Attention can shift the reference eye under binocular fusion failure: A case report

Binocular fusion normally relies on a "cyclopean eye" that integrates image disparities between the two eyes into a single coherent percept. When fusion fails, how the brain chooses its spatial reference frame remains unclear. Here, we report a rare case of a 44-year-old man who developed multiple-directions diplopia following surgical resection of a cerebellar vermis hemangioblastoma. Clinical tests showed deficits in several extraocular muscles. Experimentally, in binocular and dichoptic viewing, perception was always anchored to the left eye with the right eye's image misaligned, whereas monocular viewing produced no diplopia. Crucially, the patient could voluntarily switch to the right eye as reference, which was independent of stimulus shape similarity, stimulus exposure order, or participant response demands. This case offers a unique window to understand the relationship between automatic sensory integration and top-down control in binocular vision: When cyclopean fusion breaks down, visual perception adapts to a single-eye reference frame that can be flexibly influenced by attention.