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OPTO 375: Anomalies of Binocular Vision



Course Outline 


Course Title OPTO 375: Anomalies of Binocular Vision

Units:  2 + 0 = 2

Instructor: Safiah Mulla MSc, BSc, OC(C)

King Saud University

College of Applied Medical Science

Optometry Department

Telephone: 01-4355010 Ext: 107

Website: (



Objective and Course Content:

In this class the student will be introduced to the complexities of analysis of the anomalies of BSV system. This will be achieved through clinical scenarios in which the student will be required to engage in direct patient care, including sensory visual evaluation, motor visual evaluation. This class is a prerequisite for OPTO 493 Orthoptics.

The class will provide the student with the knowledge and experience specific to abnormal binocular vision so that the student will show the following understanding and abilities:

  1. The ability to select and administrate diagnostic tools to evaluate binocular status and identify anomalies in a patient scenario.
  2. The ability to determine the appropriate sequence and application of tests for sensory visual evaluation and physical ocular assessment, based on the findings of ophthalmic examination.
  3. Knowledge of the sensitivity and specificity of the array of visual- function tests presented in this class.
  4. The capability and proficiency required to meet international clinical standards of ophthalmic medical technology.
  5. Competence in the biomedical application of ophthalmic instrumentation.

This course is broken down into weeks and each week consists of one in- depth power point lecture, often with additional readings that you will receive in advance. Typically this takes about 2 hours for the in-class delivery, so plan on committing that much time per week for the first read- through. I will provided you with a written copy of the lectures but please also view the lectures on the internet (via your email). There is an additional recommended weekly 2-hour laboratory component in which to practice the skills taught in lectures, to practice your skills.

To aid you in your practice and help you learn proper examination techniques, you will be given a practical skills booklet in which to record your practice under observation. For each skill you will find a check-off list of things to remember when you are performing each task, and these are the things your proctor will be looking for as well. You will be required to have a proctor observe your performance, sign the corresponding page in the practice booklet confirming that you have been performing the task properly, and deliver it to me within the designated time frame (see calendar for exact weeks that these are due). Other forms of evaluation include assignments, discussion questions, and written and practical exams. Please read on for details...


  1. Introduction to anomalies of BSV
  2. Diplopia
  3. Abnormal Retinal Correspondence 
  4. Suppression
  5. Amblyopia
  6. Anisokonia
  7. Microstrabismus
  8. Extra-ocular muscle
  9. Strabismus:

·         Strabismus: Qualitative & Quantitative

  • Heterophoria
  • Heterotopias
  •  Incomitant Strabismus
  • Vertical Strabismus
  • Cyclo Strabismus
  •           1.      Muscle Sequelae
  •           2.      Parks-Bielchowsky Three-Step Tes
  •  Pattern strabismus: A and V patterns
  • Quantitating strabismus
  •                 Hirshberg
  •                 Krimsky
  • Prism cover test
  •                 Cover-uncover test
  •                 Alternate cover test
  •                                          Simultaneous prism test   

Recommended Texts/websites:

  • Griffin, J.R & Grishan, J.D.  (1995) Binocular Anomalies – Diagnosis and Vision Therapy. Published by Butterworth-Heinemann.
  • Rowe, F. (2004).Clinical Orthoptic. UK: Blackwell Publishing Ltd
  • Scheiman, M. & Wick, B. (1994). Clinical management of binocular vision: heterophoric, accommodative, and eye movement disorders. Philadelphia: Lippincott.
  • Weissberg, E.M. (2004). Essentials of Clinical binocular vision. Imprint of Elsevier
  • Von-Noorden, G. K. (1996). Binocular Vision and Ocular Motility: Theory and Management of Strabismus (5th ed.). St Louis: MOSBY.   
  • Davson, D. (1972). Physiology of the Eye (4TH d.), New York, Churchill livingstone.
  • Pickwell’s Binocular Vision Anomalies: Investigation and Treatment by Bruce Evans, David Pickwell and Bruce J.w. Ev
  • Edwaeds, K. & LIewelyn, R. (1988). Optometry, Butter worth & co, UK
  • Duane's ophthalmology on CD-ROM, 2006 Edition( e-source):
  • Lecture handouts
  • Assigned reading handouts 

Course Material:

1. By the start of the course you would receive:

·         Weekly printed copies of lectures (Outlines of the PowerPoint lectures will be circulated prior to each lecture).

·         Accompanying readings for each lecture,

·         Course outline, calendar, etc

2.      Practical Skills Booklet

Lecturer Office Hours:

Tuesday 10:00 a.m. to 11:00 a.m.

Tuesday 01:00 p.m. to 02:00 p.m. (Other times by appointment)

Continuous Assessments:

There will be 1 continuous assessment tests (written exam) during the course of this semester. It will be in the form of multiple-choice and short answer quizzes during the lecture periods or short essays on topics already covered. Other forms of evaluation include assignments, class's discussion questions, and written exams. Please read on for details...

Course Evaluation:

1.      Assignment (10%)

2.      In class participation (5%)

3.      Practical Skills Booklet (20%)

4.      Midterm Exam (25%)

5.      Final Exam (40%)

Attendance Policy

 Attendance at all lectures and laboratories is mandatory.

 Detailed Course Evaluation by Component:

1-      Assignment (10%) 

Please find the assignment section of your course and you will see that you have (Assignment #1) due at the end of the course. This involves an APA style research paper that is sent to the entire class. It will be from this research that you will study this topic and no other lectures will be provided. Please see me for more details.

2- In class participation (5%)

3- Practical Skills Booklet (20%)

 Weekly (will be indicated in the course calendar and course summary by weeks), we will clinically practice the course assigned clinical examinations. These sections are designed to explore the practical content of the class and develop your clinical skills. You are required to participate as well as completing and returned the checklist with the Skills Objective Achievement sheet you have received earlier. All completed practical skills booklet forms must be submitted by the required due date. Your participation in the practical section as well as completing your assignments will greatly impact your clinical participation grade for the course. Please review the practical skills booklet for more detail.

4-Midterm Exam (25%)

This will be a short answer and multiple-choice test to be completed within 2 hours under the supervision of a proctor. This exam will be sent to your proctor and they will administer it and then send it to me for grading.

5-Final Written Exam (40%)

Similar to the midterm, but usually requires 3 hours to complete and includes all course material.

Please Note: Examinations must be written during allotted times and make- ups will be permitted only due to illness or other very exceptional circumstances. You must notify me before the scheduled exam if you will be absent. A physician’s medical report dated that day of the missed examination will be necessary to document legitimate illness.

Late assignments will be accepted with the following penalties:

1 day late10% penalty

2 days kite20% penalty

3 days late 30% penalty and so on....

 Course Assignment


Review the literature on nystagmus and write about the following:

Section A:

·        What is nystagmus?

·        What is the Patho-physiology and causes of nystagmus?

·        What is the difference between motor and sensory nystagmus?

·        What is the difference between latent and manifest nystagmus?

·        Contrast how the congenital type differs from the acquired type. 

·        Visual acuity measurements for Nystagmus Patient

·        Fluctuations in vision for Nystagmus Patient

·        The Null Position for Nystagmus Patient

·        Null Position and Prism Therapy?

·        How does nystagmus affect people?

Section B:

As the characteristics of the nystagmus, as well as associated signs and symptoms help to localize the lesion and suggest possible etiologies, you need to focus on what feature are typical of each of the following nystagmus types. What are the associated clinical signs and symptoms of each type?  What is unique about each type?

·        Vestibular nystagmus

·        Downbeat nystagmus

·        Upbeat nystagmus

·        Torsional (rotary) nystagmus

·        Pendular nystagmus

·        Horizontal nystagmus

·        Seesaw nystagmus

·        Gaze-evoked nystagmus

·        Spasmus nutans

·        Periodic alternating nystagmus

·        Abducting nystagmus of internuclear ophthalmoplegia

·        End-point nystagmus

·        Optokinetic nystagmus

·        Convergence-retraction nystagmus

·        nystagmus blockage syndrome

You will be graded on the following:

1.     Clear statement of purpose in the introduction

2.     Logical structure of your paper

3.     Rigor applied to your research

4.     Ability to synthesized evaluate and recognize relevant information

5.     Attention to APA formatting, spelling and grammar

6.     Style and quality of your essay  


                                            updated:  15 \ 9 \ 2012


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