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D. S. Bardenstein; Quantitative Diplopometry Using a Simple Self-Registering Hand Held Diplopometer in the Management of Thyroid Eye Disease. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5252.
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To address the absence of a simple method for quantitative analysis of diplopia through the development of a simple device producing reproducible data in patients with Thyroid Eye Disease (TED)
A simple hand-held device was developed which allowed quantitation of diplopia with the subjects eyes under direct observation of the examiner. The device was designed to be self-registering allowing reproducible alignment. 40 patients with TED were studied. They were questioned regarding subjective sympotoms of diplopia. They then underwent estimation of diplopia using light reflex alignment method (Hirschberg), as well as estimation of diplopia using confrontational estimation of the angle of gaze from primary position along 8 axes (every 45 degrees) Results were recorded on a polar coordinate diagram. Subsequently, they were re-examined using the quantitative diplopometer(QD) and the results similarly recorded. The resulting diplopic fields were compared for each patient.
Several groups were identified. In patients with subjective diplopia, QD revealed diplopia closer to primary position than estimated angle. In some patients subjectively denying diplopia, QD demonstrated diplopia at large angles. In some who did not report diplopia using estimated angle method, diplopia was detected. Direct obsrvation of patient ocular alignment allowed for detection of patients with suppression who did not report diplopia even when the eyes were grossly misaligned. In all cases QD detected diplopia when it existed earlier than estimated methods. In addition, it was possible to quantitate in some patients the position of the onset of subjective muscle discomfort prior to or without actual diplopia.
A simple hand held Quantitative diplopometer, can provide useful data regarding subjective and objective extraocular muscle function, a critical part of the evaluation of TED patients.
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