Chicago 1982: 50-53.
Rosner J., Rosner J. Pediatric Optometry. 2nd Edition. Butterworths Boston 1990:175-
203.
Brooks, SE. Anisometropia and Binocularity. Ophthalmology; 1996; 103:1139-1143.

PROCEDURE
Physiological Diplopia
Hold up a pencil about 25 cm from the eyes and look, not at the pencil, but at the wall
beyond. Two images of the pencil will be perceived. Close each eye in turn and note which
image disappears.

Now, hold your finger before your eyes and the pencil further away and a bit higher
than your finger. Fixing your eyes steadily on your finger, notice that two images of the pencil
appear. Bring the pencil in slowly toward your finger. The extent of diplopia decreases. We
have demonstrated here the two types of diplopia: crossed and uncrossed. Which one is
which?

How might physiological diplopia be used in making sure both eyes are seeing during
convergence training?

Retinal Rivalry
This demo is set up in the stereoscope. First view the stereoscopic slide, and adjust the
viewing distance by sliding the cardholder closer and further from you until you perceive
maximum stereopsis; now keep the cardholder in this position. Insert the card with the oblique
lines on it. Describe your perception when dissimilar targets, one imaged in each eye are
observed. Do you get complete suppression? Rivalry?

Luster
This demo is set up in the stereoscope. Describe your perception of the black and
white targets, when an integrated image is perceived.

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Pulfrich Effect
Swing the pendulum so that its path is parallel to your subject's face plane. Have your
subject place the neutral density filter before his right eye. Describe the apparent path the
pendulum takes including shape and direction.

Now place the filter over the left eye. What differences did you notice?

View the Pulfrich video - do you see the 3-D effect?

Fechner's Paradox
Take a neutral density filter (0.8 - 1.0 ND). Look at a wall illuminated by the adjustable
table lamp, close one eye, and hold the filter before the closed eye. Note the brightness of the
wall with the open eye and assign that brightness a value of 10. Now open the other eye
behind the filter so as to see the wall binocularly. Does it's brightness increase, stay the same
or decrease? Compared to the value of 10 that you assigned the brightness of the wall with
just one eye viewing, what value would you assign to your brightness impression now? Try to
explain your results.

CLINICAL TESTS OF STEREOPSIS

Titmus StereoFly Test

The Titmus Test is one of the most widely used stereotest for measuring stereoacuity,
even though stereoacuity of only up to 40 arcsec can be measured. It is designed for testing
young children but is commonly used for adults as well.
For the Titmus test and the other printed tests of stereopsis, direct the overhead
reading lamp onto the book. Either you or the patient can hold the book at the regular reading
distance (40 cm), but it must be held perpendicular to the line of sight. Jiggling or twisting the
book to see the figures in depth is cheating. Have the patient wear the polarizing glasses. If
your patient cannot see both the R + L on the right-hand side he may be suppressing the
right eye (R not seen) or left eye (L not seen). If he can see the R + L have him view the fly
on the right-hand page. Instruct your patient to try to grab the fly by the wings. He should
grasp about 4 inches above the surface of the page. This is a test of gross stereopsis and
shows the patient what to look for in the tests of fine stereopsis. Now have him view the left-
hand page, and identify which animal in each row stands up off the page.

Cat: 400 arcsec Rabbit: 200 arcsec Monkey: 100 arcsec

Next have him view the panels with the circles. Starting with number 1 have him
indicate which circle stands off the page. Dont let the patient actually touch the surface of the
page because finger smudges are not good for the test. The disparity gets smaller as the
panels progress and the number of arcsec stereoacuity required to discriminate the depth on
each panel is tabulated. The limit of stereoacuity measurable with this test is 40 arcsec.

1 bottom 800 arcsec 6 left 80 arcsec

2 left 400 arcsec 7 right 60 arcsec
3 bottom 200 arcsec 8 left 50 arcsec
4 top 140 arcsec 9 right 40 arcsec
5 top 100 arcsec

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Randot Stereotest
All of the targets in the Randot stereotest are vectographic, so the patient must wear
polarizing filters to separate one eyes view from the other. The novel feature of the Randot
test is that some targets the shapes are random-dot stereograms. These have 2 distinct
advantages over line stereograms: there are no monocular cues and instead of
discriminating between depth planes, the patient must identify the shape of the test target.
The patient can only see the target and identify its shape if he is sensitive to the disparity in
the stereogram. A limitation of the Randot test is that random-dot stereograms are used only to
screen for global stereopsis.
In the same posture as for the Titmus test, have your patient look at the right-hand
page and identify the shapes there. This is the random-dot part of the stereotest. Identifying
the figures in the top half requires 500 arcsec, identifying the letters in the bottom half
requires 250 arcsec stereoacuity.
Top Bottom
Circle Star I Square Triangle
Blank Letter E I Plus sign Blank

The cat (400 arcsec), rabbit (200 arcsesc) and monkey (100 arecsec) are scored the same as
on the Titmus test. Try the circles next. The smallest disparity tested is 20 arcsec.

1 left 400 arcsec 6 middle 50 arcsec

2 right 200 arcsec 7 left 40 arcsec
3 left 140 arcsec 8 right 30 arcsec
4 middle 100 arcsec 9 middle 25 arcsec
5 right 70 arcsec 10 right 20 arcsec

Reindeer Stereo Test

This test is similar in the method of administration and in principle to the Titmus Test,
with just a few differences. The test distance is 14inches = 35 cm and stereoacuity is
expressed in stereo percentage. Measure and record your stereothreshold with the Reindeer
test. Convert the percent stereopsis you find to stereoacuity in seconds of arc using the table
or the formula below.
Table 1. Conversion of Percent Stereopsis to Stereoacuity for the Reindeer Stereotest
Test Item Correct Response Percent Stereopsis
Stereoacuity
A 4 10 600
B 2 25 300
C 5 40 150
D 3 60 75
E 4 75 50
F 2 85 35

Stereoacuity (arcsec) = 10100 - 81

%+5

TNO Stereoscopic Test

This test also uses random-dot stereograms and can test to small disparities. The
test plates are anaglyphs, that is two images superimposed and printed in roughly
complementary colors, red and green. Using red and green glasses, each eye sees only one
image. Go through the test noting your response to each of the seven plates. DO NOT
TOUCH THE PLATES! Record your threshold. The last plate measures stereopsis to 15
7
arcsecs.

8
Random-dot E (RDE)
The Random-dot E test consists of 3 cards and a pair of polarizing glasses. Based on
the tumbling E visual acuity chart and random dot patterns, this stereoacuity test can be used
with young children. There is a demonstration plate on which an E is presented in relief (to
show the patient what he should see) a stereogram E, and a blank stereogram (random dots
with no stereopsis stimulus). During the test, the stereogram E and the blank stereogram are
presented at the same time. The patient must choose which plate has the E on it and can be
asked to tell which direction the legs are pointing. Although the instructions recommend
testing at distances between 0.5 and 1 meter, the test is usually performed at 1.5 meters
because it is more sensitive in detecting binocular vision problems at this distance. Do 6 trials.
Passing the test requires at least 4 correct responses.
The RDE test is most useful as a screening test and has limited use in determining the
patients stereoacuity. The RDE test is advantageous for use with young children because it is
easy to understand, requires minimal cooperation, is unambiguous, quick, cannot be learned
and is culture free. A disadvantage is that polarizing filters must be used and some children
may shy away from the glasses.

Lang Stereotest
The Lang stereotest uses a technique called panography where stereoscopic depth is
achieved without the use of vectographic techniques. Two similar pictures are viewed through
cylindrical lenses which, when fused give rise to a single stereoscopic image. The lenses are
laminated onto the surface of the testing plate and make the surface look rippled (DONT
TOUCH THE SURFACE). One advantage of the Lang test is that the patient does not have to
wear any glasses to see the shapes. The primary use of the Lang test is as a screening
device. The test card is held 40 cm and the patient is asked to identify the pictures. The
pictures in the Lang 1 are: a cat (1200 arcsecs), a car (550 arcsec), and a star (600 arcsec).
The pictures in the Lang 2 are: an elephant (600 arcsecs), a car (400 arcsecs), a moon and a
star (200 arcsecs).

Frisby Test
The Frisby test utilizes real depth as a cue to stereopsis. The test consists of three
plexiglass plates (6mm, 3mm, and 1mm thickness), on which are printed four random-pattern
squares. One of the squares is produced so that a circular area of the random pattern is
printed on the other side of the plate from the rest of the pattern. If the observer can
appreciate the disparity, he will perceive a circular area in depth in that one square. The task
of the observer is to identify which of the four squares has the circle-in-depth. Depending on
the distance at which the test is performed, stereoacuity can be ascertained to be at least at a
certain level or a threshold may be determined. Perform this test at 40 cm, beginning with the
thickest plate. If an error is made, rotate the plate and retest. Two consecutive errors are
considered failure. Record the stereothreshold (see chart in the test). If all plates are correctly
identified, increase the distance by 10 cm and repeat until a threshold is obtained.
This test can be used with preschool children. It is advantageous in that red-green or
polaroid glasses are not needed. Also by rotating the plates randomly, repeated presentations
of the test are possible, thus allowing repeated testing without the subject learning the correct
response.

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Non-clinical Tests of Stereopsis
Howard-Dolman Test
We will measure stereoscopic threshold angles using the Howard-Dolman apparatus.
This apparatus consists of two vertical rods, one fixed and the other movable, controlled by a
string operated by the subject. The rods are seen through an aperture against a gray
background so that only stereoscopic cues to real depth are available. The movable rod is
adjusted so that it appears to lie just noticeably in front of the fixed rod, or just noticeably
behind the fixed rod. A scale on the side allows an experimenter to read the setting in
millimeters.
Stand as far away from the apparatus as you can while still holding the strings (about 4
meters). Pull the movable rod towards you until you can just tell that it is in front of the fixed
rod. The amount by which the movable rod is in front of the fixed rod is the alignment error in
mm. Calculate your stereoacuity with the Howard-Dolman using the following formula or by
consulting the table below:

Stereoacuity (arcsec) = P.D. (mm) x Alignment Error (mm) x 0.206

(fixation distance (m)) ^2

Table 2. Howard-Dolman Alignment Error (mm) Stereoacuity (secs of arc)

test for stereopsis, 5 4
performed at 4 meters 10 8
and assuming a P.D. of 60 mm. 15 12
20 15
40 31
60 46
80 62
100 77

Verhoeff Stereopter (used to be a clinical test for stereopsis)

One way of comparing the relative strength of a depth cue is to pit one depth cue
against another - that is to have the depth cues provide opposite depth information. In this
test, size and retinal image disparity (real depth) are used in opposition. The Stereopter
has an illuminated white window in which 3 vertically placed black strips are centered. One of
the strips is displaced from the plane of the other two, either in front or behind and the
observer is asked to tell which strip is nearest or farthest. A combination of 8 different strip
arrangements is possible. The test distance is varied until the observer responds correctly to
all 8 targets and the threshold recorded according to the disparity of the target strips at that
distance. The table below lists thresholds for various test distances.

Table 3. Verhoeff Stereopter Test Distance (cm) Stereoacuity (arcsecs)

Testing distance and corresponding 10 3090
Stereoacuities. All 8 targets must be 20 772
Responded to correctly. P.D. is 30 343
assumed to be 60 mm and the 40 193
displacement of the strips is 2.5 mm 60 86
(i.e., forward or behind). The 80 48
same formula used for the 100 31
Howard-Dolman calculations 150 14
was used here. 200 8
300 3

10
Clinical Tests of Stereopsis:
Titmus Stereofly Test:
Measure your baseline stereoacuity at 40 cm and record it in the space marked plano.
Note the perception of depth that you see. This is what you will be looking for in the
remainder of the experiment, NOT that one target is different, but that it looks in depth.
Put the +3.50 lenses over your right eye (polarizing filters still on), and with both eyes
open measure and record your stereoacuity. Start with the +3.50 lens and use decreasing
lens powers as shown in the table, so that you dont memorize the correct responses.
Put the +3.50 lens in front of both eyes (polarizing filters still on), and with both eyes
open, measure and record your stereoacuity. Use decreasing lens powers as before.
plano Lens power +3.50 +3.25 +3.00 +2.75 +2.50 +2.25
Blur right eye
xxxxx Blur both eyes
Graph your results on the graph paper provided. The horizontal x-axis will be the lens
power and the vertical y-axis will be stereoacuity. Mark which curve was obtained with
monocular blur and which was obtained with binocular blur.

Questions:
1. Which degrades stereopsis to a greater degree, monocular or binocular blur? Why?

2. Physiological Diplopia: when looking at your finger, the pencil has crossed
disparity; is it in front of your finger or behind?

3. Randot stereotest: The shapes on the right page are unique to this test. What are
the shape targets composed of so that there are no monocular cues available to
help in identifying the shapes? If your patient cannot see the shapes at all, what
should you suspect is the reason?

4. Reindeer: The test distance is unique at ________, and the threshold is in %. What
is your threshold in % and what does that translate to in arcsec?

5. TNO: How is one eyes view separated from the other in the TNO? The TNO
measures the finest stereo threshold of any clinical test at___________arcsec.

6. Random-dot E: Is the Random-dot E used to screen for stereopsis or to measure

a stereothreshold?

7. Lang 1 and Lang 2: What is the main advantage of the Lang tests? What is the
name of the method by which one eyes view is separated from the other?

8. Frisby: What makes the target appear in depth in the Frisby test?

9. Howard-Dolman: What makes the target appear in depth in the Howard-Dolman

test?

10. Verhoeff Stereopter: What 2 depth cues are you pitting against each other in the
Verhoeff Stereopter? Why is this not used in the clinic anymore?

11. What gives the SuperBowl half-time show the enhanced depth effect?

12. What is the basis of monocular stereopsis?

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