Falls in the elderly are a major cause of mortality and morbidity. Elderly people with visual impairment have been found to be at increased risk of falling, with poor visual acuity in one eye causing greater risk than poor binocular visual acuity. The present study investigated whether monocular refractive blur, at a level typically used for monovision correction, would significantly reduce stereoacuity and consequently affect gait parameters when negotiating a raised surface. Fourteen healthy subjects (25.8 ± 5.6 years) walked up to and on to a raised surface, under four visual conditions; binocular, +2DS blur over their non-dominant eye, +2DS blur over their dominant eye and with their dominant eye occluded. Analysis focussed on foot positioning and toe clearance parameters. Monocular blur had no effect on binocular acuity, but caused a small decline in binocular contrast sensitivity and a large decline in stereoacuity (p < 0.01). Vertical toe clearance increased under monocular blur or occlusion (p < 0.01) with a significantly greater increase under blur of the dominant eye compared with blur of the non-dominant eye (p < 0.01). Increase in toe clearance was facilitated by increasing maximum toe elevation (p < 0.01). Findings indicate that monocular blur at a level typically used for monovision correction significantly reduced stereoacuity and consequently the ability to accurately perceive the height and position of a raised surface placed within the travel path. These findings may help explain why elderly individuals with poor visual acuity in one eye have been found to have an increased risk of falling.

Introduction: The aim of the present study was to determine adaptive gait changes in long-term wearers of monovision correction contact lenses by comparing gait parameters when wearing monovision correction to those observed when wearing binocular distance correction contact lenses. Methods: Gait and toe clearance parameters were measured in eleven participants (53.5 ± 4.6 years, median monovision wearing time 5 years) as they repeatedly walked up to and onto a raised surface with either monovision or distance correction. Results: Compared to distance correction, monovision resulted in a large reduction in stereoacuity from 17¿ to 87¿, a slower walking velocity (p = 0.001), a reduced horizontal toe clearance of the step edge (p = 0.035) and, for trials when monovision correction occurred first, a 33% greater variability in vertical toe clearance (p = 0.021). Variability in some gait data was large due to certain study design features and learning effects. Conclusion: A slower walking velocity with monovision correction suggests participants became more cautious, likely as a result of the significantly reduced stereoacuity. The decreased horizontal toe clearance and increased vertical toe clearance variability suggests that monovision correction may cause a greater likelihood of hitting step edges and tripping during everyday gait. Recommended study design features are suggested for future adaptive gait studies to increase the precision of the data and to attempt to minimize the effects of learning from somatosensory feedback.

Dysfunctions of ocular motor and binocular vision are some of the most commonly observed problems in patients with severe traumatic brain injury. Secondarily, subjective complaints of compromised vision and ocular motor functions are also sometimes reported in mild traumatic brain injuries (mTBI). Simple ocular/vision assessments such as near point of convergence (NPC), the King-Devick Test (KDT), and stereoacuity can be performed to identify and assess these deficits, but their diagnostic accuracy has yet to be thoroughly investigated. The purpose of this study was to determine if differences exist in NPC, KDT, and stereoacuity test scores between concussed and control athletes, and to determine the diagnostic accuracy of these tests. A multicenter control group design was utilized. The independent variable was group (control vs. concussed). The dependent variables were the ocular test scores from the NPC, KDT, and stereoacuity tests. Participants were recruited from several collegiate athletic programs. In total 34 healthy, non-concussed controls (21 male, 13 female) aged 19 + 1.5 years and 19 concussions (11 male, 8 female) aged 20.42 + 1.5 years participated in the study. A concussion was operationally defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces, that was diagnosed by a health care professional through the use of signs and symptoms scales, balance and neurocognitive testing. Data were analyzed using descriptive and inferential statistics. T-tests and chi-squares were performed to ensure there were no significant differences between groups on specific demographic or relevant prognostic variables (sport, sex, and concussion history). T-tests were employed to identify significant differences between groups on ocular test scores. Then clinical and statistical cutoffs for all three tests were determined. Based off of these cutoffs sensitivity, specificity, and likelihood ratios were determined for each assessment. Furthermore, receiver operating characteristic (ROC) curves were calculated to help determine the diagnostic accuracy of these assessments. The alpha level was set at p &lt; .05 and the SPSS for Windows, Version 21.0, statistical program (IBM, Inc., Armonk, NY) was used for all data analysis. Significant differences were found between groups for all three ocular assessments. NPC demonstrated a statistical cutoff of 5.5 cm, which provided a sensitivity of 79% and specificity of 76% and an AUC of 0.827. For the KDT, a statistical cutoff time of 49.5s demonstrated a sensitivity of 58% and specificity of 72% with an AUC of 0.658. Lastly, for stereoacuity a statistical cutoff point of 28.50 arc sec was found which produced a sensitivity of 65% and specificity of 54% with a maximum AUC of 0.706. All three tests demonstrated their potential to positively contribute to the diagnosis of a concussion. / Kinesiology

Impairment of stereoacuity is common in the elderly population and is found to be a risk factor for falls. The purpose of these experiments was to extend knowledge regarding impairment of binocular vision and adaptive gait. Firstly using a 3D motion analysis system to measure how impairment of stereopsis affected adaptive gait during a negotiation of a step, secondly by determining which clinical stereotest was the most reliable for measuring stereoacuity in elderly subjects and finally investigating how manipulating the perceived height of a step in both binocular and monocular conditions affected negotiation of a step. In conditions of impaired stereopsis induced by acutely presented monocular blur, both young and elderly subjects adopted a safety strategy of increasing toe clearance of the step edge, even at low levels of monocular blur (+0.50DS) and the effect was greater when the dominant eye was blurred. The same adaptation was not found for individuals with chronic monocular blur, where vertical toe clearance did not change but variability of toe clearance increased compared to full binocular correction. Findings indicate stereopsis is important for accurately judging the height of a step, and offers support to epidemiological findings that impaired stereoacuity is a risk for falls. Poor agreement was found between clinical stereotests. The Frisby test was found to have the best repeatability. Finally, a visual illusion that caused a step to be perceived as taller led to increased toe elevation. This demonstrates a potential way of increasing toe clearance when stepping up and hence increase safety on stairs. / The Study data files are unavailable online.

Impairment of stereoacuity is common in the elderly population and is found to be a risk factor for falls. The purpose of these experiments was to extend knowledge regarding impairment of binocular vision and adaptive gait. Firstly using a 3D motion analysis system to measure how impairment of stereopsis affected adaptive gait during a negotiation of a step, secondly by determining which clinical stereotest was the most reliable for measuring stereoacuity in elderly subjects and finally investigating how manipulating the perceived height of a step in both binocular and monocular conditions affected negotiation of a step. In conditions of impaired stereopsis induced by acutely presented monocular blur, both young and elderly subjects adopted a safety strategy of increasing toe clearance of the step edge, even at low levels of monocular blur (+0.50DS) and the effect was greater when the dominant eye was blurred. The same adaptation was not found for individuals with chronic monocular blur, where vertical toe clearance did not change but variability of toe clearance increased compared to full binocular correction. Findings indicate stereopsis is important for accurately judging the height of a step, and offers support to epidemiological findings that impaired stereoacuity is a risk for falls. Poor agreement was found between clinical stereotests. The Frisby test was found to have the best repeatability. Finally, a visual illusion that caused a step to be perceived as taller led to increased toe elevation. This demonstrates a potential way of increasing toe clearance when stepping up and hence increase safety on stairs.

Abstract Introduction: H.J.-Haase developed a systematic set of tests for evaluating binocular vision called the Pola Test. The Pola Test measures associated phoria and stereoacuity at distance and near using a variety of different targets for each. This testing method and interpretation is referred to as MKH-Haase (Measuring and Correcting Methodology after H.J.Haase ???the MKH) method. The MKH method is more commonly used in Germany and other European countries than English speaking countries. The MKH-Haase method has been considered a reliable method for prescribing prisms to symptomatic binocular vision patients. Purpose: To investigate the test-retest reliability of binocular vision measurements using the MKH-Haase series of tests that comprise the Pola Test. In addition, I will compare the Pola results with other associated phoria and stereoacuity tests used in North America. Methods: Thirty-four symptomatic and 40 asymptomatic subjects (based on a symptoms questionnaire) participated in this study. Associated phoria and stereoacuity with different tests, including the Pola Test at distance and near, were measured for those subjects on two different sessions. Not all of subjects were tested with all tests. Only 30 subjects in each group completed all of tests. The Pola Test protocol requires the associated phoria and stereoacuity to be measured twice within a session; once with the Polariods oriented with their axes at 45o and 135o and again with the axes switched. Results: Within and between-sessions repeatability of MKH-Haase associated phoria and stereoacuity tests results revealed that most of MKH-Haase associated phoria and stereoacuity tests showed good repeatability within and between-sessions at both distance and near. However, there were a few exceptions to this general finding. Distance horizontal associated phoria values for the Cross Test and Pointer Test at the first session, and the distance Double Pointer Test values at the second session showed some differences between the two views. Between-sessions repeatability of the associated phoria tests did not show any significant differences. For the stereoacuity tests, the differences between the two disparities were statistically significant at the first session for the symptomatic group Line Test and asymptomatic group Step Test. For the second session at distance, the differences were significant with Step Test for both groups. The differences between sessions for both disparities were not significant for most of tests. The symptomatic group???s Step Test for crossed disparity and asymptomatic group's Step Test for uncrossed disparity were exceptions. A repeated measures ANOVA test was conducted to compare different associated phoria tests. Horizontal associated phoria tests without central fusion lock were significantly different from those with central fusion lock at distance and near. Comparison of different stereoacuity tests was conducted by comparing the number of subjects who could identify specific stereothreshold values. Results showed that at both distance and near, there were no significant differences between contour and global stereoacuity tests based on number of subjects who could attain 60 sec of arc or better. Discussion and Conclusion: Most of MKH-Haase associated phoria and stereoacuity charts have reasonable within and between-sessions repeatability. However, some associated phoria tests showed some differences especially with subjects who had higher values. Although there was a significant difference between various horizontal associated phoria tests at distance and near, most of the values differed by around 0.50 ???. The exception was the difference between the Wesson Card and Disparometer. The Wesson card was more exo by 1.50 ??? than the Disparometer. Vertical associated phoria tests did not show any significant differences. Although MKH-Haase chart can measure local stereothreshold down to 10 sec of arc at distance, the AO Slide is easier to perceive. Random dot stereoacuity can be measured with MKH-Haase charts at distance down to 30 sec of arc. All of the contour stereoacuity tests are comparable at near. However, the MKH-Haase chart was easier to perceive. The Random Dot Randot test would be more useful for fast screening purposes. Random dot MKH-Haase test would be easier than TNO Test to measure random dot stereothreshold at near.

Le terme stéréopsie renvoie à la sensation de profondeur qui est perçue lorsqu’une scène est vue de manière binoculaire. Le système visuel s’appuie sur les disparités horizontales entre les images projetées sur les yeux gauche et droit pour calculer une carte des différentes profondeurs présentes dans la scène visuelle. Il est communément admis que le système stéréoscopique est encapsulé et fortement contraint par les connexions neuronales qui s’étendent des aires visuelles primaires (V1/V2) aux aires intégratives des voies dorsales et ventrales (V3, cortex temporal inférieur, MT). A travers quatre projets expérimentaux, nous avons étudié comment le système visuel utilise la disparité binoculaire pour calculer la profondeur des objets. Nous avons montré que le traitement de la disparité binoculaire peut être fortement influencé par d’autres sources d’information telles que l’occlusion binoculaire ou le son. Plus précisément, nos résultats expérimentaux suggèrent que : (1) La stéréo de da Vinci est résolue par un mécanisme qui intègre des processus de stéréo classiques (double fusion), des contraintes géométriques (les objets monoculaires sont nécessairement cachés à un œil, par conséquent ils sont situés derrière le plan de l’objet caché) et des connaissances à priori (une préférence pour les faibles disparités). (2) Le traitement du mouvement en profondeur peut être influencé par une information auditive : un son temporellement corrélé avec une cible définie par le mouvement stéréo peut améliorer significativement la recherche visuelle. Les détecteurs de mouvement stéréo sont optimalement adaptés pour détecter le mouvement 3D mais peu adaptés pour traiter le mouvement 2D. (3) Grouper la disparité binoculaire avec un signal auditif dans une dimension orthogonale (hauteur tonale) peut améliorer l’acuité stéréo d’approximativement 30% / Stereopsis refers the perception of depth that arises when a scene is viewed binocularly. The visual system relies on the horizontal disparities between the images from the left and right eyes to compute a map of the different depth values present in the scene. It is usually thought that the stereoscopic system is encapsulated and highly constrained by the wiring of neurons from the primary visual areas (V1/V2) to higher integrative areas in the ventral and dorsal streams (V3, inferior temporal cortex, MT). Throughout four distinct experimental projects, we investigated how the visual system makes use of binocular disparity to compute the depth of objects. In summary, we show that the processing of binocular disparity can be substantially influenced by other types of information such as binocular occlusion or sound. In more details, our experimental results suggest that: (1) da Vinci stereopsis is solved by a mechanism that integrates classic stereoscopic processes (double fusion), geometrical constraints (monocular objects are necessarily hidden to one eye, therefore they are located behind the plane of the occluder) and prior information (a preference for small disparities). (2) The processing of motion-in-depth can be influenced by auditory information: a sound that is temporally correlated with a stereomotion defined target can substantially improve visual search. Stereomotion detectors are optimally suited to track 3D motion but poorly suited to process 2D motion. (3) Grouping binocular disparity with an orthogonal auditory signal (pitch) can increase stereoacuity by approximately 30%

Falls in the elderly are a major cause of mortality and morbidity. Elderly people with visual impairment have been found to be at increased risk of falling, with poor visual acuity in one eye causing greater risk than poor binocular visual acuity. The present study investigated whether monocular refractive blur, at a level typically used for monovision correction, would significantly reduce stereoacuity and consequently affect gait parameters when negotiating a raised surface. Fourteen healthy subjects (25.8 +/- 5.6 years) walked up to and on to a raised surface, under four visual conditions; binocular, +2DS blur over their non-dominant eye, +2DS blur over their dominant eye and with their dominant eye occluded. Analysis focussed on foot positioning and toe clearance parameters. Monocular blur had no effect on binocular acuity, but caused a small decline in binocular contrast sensitivity and a large decline in stereoacuity (p < 0.01). Vertical toe clearance increased under monocular blur or occlusion (p < 0.01) with a significantly greater increase under blur of the dominant eye compared with blur of the non-dominant eye (p < 0.01). Increase in toe clearance was facilitated by increasing maximum toe elevation (p < 0.01). Findings indicate that monocular blur at a level typically used for monovision correction significantly reduced stereoacuity and consequently the ability to accurately perceive the height and position of a raised surface placed within the travel path. These findings may help explain why elderly individuals with poor visual acuity in one eye have been found to have an increased risk of falling.