DraggedFovea Diplopia Syndrome Purpose To identify clinical characteristics

  • Slides: 10
Download presentation
Dragged-Fovea Diplopia Syndrome

Dragged-Fovea Diplopia Syndrome

Purpose • To identify clinical characteristics • To introduce a simple diagnostic test to

Purpose • To identify clinical characteristics • To introduce a simple diagnostic test to aid evaluation of such patients • To provide simple treatment option The Dragged-Fovea Diplopia Syndrome, Clinical Characteristics, Diagnosis and Treatment, Guyton at al Ophthalmology 2005; 112: 1455 -1462

Design • Retrospective observational case series • 95 eyes in 83 consecutive patients seen

Design • Retrospective observational case series • 95 eyes in 83 consecutive patients seen between 1 Jan 1993 to 9 Aug 2004 (>11 yrs)

Methods • 222 records reviewed of patients seen at Krieger Children’s Eye Center •

Methods • 222 records reviewed of patients seen at Krieger Children’s Eye Center • Ave age – 67 yrs (range 30 -86 yrs) – (Children’s Eye Center? ? ? ) • Diagnosis: – Maculopathy – Internal Limiting Membrane – Dragged fovea • Recruited: – Reported binocular diplopia – Not amenable to prism therapy and – Not acquired strabismus

Outcome Measures • • • Metamorphopsia on Amsler Or other clinical evidence of macular

Outcome Measures • • • Metamorphopsia on Amsler Or other clinical evidence of macular wrinkling Response to prism trial Response to lights on-off test Response to partial occlusion with Scotch Satin tape (3 M)

Results • 95 eyes in 83 patient • 69 patients tested with lights on-off

Results • 95 eyes in 83 patient • 69 patients tested with lights on-off test – all positive – Demonstrates rapid central fusion with room lights off and – Recurrence of central diplopia with peripheral fusion with room lights on • 46 patients (n=64 tested) receptive to monocular occlusion with Scotch Satin tape

Conclusions • Dragged-fovea diplopia syndrome consists of central diplopia in presence of peripheral fusion,

Conclusions • Dragged-fovea diplopia syndrome consists of central diplopia in presence of peripheral fusion, secondary to dragging of fovea in one or both eyes by retinal disease • Competition between central and peripheral fusion • The central diplopia cannot be eliminated by prism therapy or eye muscle surgery • The lights on-off test “pathognomonic” for this syndrome • Patients benefit from monocular occlusion with Scotch Satin tape

Lights on-off test • Small field fusion central fusion test • Universally positive in

Lights on-off test • Small field fusion central fusion test • Universally positive in pts with demonstrable central vs peripheral fusion conflict • As evidenced by failure of prism to maintain initial central fusion • Easy to perform • Demonstrates nature of problem to patient cf to prism trial

Response to Monocular Occlusion • Documented in 58/83 • Successful in 46 • 12

Response to Monocular Occlusion • Documented in 58/83 • Successful in 46 • 12 pts – – unable to tolerate, though diplopia eliminated

Criticisms • 9/83 followed • Aniseikonia not measured formally – Due to • macular

Criticisms • 9/83 followed • Aniseikonia not measured formally – Due to • macular disease • Anisometropia – Cause-effect? Or authors postulate contributes to fusion instability