Nonsurgical management of binocular diplopia induced by macular pathology

Arch Ophthalmol. 1999 Jul;117(7):900-3. doi: 10.1001/archopht.117.7.900.

Abstract

Objective: To treat binocular diplopia secondary to macular pathology.

Methods: Seven patients underwent evaluation and treatment. All had constant vertical diplopia caused by various maculopathies, including subretinal neovascularization, epiretinal membrane, and central serous retinopathy. Visual acuity ranged from 20/20 to 20/30 in the affected eye. All except 1 patient had a small-angle, comitant hyperdeviation with no muscle paresis. Sensory evaluation demonstrated peripheral fusion and reduced stereoacuity. Neither prism correction nor manipulation of the refractive errors corrected the diplopia. A partially occlusive foil (Bangerter) of density ranging from 0.4 to 1.0 was placed in front of the affected eye to restore stable, single vision.

Results: The Bangerter foil eliminated the diplopia in all patients. Two patients elected not to wear the foil; 1 patient was afraid of becoming dependent, and the other was bothered by the visual blur. Visual acuity in the affected eye was reduced on average by 3 lines. All patients maintained the same level of sensory fusion, with only 2 having reduced stereoacuity. Symptoms returned when the foil was removed or its density was reduced.

Conclusion: Low-density Bangerter foils provide an effective, inexpensive, and aesthetically acceptable management for refractory binocular diplopia induced by macular pathology, allowing peripheral fusion to be maintained.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Diplopia / etiology
  • Diplopia / therapy*
  • Eyeglasses
  • Female
  • Humans
  • Macula Lutea*
  • Male
  • Middle Aged
  • Retinal Diseases / complications*
  • Sensory Deprivation*
  • Treatment Outcome
  • Vision, Binocular*
  • Visual Acuity