Relative roles of luminance and fixation in inducing dissociated vertical divergence

We evaluated the roles of luminance and fixation in the pathophysiology of dissociated vertical divergence (DVD).

Vertical eye position was measured in 6 subjects with DVD (ages 11-47 years, 5 females) and 6 controls (ages 16-40 years, 5 females) using video-oculography (VOG) under conditions of change in fixation and luminance.

Subjects with DVD showed the following VOG responses. When fixation was precluded with a translucent filter and bright light was shone into one eye to produce a marked binocular luminance disparity, we found some subjects had a small induced vertical divergence causing the illuminated eye to be lower than the nonilluminated eye (mean -1.6° ± 1.5°, P = 0.06 compared to no vertical divergence using the signed rank test). When fixation was precluded with a translucent filter, while alternate occlusion produced a mild binocular luminance disparity, we found a smaller vertical divergence of the eyes that was not statistically significant (1.2° ± 2.1°, P = 0.3). When alternate occlusion produced reversal of monocular fixation in the dark (with essentially no change in peripheral luminance disparity), there was a significant vertical divergence movement causing the covered eye to be relatively higher than the uncovered eye (7.2° ± 3.1°, P = 0.03). The amplitude of this vertical divergence was similar to that measured under conditions of alternate occlusion in a lighted room (where there also was a significant average relative upward movement of the covered eye of 8.1° ± 2.9°, P = 0.03). Control subjects showed no vertical divergence under any testing conditions.

Dissociated vertical divergence is mediated primarily by changes in fixation and only to a minor degree by binocular luminance disparity.