Monocular Fixation in a Binocular Field

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Monocular Fixation in a Binocular Field

Jennifer S. Simonson, OD, FCOVD

2017 Colorado Vision Summit

Learning Objectives:

  1. Understand the levels of sensory fusion

    • Monocular

    • Monocular Fixation in a Binocular Field

    • Biocular

    • Binocular

  1. Use activities in optometric vision therapy to develop each sensory level:

    • Equal vision skills in each eye (accommodation, fixation, pursuit, saccade, perception)

    • Improve monocular fixation when both eyes are open.

    • Awareness of simultaneous perception.

  1. Learn techniques to decrease suppression.

  2. Use activities that create luster.


  • Use one eye at a time

  • Goal: Equal vision skills in each eye

Monocular Fixation in a Binocular Field (MFBF)

  • One eye sees detail and the other eye sees the background in the same space.

  • Goal: accurate perception of details with one eye and the perception of the background with the other eye.

Most Monocular Activities can be modified to MFBF –

1. Change the occluder to a filter

2. Change the target so it cannot be seen with one eye

Occlusion Types

  • Complete: “pirate” patch, “Band-Aid” patch, occluder, hand

    • Fully occluded? Then MONOCULAR

Occlusion Types - MFBF

  • Translucent: light, but no detail.

    • One eye can see background only? Then MFBF

  • Red Lens

  • Green Lens

  • Blue Lens

  • Cyan Lens

Most important Concept:


MFBF #1: WHITE background, RED detail, RED patch or Red/Green Glasses

WORKSHOP: Red Ink Activities

  1. White board/Red marker

  2. Line scrubbing

  3. Pegboard

  4. Franzblau

  5. Red Pencil

  6. Copier with pink setting

  7. Red mazes

  8. Red dot-to-dot

  9. Red letter tracking

  10. Wayne directional sequencer

  11. Red coloring book

  12. Sudoku puzzles

  13. White fish with red letters

  14. Red/Red Rock tiles

  15. White Sherman Cards

  16. Red/Green Toy box train play set

  17. Sanet Vision Integrator (SVI)

  1. Joanna Carter I'd check or Red Green Toy Box. On Amazon there's a Pinkalicious Pinkadoodles book that almost-entirely cancels. But we make our own, and others have shared theirs with us. The color combo that cancels is: R194, G24, B52. So you can make word finds, Hart Charts, etc. with that color. Hope that helps.

  2. Red print test screen.

  3. Modification: Green detail on White background

  • White board/Green marker

  • Green highlighter/crayon

  • Workbooks

  • Red/Green toy box activities

  • Vision Tap and Opto Apps

  1. MFBF #2: BLACK background, RED detail, RED patch or Red/Green Glasses
    WORKSHOP ACITIVITY: Black Felt Activities

  • Goal: accurate perception of details with one eye and the perception of the background with the other eye. Also, the perception of luster, Anti-suppression, and Detail recognition

  1. WORKSHOP ACITIVITY: Tap-n-See Now Little Bear Sees

  • Background = Black, Images = Red, Select size and speed

  • Both eyes see the iPad, but only the left eye can follow the red bear.

  1. Modification: Green Detail on Black Background

  1. MFBF #3: RED background, BLACK detail, GREEN patch or Red/Green Glasses

  2. 1. Black Print (eye under red lens sees detail)

    • Franzblau

    • Red Sherman Cards

    • Red Perceptive Cards

    • Red Carl’s Cards

    • Talking Pen

  1. Modification: White Print (eye under green lens sees detail)

    • Fish Cards

  2. Modification: Red Filter (eye under red lens sees detail)
  1. MFBF #4: GREEN background, RED/GREEN glasses

    • Eye under green lens sees detail


  • A red filter only allows RED light through and blocks all other colors

  • A green filter only allows GREEN light through and blocks all others

  • A blue filter only allows BLUE light through and blocks all others

  1. MFBF #5: RED background, RED LIGHT, RED/GREEN glasses

  2. The red light is blocked by the green filter. Use the red lens on the fixating eye.

  1. Saccadic fixator

  2. Accuvision

  1. Modification: Red Filter + White paper +White Light

  1. Mazes with red filter

  2. Posture Board

  3. Red Light Red Ring

  4. Lite Track

  • Press Lites

  • Finger lights

  1. Clinical Consideration

  • Alternate Red/Green or Red/Blue lenses with activities to fixate with each eye.

  • Use flipper

  • Biocular Activities that use Red/Green (or Red/Blue or Red/Cyan) glasses – are basically MFBF with alternation.

    • For MFBF: select just one color combination of a binocular or anti-suppression activity. For example, only the perceptive cards that are red with black ink.

  1. Biocular (Bioc)

  • Goal: to improve the ability of both eyes to alternately shift focus in an un-fused situation, which will facilitate anti-suppression and prepare the patient for simultaneous perception.

  1. Red Green filters placed side-by-side on reading material, crossword puzzle, hidden pictures.

  2. Polarized or Red/Green bar readers with the appropriate glasses

  3. Sherman Cards

  4. Red/Red Rock

  5. Perceptive or Carl’s Cards- entire deck

  6. Anaglyphic projection= projected hart chart with overlays onto wall.

  7. Dichoptic Training and Suppression Control

  1. References

  1. Fortenbacker, OD, FCOVD “Advanced Amblyopia Treatment for Better Results” – 2015 COVD Annual Meeting, April.

  2. The History of the Treatment of Amblyopia, S.E. Loudon, H.J. Simonsz, Strabismus, 13:93, 2005.

  3. Amblyopia Treatment Study 3 (ATS18) Study of Binocular Computer Activities for Treatment of Amblyopia –

  4. Bateman, R., Danner, R., Dowis, R., et al. (1985). Manual of Esotropia Therapy. Colorado Vision Consultants: Colorado.

  5. Cooper, J. S., Burns, C., Cotter, S. A., Daum, K., Griffin, J. R., & Scheiman, M. M. (1998, March). Accommodative and Vergence Dysfunction. Retrieved from

  6. Headline, T. C., Wahlmeler, I., & Bedes, V. (2005). The Vision Therapist's Toolkit. San Jose: California.

  7. Maino, D., (2011). 3D in the Classroom: See Well, Learn Well. Optometry and Vision Development, Vol. 42, Num. 4: Ohio.

  8. Press, L. J. (2008). Principles and Practice of Vision Therapy. Optometric Extension Program: California.

  9. Press Lites:

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