Deficiency of adaptive control of the binocular coordination of saccades in strabismus.

Disconjugate (different in the two eyes) oculomotor adaptation is driven by the need to maintain binocular vision. Since binocular vision is deficient in strabismus, we wondered whether oculomotor disconjugate adaptive capabilities are deficient in such subjects. We studied eight adult subjects with constant, long-standing convergent strabismus of variable angles (4-30 prism D). No subject had severe amblyopia. Binocular vision was evaluated with stereoacuity tests. Two subjects had peripheral binocular vision and gross stereopsis; two other subjects had abnormal retinal correspondence and abnormal or pseudo gross stereopsis. In the other subjects binocular vision and stereopsis were absent. To stimulate disconjugate changes of saccades, subjects viewed for 20 min an image that was magnified in one eye (aniseikonia). Subjects with residual peripheral binocular vision and even subjects with pseudo or abnormal binocular vision showed disconjugate changes of the binocular coordination of their saccades; these changes reduced the disparity resulting from the aniseikonia. In contrast, for subjects without binocular vision the changes were not correlated with the disparity induced by the aniseikonia. Rather, these changes served to improve fixation of one or the other eye individually.