Ocular dominance and refractive error: a cross-sectional study of 400 individuals at a tertiary eye hospital in eastern Nepal
Medical hypothesis, discovery & innovation in optometry,
Vol. 6 No. 2 (2025),
31 July 2025
,
Page 43-49
https://doi.org/10.51329/mehdioptometry221
Abstract
Background: Ocular dominance is the consistent preference of using one eye over the other during visual processing, a phenomenon analogous to hand dominance. Ocular dominance often aligns with the eye delivering clearer vision, but does not always correspond to superior visual acuity or refractive status. Mechanisms underlying ocular dominance remain unclear, particularly in individuals whose refractive errors have remained uncorrected since childhood. In this study, we investigated ocular dominance patterns and their association with refractive error and handedness in individuals without early optical correction.Methods: In this cross-sectional study, we recruited individuals aged 16–40 years with refractive errors, who had no history of spectacle use since childhood, from Biratnagar Eye Hospital, Nepal. Participants underwent anterior and posterior segment examinations using slit-lamp, followed by non-cycloplegic retinoscopy and subjective refraction. Ocular dominance was assessed using the Hole-in-the-Card (Dolman’s) and Miles tests. Hand dominance was determined through standardized questioning and observation during tasks. Spherical equivalents (SEQ) were calculated, and anisometropia was defined as an interocular refractive difference equal or greater than 1.00 D.
Results: Four hundred participants (mean [standard deviation, SD] age 26.1 [6.0] years; 61.3% males) were assessed for ocular and hand dominance. Refractive error SEQ ranged from +9.25 D to –13.50 D (mean [SD] –1.75 [2.46] D). Myopia was most common among students (n = 93, 23.3%) and least common among tailors (n = 14, 3.5%). The most frequent dominance pattern was right-hand combined with right-eye dominance (n = 328, 82%). A strong, statistically significant association was found between ocular and hand dominance (P < 0.01; Cramer’s V= 0.73). Moderate but statistically significant associations were observed between refractive error type and both ocular (P < 0.01; V = 0.25) and hand dominance (P < 0.01; V = 0.21). The dominant eye was not always the eye with better visual acuity. Among the 103 individuals with anisometropia (25.8%), ocular dominance was not consistently accompanied by either the higher refractive error or better visual acuity.
Conclusions: In this study, we demonstrated a strong and statistically significant association between ocular and hand dominance, suggesting existence of a significant lateralization pattern among individuals with refractive error who had no history of spectacle use since childhood. While a right-hand/right-eye dominance pattern was predominant, variations such as cross-dominance and absence of ocular dominance were also observed. A moderate but significant association was found between the type of refractive error and both ocular and hand dominance, indicating that visual and motor lateralization may influence refractive development. The dominant eye did not consistently accompany by better visual acuity or greater refractive error in individuals with anisometropia, underscoring the complexity of ocular dominance and its clinical implications. These findings may aid in understanding visual behavior and inform clinical decisions related to refractive surgeries, amblyopia management, and binocular vision assessments. Further research is needed to explore the underlying neurophysiological mechanisms.
Keywords:
- preference
- dominant
- hands
- eyes
- refractive error
- vision, Nepal
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3. Khan AZ, Crawford JD. Ocular dominance reverses as a function of horizontal gaze angle. Vision Res. 2001 Jun;41(14):1743-8. doi: 10.1016/s0042-6989(01)00079-7. PMID: 11369037.
4. Willems RM, Peelen MV, Hagoort P. Cerebral lateralization of face-selective and body-selective visual areas depends on handedness. Cereb Cortex. 2010 Jul;20(7):1719-25. doi: 10.1093/cercor/bhp234. Epub 2009 Nov 4. PMID: 19889713.
5. Mapp AP, Ono H, Barbeito R. What does the dominant eye dominate? A brief and somewhat contentious review. Percept Psychophys. 2003 Feb;65(2):310-7. doi: 10.3758/bf03194802. PMID: 12713246.
6. Schwartz R, Yatziv Y. The effect of cataract surgery on ocular dominance. Clin Ophthalmol. 2015 Dec 14;9:2329-33. doi: 10.2147/OPTH.S93142. PMID: 26715837; PMCID: PMC4686333.
7. Rodriguez-Lopez V, Barcala X, Zaytouny A, Dorronsoro C, Peli E, Marcos S. Monovision Correction Preference and Eye Dominance Measurements. Transl Vis Sci Technol. 2023 Mar 1;12(3):18. doi: 10.1167/tvst.12.3.18. PMID: 36939712; PMCID: PMC10043500.
8. Kommerell G, Schmitt C, Kromeier M, Bach M. Ocular prevalence versus ocular dominance. Vision Res. 2003 Jun;43(12):1397-403. doi: 10.1016/s0042-6989(03)00121-4. PMID: 12742109.
9. Yuan L, Wan B, He Y, Bao Y. The association between ocular dominance and refractive errors in chinese myopic subjects. J Clin Exp Ophthalmol. 2015;6(487):2. doi: 10.4172/2155-9570.1000487.
10. Jiang F, Chen Z, Bi H, Ekure E, Su B, Wu H, Huang Y, Zhang B, Jiang J. Association between Ocular Sensory Dominance and Refractive Error Asymmetry. PLoS One. 2015 Aug 21;10(8):e0136222. doi: 10.1371/journal.pone.0136222. PMID: 26295803; PMCID: PMC4546588.
11. García-Pérez MA, Peli E. Psychophysical Tests Do Not Identify Ocular Dominance Consistently. Iperception. 2019 Apr 29;10(2):2041669519841397. doi: 10.1177/2041669519841397. PMID: 31069044; PMCID: PMC6492369.
12. Linke SJ, Baviera J, Richard G, Katz T. Association between ocular dominance and spherical/astigmatic anisometropia, age, and sex: analysis of 1274 hyperopic individuals. Invest Ophthalmol Vis Sci. 2012 Aug 9;53(9):5362-9. doi: 10.1167/iovs.11-8781. PMID: 22714892.
13. Pepose JS, Thompson V, Hoopes P, Waring G 4th, Rebenitsch RL, MacRae SM, Donaldson KE, Durrie DS, Marcos S. Assessing Ocular Dominance: Rethinking the Current Paradigm. J Cataract Refract Surg. 2025 Mar 26;51(7):592–9. doi: 10.1097/j.jcrs.0000000000001659. Epub ahead of print. PMID: 40135797; PMCID: PMC12187140.
14. Yang E, Blake R, McDonald JE 2nd. A new interocular suppression technique for measuring sensory eye dominance. Invest Ophthalmol Vis Sci. 2010 Jan;51(1):588-93. doi: 10.1167/iovs.08-3076. Epub 2009 Jul 23. PMID: 19628736; PMCID: PMC2810859.
15. Min SH. Ocular Dominance Plasticity: A Mini-Review. Eye Brain. 2025 Jun 10;17:37-48. doi: 10.2147/EB.S532627. PMID: 40519698; PMCID: PMC12166856.
16. Mohammadi SF, Aghazade Amiri M, Naderifar H, Rakhshi E, Vakilian B, Ashrafi E, Behesht-Nejad AH. Vision Examination Protocol for Archery Athletes Along With an Introduction to Sports Vision. Asian J Sports Med. 2016 Mar 8;7(1):e26591. doi: 10.5812/asjsm.26591. PMID: 27217923; PMCID: PMC4870828.
17. Akbari MR, Mirzajani A, Moeinitabar MR, Mirmohammadsadeghi A, Khorrami-Nejad M, Sharbatoghli L. The effect of alternate occlusion on control of intermittent exotropia in children. Eur J Ophthalmol. 2020 Mar;30(2):275-279. doi: 10.1177/1120672119827764. Epub 2019 Feb 12. PMID: 30755034.
18. Song T, Duan X. Ocular dominance in cataract surgery: research status and progress. Graefes Arch Clin Exp Ophthalmol. 2024 Jan;262(1):33-41. doi: 10.1007/s00417-023-06216-9. Epub 2023 Aug 30. PMID: 37644327.
19. Burnat K, Van Der Gucht E, Waleszczyk WJ, Kossut M, Arckens L. Lack of early pattern stimulation prevents normal development of the alpha (Y) retinal ganglion cell population in the cat. J Comp Neurol. 2012 Aug 1;520(11):2414-29. doi: 10.1002/cne.23045. PMID: 22237852.
20. Flitcroft DI, He M, Jonas JB, Jong M, Naidoo K, Ohno-Matsui K, Rahi J, Resnikoff S, Vitale S, Yannuzzi L. IMI - Defining and Classifying Myopia: A Proposed Set of Standards for Clinical and Epidemiologic Studies. Invest Ophthalmol Vis Sci. 2019 Feb 28;60(3):M20-M30. doi: 10.1167/iovs.18-25957. Erratum in: Invest Ophthalmol Vis Sci. 2024 Nov 4;65(13):19. doi: 10.1167/iovs.65.13.19. PMID: 30817826; PMCID: PMC6735818.
21. Gabai A, Zeppieri M. Anisometropia. 2023 May 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 35881751.
22. Brown SG, Roy EA, Rohr LE, Bryden PJ. Using hand performance measures to predict handedness. Laterality. 2006 Jan;11(1):1-14. doi: 10.1080/1357650054200000440. PMID: 16414911.
23. Scharoun SM, Bryden PJ. Hand preference, performance abilities, and hand selection in children. Front Psychol. 2014 Feb 18;5:82. doi: 10.3389/fpsyg.2014.00082. PMID: 24600414; PMCID: PMC3927078.
24. Chia A, Jaurigue A, Gazzard G, Wang Y, Tan D, Stone RA, Saw SM. Ocular dominance, laterality, and refraction in Singaporean children. Invest Ophthalmol Vis Sci. 2007 Aug;48(8):3533-6. doi: 10.1167/iovs.06-1489. PMID: 17652720.
25. Robert R, Babu M, Unnikannan K. Sighting Dominance, Biometric Parameters, and Refractive Status Analyzing the Role of Ocular Dominance. Beyoglu Eye J. 2023 May 1;8(2):104-109. doi: 10.14744/bej.2023.46504. PMID: 37521883; PMCID: PMC10375208.
26. Roth HL, Lora AN, Heilman KM. Effects of monocular viewing and eye dominance on spatial attention. Brain. 2002 Sep;125(Pt 9):2023-35. doi: 10.1093/brain/awf210. PMID: 12183348.
27. Subudhi P, Agarwal P. Myopia. 2023 Mar 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 35593836.
28. Linke SJ, Baviera J, Munzer G, Steinberg J, Richard G, Katz T. Association between ocular dominance and spherical/astigmatic anisometropia, age, and sex: analysis of 10,264 myopic individuals. Invest Ophthalmol Vis Sci. 2011 Nov 25;52(12):9166-73. doi: 10.1167/iovs.11-8131. PMID: 22025570.
29. Zhou D, Ni N, Ni A, Chen Q, Hu DN, Zhou J. Association of Visual Acuity with Ocular Dominance in 2045 Myopic Patients. Curr Eye Res. 2017 Aug;42(8):1155-1159. doi: 10.1080/02713683.2017.1297464. Epub 2017 May 11. PMID: 28494159.
30. Toyoizumi T, Miller KD. Equalization of ocular dominance columns induced by an activity-dependent learning rule and the maturation of inhibition. J Neurosci. 2009 May 20;29(20):6514-25. doi: 10.1523/JNEUROSCI.0492-08.2009. PMID: 19458222; PMCID: PMC2923481.
31. Katz LC, Crowley JC. Development of cortical circuits: lessons from ocular dominance columns. Nat Rev Neurosci. 2002 Jan;3(1):34-42. doi: 10.1038/nrn703. PMID: 11823803.
32. Crowley JC, Katz LC. Ocular dominance development revisited. Curr Opin Neurobiol. 2002 Feb;12(1):104-9. doi: 10.1016/s0959-4388(02)00297-0. PMID: 11861172.
33. Zhou Q, Li H, Yao S, Takahata T. Visual experience-dependent development of ocular dominance columns in pigmented rats. Cereb Cortex. 2023 Aug 8;33(16):9450-9464. doi: 10.1093/cercor/bhad196. PMID: 37415464.
34. Smith GB, Heynen AJ, Bear MF. Bidirectional synaptic mechanisms of ocular dominance plasticity in visual cortex. Philos Trans R Soc Lond B Biol Sci. 2009 Feb 12;364(1515):357-67. doi: 10.1098/rstb.2008.0198. PMID: 18977732; PMCID: PMC2674473.
35. Crowley JC, Katz LC. Early development of ocular dominance columns. Science. 2000 Nov 17;290(5495):1321-4. doi: 10.1126/science.290.5495.1321. PMID: 11082053.
36. Choi JA, Kim JS, Jeong HJ, Lee JA, Park CK. Ocular Dominance Is Associated with the Ganglion Cell-Inner Plexiform Layer Thickness Profile in the Macula. PLoS One. 2016 Feb 26;11(2):e0150035. doi: 10.1371/journal.pone.0150035. PMID: 26918335; PMCID: PMC4769019.
37. Mendola JD, Conner IP. Eye dominance predicts fMRI signals in human retinotopic cortex. Neurosci Lett. 2007 Feb 27;414(1):30-4. doi: 10.1016/j.neulet.2006.12.012. Epub 2006 Dec 15. PMID: 17194544; PMCID: PMC2740649.
38. Lopes-Ferreira D, Neves H, Queiros A, Faria-Ribeiro M, Peixoto-de-Matos SC, González-Méijome JM. Ocular dominance and visual function testing. Biomed Res Int. 2013;2013:238943. doi: 10.1155/2013/238943. Epub 2013 Nov 11. PMID: 24319677; PMCID: PMC3844205.
39. Petit L, Zago L, Mellet E, Jobard G, Crivello F, Joliot M, Mazoyer B, Tzourio-Mazoyer N. Strong rightward lateralization of the dorsal attentional network in left-handers with right sighting-eye: an evolutionary advantage. Hum Brain Mapp. 2015 Mar;36(3):1151-64. doi: 10.1002/hbm.22693. Epub 2014 Nov 19. PMID: 25409934; PMCID: PMC6869826.
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