Impairment of the binocular coordination of saccades in strabismus.

To examine the link between binocular vision and binocular coordination of saccades we studied subjects with convergent strabismus since childhood with mild or no amblyopia: three subjects had small squint (< 10 prism D) and preserved peripheral binocular visual function with gross stereopsis; four subjects had larger squint (18-35 prism D) and no detectable stereopsis. A standard paradigm was used to elicit horizontal saccades; binocular recordings were made with the IRIS device. For subjects with small strabismus, saccades were disconjugate (unequal between the two eyes) typically by 1 deg. Subjects with larger strabismus exhibited even larger and more variable disconjugacy (typically 1.8 deg). Post-saccadic eye drift was consistently divergent in subjects with small strabismus and tended to reduce the convergent squint angle. In contrast, in subjects with large strabismus drift was convergent. The impairment of the binocular control of saccades is attributed to the deficiency of disconjugate oculomotor adaptive capabilities necessary to compensate for the natural asymmetries or changes in the two oculomotor plants; such deficiency would be more severe in subjects with large strabismus who have neither central nor peripheral binocular vision.