Purchase this article with an account.
Jonathan M Holmes, Sarah R Hatt, David A Leske, Raymond Iezzi; Binocular interference versus diplopia in patients with epiretinal membrane. Invest. Ophthalmol. Vis. Sci. 2020;61(7):1142.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Patients with epiretinal membrane (ERM) may have symptoms of monocular eye closure, commonly attributed to diplopia either of central-peripheral rivalry (CPR)-type (dragged-fovea diplopia) or co-existent strabismus. We report a phenomenon we term “binocular interference” in which patients shut one eye to improve the quality of their vision, in the absence of diplopia.
Patients with ERM referred to a strabismus service completed the Adult Strabismus (AS)-20 questionnaire and the Diplopia Questionnaire (DQ). We identified a cohort who responded “sometimes” or more to the AS-20 question, “I cover or close one eye to see things better.” We defined no diplopia as “never” diplopia in any gaze position on the DQ or during examination. Reviewing the medical record, we categorized cause of monocular eye closure as either: 1) binocular interference (monocular eye closure but no evidence of diplopia or strabismus), 2) CPR-type diplopia, 3) strabismus, or 4) other. Aniseikonia was assessed using the New Aniseikonia Test and metamorphopsia using M-charts. Clinical characteristics were compared between patients with binocular interference and 1) CPR-type diplopia, and 2) strabismus.
124 patients with ERM reported monocular eye closure “sometimes” or worse. For 36 (29%) the cause was binocular interference, 37 (30%) CPR-type diplopia, 38 (31%) strabismus, 6 (5%) combined CPR-type/strabismus, and 7 (6%) other. Patients with binocular interference had poorer worst-eye VA than those with CPR-type diplopia (median 20/63 vs 20/40, P=.01), less aniseikonia (median 5% vs 7.5%, P=.04), and similar metamorphopsia (median 0.7 vs 0.85, P=.64). When compared with strabismus, patients with binocular interference had similar worst-eye VA (median 20/63 vs 20/50, P=.93), aniseikonia (median 5% vs 6%, P=.43), and metamorphopsia (median 0.7 vs 0.8, P=.51).
Binocular interference, manifesting as monocular eye closure in the absence of diplopia or strabismus, is a distinct entity and is associated with ERM. Further work is needed on the potential role of ERM peeling to treat binocular interference.
This is a 2020 ARVO Annual Meeting abstract.
This PDF is available to Subscribers Only