Development of distant stereoacuity in visually normal children as measured by the Frisby-Davis distance stereotest

Stereoacuity and its determinants in 7-year-old children: the Lhasa Childhood Eye Study

PURPOSE

To explore the distribution of stereoacuity and to examine its determinants in school-age children in Tibetan plateau, Southwest China.

METHODS

This is the cross-sectional part of a school-based cohort study of 7-year-old children in Lhasa, Tibet Autonomous Region, Southwest China. Children in first year of primary school were invited to undergo a comprehensive examination, including height, weight, visual acuity, cycloplegic autorefraction (1% cyclopentolate), anterior segment, cover and uncover test, and stereoacuity (Titmus Stereo Test).

RESULTS

A total of 1833 eligible subjects were included, with a mean age of 6.82 ± 0.46 years. Mean stereoacuity was 1.78 ± 0.21 in log units (median: 60 arcsec). Children with stereoacuity equal to 40 arcsec and stereoacuity worse than 100 arcsec accounted for 29.24% and 8.18% of the cohort, respectively. Tibetan ethnicity (OR = 1.98; 95%CI, 1.30-3.03), astigmatism (OR = 1.65; 95%CI, 1.26-2.17), strabismus (OR = 2.92; 95%CI, 1.38-6.18), and amblyopia (OR = 3.77; 95%CI, 1.14-12.49) were risk factors for normal stereoacuity (= 40 arcsec). Shorter height, younger age, strabismus, and worse BCVA (P < 0.05 for all) were both related to lower stereoacuity in Spearman correlation analysis and associated with lower stereoacuity in multivariate regression analysis.

CONCLUSION

Stereoacuity maturation does not appear fully completed in 7-year-old children, while few children present stereoacuity worse than 100 arcsec (8.18%). Lower stereoacuity was associated with younger age, shorter height, strabismus, and lower best-corrected visual acuity.

Stereoacuity and Related Factors in Healthy Preschool Children: The Nanjing Eye Study

Purpose: To assess the distribution of stereoacuity and related factors in healthy preschool children aged 48-60 months in eastern China. Methods: This cross-sectional study was part of the Nanjing Eye Study, a longitudinal population-based cohort study. In 2016, preschool children without any neurological problems or ophthalmological abnormalities completed comprehensive eye examinations, including visual acuity, ocular alignment and movements, cycloplegic refraction, axial length, interpupillary distance, Titmus stereotest, anterior segment, and fundus examination. Multivariate linear regression model was used to determine the factors associated with stereoacuity score, and logistic regression model was used to determine the factors associated with subnormal stereoacuity (worse than 40 arc-seconds). Results: Among 942 healthy preschool children (mean age = 55 months), the mean (SD) stereoacuity was 81 (2.3) arc-seconds with majority (76.5%) worse than 40 arc-seconds. In the multivariate analysis, older age (p = 0.001) and better presenting visual acuity (PVA) (p = 0.01) were independently associated with better stereoacuity score. Older age was also associated with low risk of subnormal stereoacuity (odds ratio = 0.37,p < 0.001 for age 57-60 months compared to age 48-51 months). Conclusions: The maturation of stereopsis has not completed by the age of 48-60 months. Age and PVA should be taken into account when evaluating stereopsis in healthy preschoolers. The significant associations of age and PVA with stereoacuity provide valuable insights into possible intervention for healthy preschool children with poor stereoacuity.

Stereoacuity and Related Factors: The Shandong Children Eye Study

Objective

To assess stereoacuity in a population-based sample of children and to examine ocular and systemic parameters related to stereoacuity.

Methods

Using a random cluster sampling method, four- to 18-year-old children from kindergartens, elementary schools, junior high schools and senior high schools from a rural area and an urban area in the East Chinese province of Shandong were included in the school-based cross-sectional study. All participants underwent a comprehensive eye examination including assessment of cycloplegic refraction and measurement of stereoacuity using the Titmus Stereo test.

Results

Out of 6364 eligible children, 5780 (90.8%) children with a mean age of 10.1 ± 3.2 years (range: 4 to 18 years) participated. Mean (± standard deviation) stereoacuity was 50.2 ± 50.6 arc seconds. Stereoacuity improved significantly (P<0.01) from the age group of 4 years to the age group of 6 to 7 years, then showed a plateau, deteriorated (P = 0.001) for both sexes from the age group of 9 years to the age group of 12 years (P<0.001), after which it improved (P = 0.001) again in the age group of 16 years or older to the pre-puberty values. In multivariate analysis, larger angle of binocular disparity (i.e., lower stereoacuity) was significantly associated with lower best corrected visual acuity (logMAR; P<0.001), higher intereye difference in refractive error (spherical equivalent) (P<0.001), higher cylindrical refractive error (P<0.001), higher refractive error (spherical value; P<0.001), higher intereye difference in best corrected visual acuity (logMAR) (P = 0.001), higher intereye difference in axial length (P = 0.001), and rural region of habitation (P = 0.006).

Conclusions

Stereoacuity as tested with the Titmus Stereo test improved significantly from an age of 4 years to an age of 6 and 7 years, then remained constant, temporarily deteriorated for both sexes in pre-puberty and puberty, after which it improved again to pre-puberty or better values at the age of 16 years or older. Lower stereoacuity was associated with lower best corrected visual acuity and higher intereye difference in best corrected visual acuity, higher cylindrical and spherical refractive errors, higher inter-eye difference in refractive error, higher intereye difference in axial length, and rural region of habitation.

Evaluating stereoacuity with 3D shutter glasses technology

Background

To determine the stereoacuity threshold with a 3D laptop equipped with 3D shutter glasses, and to evaluate the effect of different shape and size of test symbols and different type of disparities to stereoacuity.

Methods

Thirty subjects with a visual acuity in each eye of at least 0 logMAR and a stereoacuity of at least 32 arcsec (as assessed in Fly Stereo Acuity Test) were recruited. Three target symbols—tumbling "E", tumbling "C", and "□"—were displayed, each with six different sizes representing a visual acuity ranging from 0.5 to 0 logMAR when tested at 4.1 m, and with both crossed and uncrossed disparities. Two test systems were designed - fixed distance of 4.1 m and one for variable distance. The former has disparities ranging from 10 to 1000 arcsec. Each subject completed 36 trials to investigate the effect of different symbol sizes and shapes, and disparity types on stereoacuity. In the variable distance system, each subject was tested 12 times for the same purposes, both proximally and distally (the point where the 3D effect just appears and where it just disappears respectively), and the mean value was calculated from the mean proximal and distal distances.

Results

No significant difference was found among the groups in the fixed distance test system (Kruskal-Wallis test; Chi-square = 29.844, P = 0.715). Similarly, no significant difference was found in the variable distance system (Kruskal-Wallis test; proximal: Chi-square = 5.687, P = 0.338; distal: Chi-square = 5.898, P = 0.316; mean: Chi-square = 6.152, P = 0.292).

Conclusions

Evaluating stereoacuity using this measurement system was convenient and effective. Changes in target shape and size and disparity types had no significant effect on stereoacuity. It would be helpful to choose optimal targets according to different purposes using computer-assisted 3D measurements.

Electronic supplementary material

The online version of this article (doi:10.1186/s12886-016-0223-3) contains supplementary material, which is available to authorized users.

Quantification of Stereopsis in Patients with Impaired Binocularity

PURPOSE

To quantify stereopsis at distance resulting from binocular fusion in patients with impaired binocular vision using a three-dimensional (3-D) display stereotest.

METHODS

A total of 68 patients (age range, 6 to 85 years) with strabismus (40 esotropes and 28 exotropes) whose stereoacuity could not be measured with the near and distance Randot stereotests were included. Contour-based circles with a wide range of crossed horizontal disparities (2500 to 20 arcsec) displayed on a 3-D monitor were presented to subjects at 3 m. Between the patients who had stereoacuity of at least 2500 arcsec and those with no measurable stereoacuity, parameters including age, sex, best-corrected visual acuity, spherical equivalent refractive error, Worth 4 dot test results, and type and angle of deviation were compared.

RESULTS

Stereoacuity at distance of 2500 arcsec or better was detected in 25 (63%) of 40 esotropes, and 16 (57%) of 28 exotropes, although stereoacuity of 800 arcsec or better was found only in two (5%) esotropes and one (4%) exotrope. Patients with stereopsis were significantly younger (19.3 ± 16.9 years) than those with no measurable stereopsis (31.5 ± 26.4 years) (p = 0.040). There were no significant differences in best-corrected visual acuity, presence of amblyopia >20/100, spherical equivalent refractive error, type of deviation, deviation angle, sex, and Worth 4 dot test results between these groups.

CONCLUSIONS

Stereopsis at distance resulting from binocular fusion that cannot be measured with conventional stereoacuity tests may be preserved in patients with impaired binocular vision. The 3-D display stereotest can be useful for quantifying stereopsis at distance resulting from binocular fusion.

Stereo vision and strabismus

Binocular stereopsis, or stereo vision, is the ability to derive information about how far away objects are, based solely on the relative positions of the object in the two eyes. It depends on both sensory and motor abilities. In this review, I briefly outline some of the neuronal mechanisms supporting stereo vision, and discuss how these are disrupted in strabismus. I explain, in some detail, current methods of assessing stereo vision and their pros and cons. Finally, I review the evidence supporting the clinical importance of such measurements.

Why can't my child see 3D television?

A child encountering difficulty in watching three-dimensional (3D) stereoscopic displays could have an underlying ocular disorder. It is therefore valuable to understand the differential diagnoses and so conduct an appropriate clinical assessment to address concerns about poor 3D vision.

Stereoacuity with Frisby and revised FD2 stereo tests

We compared near stereoacuity, measured with the Frisby test, and distance stereoacuity, measured with the revised Frisby-Davis (FD2) test, enabling a comparison with the original version of the FD2. In the revised version of the FD2 test, a white background is used instead of a backlit background. We also examined the effect of age, gender and visual problems. We used the Frisby test at distances ranging from 30–80 cm and FD2 at 6 m. The best possible score was 20 seconds of arc (arcsec) on the Frisby and 5 arcsec on the FD2; participants who could not perform a test despite demonstrating understanding of it were classed as stereonegative. We examined both the whole population recruited, and a sub-population screened so as to exclude visual problems. We analysed our results in three age-groups: “visually developing” (36 children aged 5–10 years); “visually mature” (300 participants aged 11–49 years) and “older” (29 participants aged 50–82). In the whole population, the median stereoacuity on the Frisby test was 25, 20 and 85 arcsec in the three age-groups. In the sub-population with no visual problems, median Frisby stereoacuity was similar at 20, 20 and 80 arcsec respectively. On the FD2, the medians were 10, 10, 20 arcsec for the whole population and 7.5, 10 and 12.5 for the sub-population. Children were more likely than adults to be stereonegative on the FD2, although none of the children were stereonegative on the Frisby. The two tests showed fair agreement when used to classify people into three categories of stereovision. Poor stereovision was often associated with binocular problems such as tropia, but with many exceptions. In line with previous studies, we found improvements in measured stereoacuity in childhood and declines in late adulthood. The new FD2 test gives comparable values to the original FD2.

Influence of stereopsis and abnormal binocular vision on ocular and systemic discomfort while watching 3D television

PURPOSE

To evaluate the degree of three-dimensional (3D) perception and ocular and systemic discomfort in patients with abnormal binocular vision (ABV), and their relationship to stereoacuity while watching a 3D television (TV).

METHODS

Patients with strabismus, amblyopia, or anisometropia older than 9 years were recruited for the ABV group (98 subjects). Normal volunteers were enrolled in the control group (32 subjects). Best-corrected visual acuity, refractive errors, angle of strabismus, and stereoacuity were measured. After watching 3D TV for 20 min, a survey was conducted to evaluate the degree of 3D perception, and ocular and systemic discomfort while watching 3D TV.

RESULTS

One hundred and thirty subjects were enrolled in this study. The ABV group included 49 patients with strabismus, 22 with amblyopia, and 27 with anisometropia. The ABV group showed worse stereoacuity at near and distant fixation (P<0.001). Ocular and systemic discomfort was, however, not different between the two groups. Fifty-three subjects in the ABV group and all subjects in the control group showed good stereopsis (60 s of arc or better at near), and they reported more dizziness, headache, eye fatigue, and pain (P<0.05) than the other 45 subjects with decreased stereopsis. The subjects with good stereopsis in the ABV group felt more eye fatigue than those in the control group (P=0.031). The subjects with decreased stereopsis showed more difficulty with 3D perception (P<0.001).

CONCLUSIONS

The subjects with abnormal stereopsis showed decreased 3D perception while watching 3D TV. However, ocular and systemic discomfort was more closely related to better stereopsis.

Correlation between myopic ametropia and stereoacuity in school-aged children in Taiwan

PURPOSE

To investigate the correlation between stereoacuity, as analyzed by the Titmus stereotest, and the severity of myopia, astigmatism and anisometropia in a school-aged population in Taiwan.

METHODS

Cycloplegic autorefraction, best corrected monocular visual acuity and stereoacuity were measured in 6- to 18-year-old school children. Children with amblyopia (best corrected visual acuity of <20/25) or strabismus were excluded from this study. The correlation between stereoacuity and the severity of myopia, astigmatism and anisometropia was analyzed by the Titmus stereotest.

RESULTS

A total of 166 children (95 boys, 71 girls; mean age 10.75 years, range 6-18 years) with myopia or astigmatism were enrolled in the study. The mean spherical error was -2.22 ± 1.70 diopters (D) (range -0.25 to -9.50 D), and the mean astigmatism was -0.72 ± 0.89 (range 0 to -4.50) D. An anisometropia of >1.00 D and spherical anisometropia of >1.00 D were strongly associated with decreased stereoacuity on the Titmus stereotest (P < 0.001). Astigmatism was also correlated with the performance of stereopsis (P = 0.013).

CONCLUSION

Anisometropia (>1.00 D), spherical anisometropia (>1.00 D), and astigmatism were associated with reduced stereoacuity in school-aged children.

The influence of manifest strabismus and stereoscopic vision on non-verbal abilities of visually impaired children

This research was conducted in order to examine the influence of manifest strabismus and stereoscopic vision on non-verbal abilities of visually impaired children aged between 7 and 15. The sample included 55 visually impaired children from the 1st to the 6th grade of elementary schools for visually impaired children in Belgrade. RANDOT stereotest and polaroid glasses were used for the examination of stereoscopic vision, while Cover test and Hirschberg's pupils reflex test were used for the evaluation of strabismus. In the area of non-verbal abilities was evaluated visual discrimination, visuomotor integration, constructive praxia, visual memory, strategy formation, non-verbal reasoning and the representational dimension of drawings. Subtests of ACADIA test of developmental abilities were used for the evaluation of non-verbal abilities (Atkinson et al., 1972). Statistically significant relations between strabismus and constructive praxia (p=0.009), visual memory (p=0.037), strategy formation (0.040) and the quality of drawings were determined by the results analysis. According to our findings, children with divergent strabismus achieve the best results. Children with stereoscopic vision generally achieve better results in all the examined areas of non-verbal abilities, and statistically significant relations were determined in the areas of visuomotor coordination (0.002), constructive praxia (0.026) and non-verbal reasoning (0.015), which are directly connected to visuospatial abilities. Children with convergent strabismus achieve significantly lower results in the areas of constructive praxia, visual memory, strategy formation and representational dimension of drawings, and children with the lack of stereoscopic vision--in the areas of visuomotor integration, constructive praxia and non-verbal reasoning.

Eye-hand coordination skills in children with and without amblyopia

PURPOSE

To investigate whether binocular information provides benefits for programming and guidance of reach-to-grasp movements in normal children and whether these eye-hand coordination skills are impaired in children with amblyopia and abnormal binocularity.

METHODS

Reach-to-grasp performance of the preferred hand in binocular versus monocular (dominant or nondominant eye occluded) conditions to different objects (two sizes, three locations, and two to three repetitions) was quantified by using a 3D motion-capture system. The participants were 36 children (age, 5-11 years) and 11 adults who were normally sighted and 21 children (age, 4-8 years) who had strabismus and/or anisometropia. Movement kinematics and error rates were compared for each viewing condition within and between subject groups.

RESULTS

The youngest control subjects used a mainly programmed (ballistic) strategy and collided with the objects more often when viewing with only one eye, while older children progressively incorporated visual feedback to guide their reach and, eventually, their grasp, resulting in binocular advantages for both movement components resembling those of adult performance. Amblyopic children were the worst performers under all viewing conditions, even when using the dominant eye. They spent almost twice as long in the final approach to the objects and made many (1.5-3 times) more errors in reach direction and grip positioning than their normal counterparts, these impairments being most marked in those with the poorest binocularity, regardless of the severity or cause of their amblyopia.

CONCLUSIONS

The importance of binocular vision for eye-hand coordination normally increases with age and use of online movement guidance. Restoring binocularity in children with amblyopia may improve their poor hand action control.