Development of Binocular

vision
University of Gondar
Department of optometry
By Nebiyat Feleke

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 Learning objectives
By the end of this session , the student is expected
to
Explain the normal development period of ocular structures

Assess the critical period of visual system development

Analyzes the normal anatomical development of binocular

vision

Identify the obstacles to the development of binocular vision

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 Development of binocular vision
• The eye at birth
Gross anatomy
Retina and visual pathway

The pupil
Accommodation
Convergence
Refractive error
• Assessment of and obstacles to visual acuity
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 Development of BV
During the first few years of life certain normal
anatomical and physiological conditions are
required for the development of binocular vision.

factors concerned for the development of

Binocular vision are anatomical and physiological
factors

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 A. Anatomical factors

The two eyes are so situated in the orbit that the visual axis
is directed in the same direction. This is due to:

Shape of the orbit

Presence of adjacent ligaments, muscles and connective

tissues.

The extra-ocular muscles have an important role to play

as they provide motor correspondence because of the
reciprocal innervationsBinocular
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of the vision
extra-ocular muscles. 5
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 Anatomical ….
The aim of the motor correspondence is to-

Enlarge the field of view by transforming the field of

vision into the field of fixation.

Bring back the object of attention on to the fovea and to

maintain it.

Position the two eyes in such a way that all the times they
are properly aligned
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 B) Physiological factors

• The development of binocular vision (BV) depends

upon certain normal physiological binocular reflexes.
• The reflexes can either be inborn or acquired as a
result of appropriate stimulation.
• The various binocular reflexes are; fixation reflexes,
pupillary reflexes

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 THE EYE AT BIRTH
Gross anatomy

At birth the eye is relatively large and has an axial length

of about 16 mm compared to about 23 mm in the adult

The volume of the eye grows 2-3 times compared to the

body’s 20 times

The distance between the eyes, the inter-pupillary

distance, is ~ 40 mm

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 Eye @birth
The corneal radius is steep at ~ 6.7 mm, as are
the surfaces of the lens (+5.0 mm and –3.7 mm)

The infant eye has a power of ~ 85 DS

Growth of the eye is initially rapid increasing to

21 mm in the first year and then continuing
more slowly up to about 10 years
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• When we remove the eye from the orbit, we can see that
the eye is a slightly asymmetrical sphere with an
approximate:
 sagittal diameter or length of 24 to 25 mm. and a

 transverse diameter of 24 mm.

 It has a volume of about 6.5 cc.

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 ANGLE KAPPA
o angle formed by visual and pupillary axis

o +ve = Normal =0.5mm nasal

o There is a disproportionate early development of

the temporal side of the globe in the first three
months of gestation, thus the optic nerve is
“pushed” nasally
o This results in a large angle Kappa about 8 degree.
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 Angle kappa

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The Retina & Neural Visual Apparatus
• At birth the peripheral retina appears histologically
mature but is not fully functional (e.g. the field
sensitivity increases dramatically in the first few
months.
– However, at birth the central 5 degrees is
markedly different from its adult structure.

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 The retina …
– The inner nuclear and ganglion cell layers extend
across the fovea
– The foveal cone inner segments are short and thick

– Almost all the outer segment develop after birth

– The fovea only adopts adult characteristics by

about the age of two years and even at four years
the outer segment length and cone density have
not reached adult values
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 The retina and visual pathway…
– The foveal optic nerve fibres are the first to be
myelinated
– All fibres are myelinated by about 5 months

– In the LGN there is rapid cell growth in the first six

months, adult characteristics are achieved by about 2
years
– The cortex shows parallel development.
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 The final portion of the sensory retina to
mature is the fovea, where the ganglion cell
layer thickening begins during mid gestation.
 Foveal development continues with cell
rearrangements and alteration in cone shape
until about 4 years after birth
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 THE PUPIL

• The mean pupil size slightly increases from about 4

mm to 5 mm over the first three months
• The pupil tends not to dilate as much as in the young
adult (perhaps because of the slower development of
the dilator than the sphincter muscles)

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 The Ocular Media And Accommodation

• The media are clear at birth

• Accommodation is not active at birth, but there

is some stimulus related accommodation as
early as the first few weeks
• This becomes more accurate over the next 4/5
months.

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 EYE MOVEMENTS AND CONVERGENCE

• Conjugate eye movements are detectable by ultra-

sound from about 20 weeks gestation, and the

postural vestibular ocular reflexes are present at

birth

• Crude convergence is present at 1 month

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 Eye movement & convergence

• Fusion has developed by 6 months to the

extent of overcoming a 5∆ or perhaps 10∆
base out prism
• Accommodation-convergence interactions are
established by about 3 months

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• At birth there is a wide range of refractive errors in infants
who subsequently prove to be normal, mean +2.00DS
• Emetropization takes place rapidly with in the first year
and gradually to reach adult level up to 4-5 yr.

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• The mean reduces and the spread diminishes
over the first year under the influence of
emmetropization to give a typical value of
about +1.00DS by 12 months.
– Large refractive errors are unusual:
– 5% of 6-9 month olds have hypermetropia
>+3.50DS
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 RE cont’d
– and only 0.5% have myopia >-3.00DS

– Astigmatism of 1-2 DC is typical and regresses

spontaneously over the first year, as the cornea
becomes more spherical
– This early astigmatism does not cause any
permanent Meridonal defects though Vernier
acuity may be affected
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 RE cont’d
• The remaining astigmatism diminishes over the next year
or two towards the typical adult incidence of <30% of
eyes having > 1.00DC of astigmatism
• The minority of children whose astigmatism persists are
likely to get Meridonal amblyopia if not corrected in the
first few years

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• This is a permanent, cortical, loss in contrast

sensitivity for gratings of the habitually most

defocused orientation, despite optimum

refractive correction of the astigmatism

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 DEPTH OF FOCUS

• The typical refractive errors of infancy do not impede

the development of acuity because the depth of focus
of the eye, about 1.00DS at 1 month, O.5DS at 3
months, gives adequate tolerance until accommodation
becomes more accurate after 4-5 months

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 visual Acuity

• Acuity can be assessed by the visually evoked cortical

potential (VECP) or by preferential looking (PL)
• At birth, both techniques give acuities of about 6/240
– VECP indicates that acuity increases rapidly up to 6/6
equivalent within the first year,
– Where as PL shows a slower development taking at
least two years to reach 6/6
– VECP indicates transmission of information as far as
the visual cortex
– PL requires a motor response to be stimulated

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 Acuity ….
The infant’s acuity can improve because of :
o The increased cone packing (~4X)
o The growth in axial length
o The myelination of the optic nerve speeds up
transmission and reduces cross-talk
o The cortex responds with increasing specificity and
resolution of cortical neurones
o The cone packing continues to increase for several
years, long after maximum acuity is attained
o Functions which require complex analysis of phase and
spatial frequencies continue to improve until at least 4
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years
Obstacles for the development of BV
• 1. Sensory obstacles
• Dioptric obstacles – e.g. media opacities,
uncorrected errors of refraction.
• Prolonged uniocular activity- e.g. severe
ptosis, anisometropia
• Retinoneural obstacles – lesions of retina,
optic nerve
• Proprioceptive obstacle
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• 2. Motor obstacles
• Congenital craniofacial malformations
• Conditions effecting extra-ocular muscles
• CNS lesions- involving the nerve trunks, root
of nuclei

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• 3. Central obstacles
• The presence of these obstacles gives rise to
various sensory adaptations to binocular
dysfunction especially if the disruptive factor is
present in the sensitive period. This can be in the
form of:
• ARC
• SUPPRESSION
• AMBLYOPIA
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 CONCLUSIONS

• Visual acuity develops quickly in the first year

• Any disruption of development usually results in

amblyopia and loss of binocular vision

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 Conclusion …

Most critical period: the first 18 months of life

After this, the plasticity decreases rapidly at first,

visual system remains sensitive up to ~ 7-8 yrs.

If an eye is deprived of a central or clear image

before this age => amblyopia

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