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Dragged-Fovea Diplopia Syndrome

Dragged-Fovea Diplopia Syndrome. Purpose. To identify clinical characteristics To introduce a simple diagnostic test to aid evaluation of such patients To provide simple treatment option. The Dragged-Fovea Diplopia Syndrome, Clinical Characteristics, Diagnosis and Treatment,

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Dragged-Fovea Diplopia Syndrome

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  1. Dragged-Fovea Diplopia Syndrome

  2. Purpose • To identify clinical characteristics • To introduce a simple diagnostic test to aid evaluation of such patients • To provide simple treatment option The Dragged-Fovea Diplopia Syndrome, Clinical Characteristics, Diagnosis and Treatment, Guyton at al Ophthalmology 2005; 112: 1455-1462

  3. Design • Retrospective observational case series • 95 eyes in 83 consecutive patients seen between 1 Jan 1993 to 9 Aug 2004 (>11yrs)

  4. Methods • 222 records reviewed of patients seen at Krieger Children’s Eye Center • Ave age – 67yrs (range 30-86yrs) • (Children’s Eye Center???) • Diagnosis: • Maculopathy • Internal Limiting Membrane • Dragged fovea • Recruited: • Reported binocular diplopia • Not amenable to prism therapy and • Not acquired strabismus

  5. Outcome Measures • Metamorphopsia on Amsler • Or other clinical evidence of macular wrinkling • Response to prism trial • Response to lights on-off test • Response to partial occlusion with Scotch Satin tape (3M)

  6. Results • 95 eyes in 83 patient • 69 patients tested with lights on-off test – all positive • Demonstrates rapid central fusion with room lights off and • Recurrence of central diplopia with peripheral fusion with room lights on • 46 patients (n=64 tested) receptive to monocular occlusion with Scotch Satin tape

  7. Conclusions • Dragged-fovea diplopia syndrome consists of central diplopia in presence of peripheral fusion, secondary to dragging of fovea in one or both eyes by retinal disease • Competition between central and peripheral fusion • The central diplopia cannot be eliminated by prism therapy or eye muscle surgery • The lights on-off test “pathognomonic” for this syndrome • Patients benefit from monocular occlusion with Scotch Satin tape

  8. Lights on-off test • Small field fusion central fusion test • Universally positive in pts with demonstrable central vs peripheral fusion conflict • As evidenced by failure of prism to maintain initial central fusion • Easy to perform • Demonstrates nature of problem to patient cf to prism trial

  9. Response to Monocular Occlusion • Documented in 58/83 • Successful in 46 • 12 pts – • unable to tolerate, though diplopia eliminated

  10. Criticisms • 9/83 followed • Aniseikonia not measured formally • Due to • macular disease • Anisometropia • Cause-effect? Or authors postulate contributes to fusion instability

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