Purpose To report prevalence, type, and etiology of diplopia in medically and surgically treated glaucoma patients. Design Cohort study Participants 195 adult glaucoma patients treated in a glaucoma referral practice. Methods 195 adult glaucoma patients who had undergone surgical or medical management were prospectively enrolled. Forty-seven patients had undergone glaucoma drainage device (GDD) surgery (Baerveldt 350, Baerveldt 250, and/or Ahmed FP7), 61 had undergone trabeculectomy, and 87 were medically treated. All patients completed the Diplopia Questionnaire to assess diplopia. We defined presence of diplopia as “Sometimes,” “Often,” or “Always” in distance straight ahead and/or reading positions on the Diplopia Questionnaire. A chart review was performed jointly by a strabismus and glaucoma sub-specialist to characterize the type and etiology of the diplopia. Main Outcome Measures Frequency, type, and etiology of diplopia. Results Diplopia was reported in 41 (21%) of 195 medically and surgically treated glaucoma patients. Binocular diplopia attributable to the glaucoma procedure was present in 11 of 47 (23%) post-GDD patients (95% CI; 12%–38%), which was significantly greater than in post-trabeculectomy patients (2 of 61 (3%), 95% CI; 0.4% –11%; P=0.002). The most common type of strabismus associated with binocular diplopia attributable to glaucoma surgery was hypertropia (10 out of 11 GDD patients, 2 out of 2 trabeculectomy patients). Monocular diplopia was found in a similar proportion of medically treated, post-trabeculectomy, and post-GDD (4 of 87 (5%), 4 of 61 (7%), and 2 of 47 (4%) respectively) patients. Binocular diplopia not attributable to surgery was found in similar proportions of GDD, trabeculectomy, and medically treated patients (3 of 47 (6%), 5 of 61 (8%), and 10 of 87 (11%) respectively). Conclusions Diplopia may be under-recognized in medically and surgically treated glaucoma patients and standardization of ascertaining patient symptoms using the Diplopia Questionnaire may be useful in these patients. Diplopia was more commonly seen after GDD than trabeculectomy, typically a non-comitant restrictive hypertropia. The prevalence of monocular diplopia and binocular diplopia unrelated to glaucoma surgery was similar among medical and surgical groups. It is important to counsel patients on the higher occurrence of diplopia associated with GDD surgery.

In patients with P-PHPT or R-PHPT and nonlocalizing imaging studies, sPVS is a sensitive test for localizing the source of PHPT when a positive PTH gradient is present.

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