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J.M. Holmes, D.A. Leske; Diplopia Scoring Systems and Subjective Improvement After Surgery . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2483.
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The Cervical Range of Motion (CROM) diplopia exam and a Diplopia Questionnaire have recently been shown to be comparable to the previous standard of a diplopia field on a Goldmann perimeter, but have the advantage of not requiring expensive and cumbersome equipment. The scoring scheme developed for these new methods paralleled that developed for the Goldmann, with higher scoring weight for primary and downgaze. To investigating the appropriateness of this scoring system we compared post–operative changes in patient scores to an overall patient assessment of perceived improvement.
26 patients who underwent surgery for diplopia secondary to acquired paretic or restrictive strabismus had their diplopia assessed pre–operatively (median 1 day) and post–operatively (median 7 weeks) using the CROM diplopia exam and Diplopia Questionnaire. Scores were scaled from 0 to 100. Post–operatively, patients were asked to estimate their overall % perceived improvement from 0 to 100%, considering all activities of daily living. Comparisons were made using intraclass correlation coefficients (ICC).
Baseline CROM diplopia scores ranged from 12 to 100 (where 0 is no diplopia and 100 is diplopia in all positions) and baseline Diplopia Questionnaire scores ranged from 28 to 100. Percent improvement in each score was calculated and ranged from 0% to 92% for CROM diplopia score and 0 to 96% for Diplopia Questionnaire score (worsening was assigned a score of 0% improvement). Percent perceived improvement ranged from 0% to 100%. Overall there was good correlation between % perceived improvement and either improvement in CROM diplopia score (ICC= 0.49) or Questionnaire score (ICC= 0.55), but there were some notable exceptions. For patients with large discrepancies between % perceived improvement and CROM or Diplopia Questionnaire improvement, the most common causes appeared to be assigning insufficient weight to primary, down–gaze and reading scores.
Although there was excellent overall correlation between patient’s perceived improvement and their CROM diplopia score and Diplopia Questionnaire scores, there were individual cases with poor agreement. Further studies are needed to determine whether modification of scoring weights, would yield closer agreement. Despite this current limitation, the CROM diplopia exam and Diplopia Questionnaire are useful outcome measures in clinical studies of diplopia when comparing groups of patients.
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