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T. Fujikado, A. Kim, T. Kuroda, N. Maeda, T. Oshika, Y. Hirohara, T. Mihashi; Wavefront analysis of monocular triplopia in eyes of nuclear cataract . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1748.
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Purpose: Monocular triplopia is sometimes complained by patients with cataract. However, it has not been investigated about the mechanism, which causes monocular triplopia. We measured optical aberration of patients with cataract and with complaints of intolerable monocular triplopia using Hartman Shack aberrometer and investigated if higher–order aberrations are the cause of triplopia. Methods: From the consecutive patients with cataract at Osaka University Hospital from January to November in 2003, 8 eyes of 6 patients (age range 38 to 58 years; average 48.5 ± 7.2 years) who complained monocular triplopia were examined. Wavefront ocular and corneal aberrations for central 4mm diameter were measured using Hartmann–Shack (H–S) aberrometer equipped with a Placido ring (Topcon Wavefront Analyzer KR–9000PW) and the ocular and corneal higher–order aberration were calculated with Zernike polynomials up to 4th order. Results: All 8 eyes showed mild nuclear cataract with the refractive error ranged from –7.5 D to –19.0 D, average –10.5 ± 4.0 D. Except one eye with glaucoma, the visual acuity ranged from 20/40 to 20/15 (median, 20/25). Among the coefficient of Zernike polynomials, the trefoil aberration (C3–3, –0.141 ± 0.055 um RMS) and the spherical aberration (C40, –0.209 ± 0.086 um RMS) were significantly higher than those of age matched normal controls. Corneal higher–order aberrations were not different from those of normal controls. The simulated image of Landolt’s C showed triple configuration in all eyes. Conclusions: Monocular triplopia was observed in middle–aged patients with mild nuclear cataract and with high myopia. The wavefront analysis showed that the triple configuration was caused by the increase of trefoil and spherical aberration in the lens of nuclear cataract.
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