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Research Article: Stereopsis impairment and its association with fovea-disc angle in congenital superior oblique palsy patients with compensatory head posture: a cross-sectional study

Date Published: 2026-06-12

Abstract:
To characterize stereopsis impairment in patients with congenital superior oblique palsy (CSOP) with compensatory head posture (CHP) and to explore the fovea-disc angle (FDA) as a potential imaging parameter for assessing binocular visual dysfunction. This cross-sectional study enrolled 20 CSOP patients with CHP and 20 age- and sex-matched controls between November 2024 and March 2026. Stereopsis was assessed using the Titmus Stereotest, Randot Stereotest (near), and Distance Randot Stereotest under both the CHP and the primary position. Stereopsis was compared between CSOP patients and controls, and between the CHP and the primary position within the CSOP group. Stereopsis was categorized as normal (?100?arcsec) or impaired (>100?arcsec), and the proportions of CSOP patients with impaired distance and near stereopsis under the CHP were compared. FDA was measured using fundus photography and an imaging analysis software in patients with CSOP. Correlation analyses were performed to evaluate the associations between log-transformed stereopsis and clinical parameters. CSOP patients with CHP showed significantly worse stereopsis than controls (Titmus: U =?20.00, p <?0.0001; Randot near: U =?63.00, p <?0.0001; Randot distance: U =?23.50, p <?0.0001). Within the CSOP group, near stereopsis was significantly better under the CHP than under the primary position (Titmus: W =?61.00, p =?0.004; Randot near: W =?80.00, p =?0.003), whereas distance stereopsis showed no significant improvement with CHP ( W =?11.00, p =?0.250). Furthermore, the proportion of impaired distance stereopsis under the CHP remained high (85.00%, 17/20), whereas near stereopsis was impaired in only 35.00% (7/20) ( p =?0.003). The binocular FDA was negatively correlated with both near ( r =??0.50, 95% CI : ?0.77 to ?0.07, uncorrected p =?0.025) and distance ( r =??0.48, 95% CI : ?0.77 to ?0.04, uncorrected p =?0.031) stereopsis under the CHP. No correlations were found between stereopsis and astigmatism, interocular differences in SE and astigmatism, or inferior oblique overaction (all p >?0.05). CSOP patients with CHP exhibit impairment in both distance and near stereopsis, with distance stereopsis being more severely affected. Binocular FDA is negatively correlated with stereopsis and may serve as a promising imaging parameter for assessing binocular visual dysfunction in CSOP with CHP.

Introduction:
Stereopsis is the highest form of binocular visual function, enabling the perception of depth through the neural integration of disparate retinal images from both eyes. This capacity is fundamental for fine motor coordination, precise hand-eye coordination, and spatial navigation in daily activities ( 1 ). There is evidence demonstrating that impaired stereopsis compromises gross motor skills and daily living tasks across all age groups ( 2 ). Congenital superior oblique palsy (CSOP) is a common type of paralytic…

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