Abstract
Purpose: :
To determine if dense unilateral cataracts, present for more than 3 months, can cause acquired monofixation syndrome (AMS) despite cataract extraction with good results.
Methods: :
Charts were reviewed from 1994 to 2008 at the Leonard J. Chabert Medical Center and Ochsner Clinic Foundation in Louisiana to find patients with unilateral cataracts. Patients were placed into a dense cataract (DC) group (n=21) based on the presence of a unilateral cataract, present for at least 3 months, leading to visual acuity (Va) of less than 20/200. They were compared to a control group (n=17), in which a unilateral cataract was present, but allowed a Va of no worse than 20/200. The fellow eye had a Va of better than 20/30 in both groups. There was no history of amblyopia, strabismus, or macular pathology in either group. Both groups achieved a postoperative Va of better than 20/30 after cataract extraction. Stereoacuity was assessed using Titmus or Randot tests. A Worth-4-dot (W4D) test assessed central binocularity. Also, 13 DC patients were tested with a distance vectograph for confirmation of a central scotoma. Criteria for monofixation syndrome were met if stereoacuity was less than 60 seconds and W4D showed suppression at distance.
Results: :
In the DC group, 10 patients showed abnormal central macular testing and reduced stereoacuity. In the control group, no patients had both abnormal macular testing and reduced stereoacuity (p<.0001).
Conclusions: :
Dense unilateral cataracts, present for greater than three months, are associated with the development of AMS despite good visual acuity after cataract surgery. Patients with unilateral dense cataracts should be informed of the possibility of AMS after cataract surgery even after achieving a good Va. Dense unilateral cataracts should be removed promptly to prevent aquired monofixation syndrome.
Keywords: binocular vision/stereopsis • cataract • amblyopia