Diplopia Secondary to Aniseikonia Associated With Macular Disease

Benegas, Nancy; Egbert, James E.; Engel, W. Keith; Kushner, Burton J.

doi:10.1001/archopht.117.7.896

Cited by 68 publications

(37 citation statements)

References 16 publications

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“…If tests for retinal misregistration were positive, a diagnosis of strabismic diplopia alone as the barrier to single vision was confirmed only if the diplopia resolved with ground-in prism or surgery, because previous studies report poor success with prism correction for diplopia associated with maculopathies. 1,7,16,17 We did not consider improvement with a temporary Fresnel prism as confirmed strabismic diplopia, since Fresnel prisms may enable suppression by degrading image quality.…”

Section: Discussionmentioning

confidence: 99%

“…An ERM may cause abnormalities of the retinal mosaic leading to aniseikonia, 1-6 metamorphopsia, 3,6-11 and decreased visual acuity. 1,12 In addition, binocular misregistration of the retinal mosaics may cause binocular diplopia, 1,5,9 which we term central-peripheral rivalry-type diplopia, also known as dragged-fovea diplopia, 3 or macular diplopia 13 and may manifest as foveal-peripheral rivalry on synoptophore testing. 7 Nevertheless, there are many potential causes of diplopia in adults 14 such that in the patient with an ERM, diplopia may, or may not, be specifically caused by the ERM.…”

Section: Introductionmentioning

confidence: 99%

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Causes of Diplopia in Patients With Epiretinal Membranes

Veverka

Hatt

Brown

et al. 2017

American Journal of Ophthalmology

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Purpose To describe the causes of diplopia in patients with an epiretinal membrane (ERM) and presenting diplopia. Design Retrospective observational case series Methods We reviewed patients diagnosed with an ERM, who had been seen by both retinal and strabismus specialists in a tertiary medical center. Data recorded: orthoptic evaluation, retinal misregistration (optotype-frame test, and synoptophore central peripheral superimposition slides at 5 and 10 degrees), and cause of any diplopia (retinal misregistrationvs strabismus vs optical/refractive error). We defined central-peripheral rivalry-type diplopia as presenting symptomatic diplopia with evidence of retinal misregistration, and where other causes did not fully explain diplopia. The frequency of each cause of diplopia in patients with ERM was determined. Results Of 50 patients with ERM, 25 had symptomatic diplopia and 25 had no diplopia. 11 (44%) of 25 diplopic patients had retinal misregistration as the sole cause (central-peripheral rivalry-type diplopia), 7 (28%) strabismus (1 of 7 initially appeared to have central-peripheral rivalry-type diplopia), 1 (4%) optical/refractive error (monocular diplopia), 2 (8%) mixed retinal misregistration (central-peripheral rivalry-type diplopia) and strabismus and for 4 (16%) diplopia cause was indeterminate. Unexpectedly, 15 (60%) of 25 patients without diplopia had evidence of retinal misregistration. Conclusions Patients with ERM and presenting diplopia may have one of several causes of diplopia, most commonly retinal misregistration (central-peripheral rivalry-type diplopia). Nevertheless, diplopic patients with retinal misregistration may also have treatable strabismus or optical/refractive error as the primary barrier to single vision and therefore many potential barriers to single vision should be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Causes of Diplopia in Patients With Epiretinal Membranes

Veverka

Hatt

Brown

et al. 2017

American Journal of Ophthalmology

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“…Some of the symptoms in patients with ERM may result from aniseikonia (Greek: anisos, unequal; eikon, image) or the perception of the same image as being of different size with each eye. A few studies have reported aniseikonia in macular disease such as ERM, 3 4 vitreoretinal traction, 4 and central serous retinopathy. 5 However, the prevalence of aniseikonia in ERM is unknown since it is not tested routinely in the clinic.…”

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confidence: 99%

Aniseikonia associated with epiretinal membranes

Ugarte

2005

British Journal of Ophthalmology

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Aims: To determine whether the computerised version of the new aniseikonia test (NAT) is a valid, reliable method to measure aniseikonia and establish whether aniseikonia occurs in patients with epiretinal membranes (ERM) with preserved good visual acuity. Methods: With a computerised version of the NAT, horizontal and vertical aniseikonia was measured in 16 individuals (mean 47 (SD 16.46) years) with no ocular history and 14 patients (mean 67.7 (14.36) E piretinal membranes (ERM) are non-vascular fibrocellular proliferations on the retinal inner surface. They develop either spontaneously, in association with ocular diseases (for example, retinal detachment, chorioretinitis, retinal vein occlusions), or following surgery (for example, scleral buckling, cataract extraction, retinal cryopexy). The 5 year Blue Mountain Study found a 5.3% cumulative incidence of spontaneous ERM above the age of 49.1 ERM are generally located in the macula and their ability to contract 2 can distort the photoreceptor distribution in the fovea. This would affect image perception causing an object to appear larger (macropsia) or smaller (micropsia). Some of the symptoms in patients with ERM may result from aniseikonia (Greek: anisos, unequal; eikon, image) or the perception of the same image as being of different size with each eye. A few studies have reported aniseikonia in macular disease such as ERM, 3 4 vitreoretinal traction, 4 and central serous retinopathy.5 However, the prevalence of aniseikonia in ERM is unknown since it is not tested routinely in the clinic.Aniseikonia can be measured by two dimensional and three dimensional methods. The space eikonometer 6 depends on the observed effect of size lenses on a three dimensional array of cords and rods. It is very accurate but the information provided is difficult to interpret. The use of the instrument was discontinued in the 1970s. A simplified test consisting of graded stereoscopic cards reproducing the space eikonometer target was developed later on. 7 The performance of this test requires good stereopsis. This is known to be reduced in patients with aniseikonia, making its results unreliable. The NAT measures aniseikonia directly, by presenting a red and a green semicircle to each eye by means of dissociation with red/green goggles. It is easy and rapid to perform 2 8 and we consider it ideal for clinical use. We used a computerised version of the NAT after confirming its validity and reliability to measure aniseikonia in symptomatic patients with unilateral macular ERM. MATERIALS AND METHODSSixteen volunteers, mean age 47 (SD 16.46), 10 women and six men, without ocular history and less than 1 dioptre (D) anisometropia were included in the control group. Fourteen patients, mean age 67.7 (SD 14.36), five women and nine men, with ERM were recruited between October 2003 and December 2004. Inclusion criteria were visual complaints, less than 1 D anisometropia, logarithmic minimum angle of resolution (logMAR) visual acuity (VA) 0.5 or better in each eye, and unilateral macula...

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“…Kirschen 4 states that the 2 terms "should not be confused." Kushner and colleagues 5 and Pratt-Johnson and Tillson 6(p208) have also used the terms synonymously.…”

Section: Central Fusion Disruption Is Not Horror Fusionismentioning

confidence: 99%

Central Fusion Disruption Is Not Horror Fusionis

2010

Arch Ophthalmol

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Diplopia Secondary to Aniseikonia Associated With Macular Disease

Cited by 68 publications

References 16 publications

Causes of Diplopia in Patients With Epiretinal Membranes

Causes of Diplopia in Patients With Epiretinal Membranes

Aniseikonia associated with epiretinal membranes

Central Fusion Disruption Is Not Horror Fusionis

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