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Related Experiment Video

Updated: Jul 5, 2026

Assessing Binocular Central Visual Field and Binocular Eye Movements in a Dichoptic Viewing Condition
07:45

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Published on: July 21, 2020

Monocular fixation with the optic nerve head: a case report.

Fuensanta A Vera-Diaz1, Eli Peli

  • 1Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, 20 Staniford Street, Boston, MA 02114, USA. fuensanta.veradiaz@schepens.harvard.edu

Ophthalmic & Physiological Optics : the Journal of the British College of Ophthalmic Opticians (Optometrists)
|April 23, 2008
PubMed
Summary

This study documents a rare case of left esotropia where the patient uses the optic nerve head (ONH) instead of the fovea for stable monocular fixation, a unique ocular motor adaptation.

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Area of Science:

  • Ophthalmology
  • Neuroscience
  • Visual Science

Background:

  • Esotropia (ET) is a common form of strabismus characterized by inward turning of the eyes.
  • Typically, visual fixation is achieved using the fovea, the central area of the retina with the highest visual acuity.

Observation:

  • A case report of an 80-year-old male with lifelong left esotropia.
  • Monocular fixation measurements revealed stable fixation within the left optic nerve head (ONH) area, deviating from typical foveal fixation.
  • Fixation remained stable across various target sizes and gaze positions, confirmed by MP-1 retinal tracking and visuoscopy.

Findings:

  • This is the first documented case of an abnormally developed monocular ocular motor system where fixation is centered on the ONH.
  • The principal visual direction and zero retinomotor value were shifted from the fovea to the ONH.
  • While direct visual input from the ONH is unlikely, the patient may use peri-papillary visual information or scattered light around the ONH margin for positional awareness.

Implications:

  • This case challenges conventional understanding of visual fixation mechanisms in strabismus.
  • The findings suggest that extraretinal information combined with abnormal oculocentric direction can stabilize fixation.
  • The study proposes using retinal perimetry for documenting eccentric fixation in strabismus cases.