Nonsurgical Management of Binocular Diplopia Induced by Macular Pathology

Silverberg, Mark; Schuler, Eileen; Véronneau-Troutman, Suzanne; Wald, Kenneth J.; Schlossman, A; Medow, Norman B.

doi:10.1001/archopht.117.7.900

Cited by 45 publications

(22 citation statements)

References 8 publications

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“…20 The 0.2 and 0.3 filters used in this previous study would not only have reduced acuity in the fellow eye but also would have significantly disrupted binocular function rather than promoting binocular recovery. Notably, the fact that Bangerter filters have such profound detrimental effects on binocular vision has been exploited for the treatment of diplopia [42][43][44] and the induction of deprivation amblyopia in primates. 45 This is not to say that these filters are inappropriate for amblyopia therapy, in fact they are as effective as full occlusion and are more cosmetically acceptable 20 ; however, they should not be considered as a reliable method of promoting binocular function.…”

Section: Discussionmentioning

confidence: 99%

Does Partial Occlusion Promote Normal Binocular Function?

Thompson

Ding

et al. 2012

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. There is growing evidence that abnormal binocular interactions play a key role in the amblyopia syndrome and represent a viable target for treatment interventions. In this context the use of partial occlusion using optical devices such as Bangerter filters as an alternative to complete occlusion is of particular interest. The aims of this study were to understand why Bangerter filters do not result in improved binocular outcomes compared to complete occlusion, and to compare the effects of Bangerter filters, optical blur and neutral density (ND) filters on normal binocular function.METHODS. The effects of four strengths of Bangerter filters (0.8, 0.6, 0.4, 0.2) on letter and vernier acuity, contrast sensitivity, stereoacuity, and interocular suppression were measured in 21 observers with normal vision. In a subset of 14 observers, the partial occlusion effects of Bangerter filters, ND filters and plus lenses on stereopsis and interocular suppression were compared. RESULTS.Bangerter filters did not have graded effect on vision and induced significant disruption to binocular function. This disruption was greater than that of monocular defocus but weaker than that of ND filters. The effect of the Bangerter filters on stereopsis was more pronounced than their effect on monocular acuity, and the induced monocular acuity deficits did not predict the induced deficits in stereopsis.CONCLUSIONS. Bangerter filters appear to be particularly disruptive to binocular function. Other interventions, such as optical defocus and those employing computer generated dichoptic stimulus presentation, may be more appropriate than partial occlusion for targeting binocular function during amblyopia treatment. (Invest Ophthalmol Vis Sci. 2012; 53:6818-6827)

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Section: Discussionmentioning

confidence: 99%

Does Partial Occlusion Promote Normal Binocular Function?

Thompson

Ding

et al. 2012

Invest. Ophthalmol. Vis. Sci.

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“…The study by Janknecht and Funk, 14 while confirming our finding that mean acuity levels are not consistent with the filter label, found markedly different acuities to those we report in this present study. It is possible that, due to the manufacturing process, filters of the same labeled density do not achieve comparable reductions in visual acuity or that density may not be uniform across the entire filter 3, 14 (The Reproducibility of Blur with a Bangerter Filter. Repka MX et al Poster presentation, AAPOS 2006; Evaluation of Bangerter Filters as a Predictable Means of Blurring Vision.…”

Section: Discussionmentioning

confidence: 99%

“…1, 2 Clinically, Bangerter filters are used in the treatment of diplopia 2, 3 and amblyopia. 4, 5 Nevertheless, there are few data reporting the degree of visual degradation achieved using Bangerter filters or their effect on other measures of visual functions, such as vernier acuity or contrast sensitivity.…”

Section: Introductionmentioning

confidence: 99%

The effect of Bangerter filters on optotype acuity, Vernier acuity, and contrast sensitivity

Odell

Leske

Hatt

et al. 2008

Journal of American Association for Pediatric Ophthalmology and

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Purpose Bangerter filters are designed to cause progressive degradation of distance optotype acuity to predicted levels (density label indicating expected decimal acuity) and are used to treat amblyopia and diplopia. Nevertheless, there are few data reporting induced acuity deficits. We investigated the effect of Bangerter filters on distance and near optotype acuity, vernier acuity, and contrast sensitivity. Methods Fifteen subjects with best corrected optotype acuity of at least 20/25 in each eye were blurred sequentially in one eye with 7 Bangerter filters (densities <0.1, 0.1, 0.2, 0.3, 0.4, 0.8, 1.0). At each filter level distance and near optotype acuity (LogMAR), vernier acuity and contrast sensitivity were assessed. Mean log acuities were compared using generalized estimating equation methods. Results The 1.0, 0.8, and 0.4 filters degraded distance optotype acuity to a similar degree (mean 0.22, 0.23, and 0.28 logMAR). Subsequent filters progressively degraded acuity: 0.44, 0.57, 0.93, 1.69 logMAR. Near optotype acuity was reduced in a similar pattern. Vernier acuity was minimally degraded by 1.0, 0.8, and 0.4 filters (18, 19, and 20 arcsec), followed by progressive degradation with subsequent filters (31, 35, 113, and 387 arcsec). Contrast sensitivity was minimally reduced with filters 1.0 through 0.2, and then precipitously degraded with 0.1 and <0.1 filters. Conclusion The 1.0, 0.8, and 0.4 filters cause similar, minimal degradation of distance and near optotype, and vernier acuity, whereas subsequent filters cause progressive degradation. Contrast sensitivity is not markedly reduced until the 0.1 filter. These results have important implications for using Bangerter filters therapeutically.

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“…Restoration of visual acuity by cataract extraction reveals the diplopia caused by the underlying macular abnormality. The most common causes of foveal displacement are epiretinal membranes and choroidal neovascular membranes [20].…”

Section: Cataract Extractionsmentioning

confidence: 99%