Binocular Interference vs Diplopia in Patients With Epiretinal Membrane

Abstract

ymptoms of epiretinal membrane (ERM) include reduced visual acuity, metamorphopsia, 1-3 aniseikonia, 4 and/or central-peripheral rivalry (CPR)-type diplopia 5 (also known as dragged-fovea diplopia 3 ). Over the years, [5][6][7][8] we have noted that some patients with ERM describe another apparently distinct symptom; needing to close 1 eye to improve their overall visual experience but in the absence of diplopia or strabismus. We term this phenomenon binocular interference, where a patient has reduced binocular visual quality vs monocular visual quality, manifesting as the need to close 1 eye in the absence of diplopia or strabismus. The aim of this study was to report the frequency of binocular interference associated with monocular eye closure in patients with ERM and also to evaluate its association with clinical parameters and quality of life domain scores. MethodsApproval was obtained from the institutional review board at Mayo Clinic, Rochester, Minnesota, for data collection and analysis, and written informed consent was obtained. No compensation or incentives were offered for participation. All procedures and data collection were conducted in a manner IMPORTANCE Patients with epiretinal membrane (ERM) sometimes close 1 eye for improved vision, but associations have not been rigorously studied.OBJECTIVE To evaluate associations with monocular eye closure in patients with ERM, and to report binocular interference (closing 1 eye to improve visual quality). DESIGN, SETTING, AND PARTICIPANTSRetrospective medical record review of an adult strabismus clinic at a tertiary referral center. Patients with ERM referred from retina clinicians between June 2010 and October 2019 who completed the Adult Strabismus (AS)-20 questionnaire, including the question: "I cover or close one eye to see things better." Two groups were identified: (1) patients reporting eye closure sometimes or more, and (2) patients reporting no eye closure (as control patients). MAIN OUTCOMES AND MEASURESFrequencies of (1) central-peripheral rivalry (CPR)-type diplopia (dragged fovea diplopia); (2) binocular interference (monocular eye closure but no diplopia or strabismus); and (3) other, associated with monocular eye closure. Visual acuity, metamorphopsia, aniseikonia, and AS-20 quality of life domain scores (self-perception, interactions, reading function, and general function) compared between binocular interference, CPR-type diplopia, and control patients.RESULTS A total of 124 patients with ERM (58 of 124 were women [47%]; mean [SD] age, 70 [9] years) reported monocular eye closure. Associations were binocular interference in 36 (29%; 95% CI, 21%-38%), CPR-type diplopia in 34 (27%; 95% CI, 20%-36%), and other (primarily strabismus) in 54 (44%). Compared with control patients with ERM (n = 11), patients with ERM and binocular interference had worse quality of life on AS-20 reading function (95 vs 62; mean difference, 22 points; 95% CI, 7-27 points; P = .007) and general function (89 vs 68; mean difference, 23 points; 95% CI, 13-34 points; P =...

Epiretinal membrane: A review

“…72 A newly recognised symptom of ERM has been coined binocular interference and occurs when the affected subject needs to close one eye to improve their overall vision in the absence of either diplopia or strabismus. In a study by Hatt et al 73 the most common associations in patients with ERM and who reported monocular eye closure were binocular interference and centralperipheral rivalry-type diplopia. These patients had significantly reduced quality of life.…”

Diagnostic and Therapeutic Challenges

“…We value the patient's subjective report regarding quality of vision and impact on activities of daily living, including presence and degree of metamorphopsia, aniseikonia, diplopia, and binocular interference. 15 In retinal structure, we evaluate the whole OCT cube as well as the fundus examination and near-infrared reflectance (or en face OCT) image to get an appreciation of the three-dimensional impact on retinal architecture. Numerous studies report specific anatomical features correlated with better postoperative result, including recent deep learning studies.…”

Artificial Intelligence Segmentation Algorithm-Based Optical Coherence Tomography Image in Evaluation of Binocular Retinopathy

“…However, binocular retinopathy is a genetic disease which is difficult to use effective drugs to treat [ 3 , 4 ]. The factors causing retinopathy are relatively complex, and different cases are analyzed according to the specific situation [ 5 , 6 ].…”