Dragged-Fovea Diplopia Syndrome

Purpose To identify clinical characteristics To introduce a simple diagnostic test to aid evaluation of such patients To provide simple treatment option The Dragged-Fovea Diplopia Syndrome, Clinical Characteristics, Diagnosis and Treatment, Guyton at al Ophthalmology 2005; 112: 1455-1462

Design Retrospective observational case series 95 eyes in 83 consecutive patients seen between 1 Jan 1993 to 9 Aug 2004 (>11yrs)

Methods 222 records reviewed of patients seen at Krieger Children’s Eye Center Ave age – 67yrs (range 30-86yrs) (Children’s Eye Center???) Diagnosis: Maculopathy Internal Limiting Membrane Dragged fovea Recruited: Reported binocular diplopia Not amenable to prism therapy and Not acquired strabismus

Outcome Measures Metamorphopsia on Amsler Or other clinical evidence of macular wrinkling Response to prism trial Response to lights on-off test Response to partial occlusion with Scotch Satin tape (3M)

Results 95 eyes in 83 patient 69 patients tested with lights on-off test – all positive Demonstrates rapid central fusion with room lights off and Recurrence of central diplopia with peripheral fusion with room lights on 46 patients (n=64 tested) receptive to monocular occlusion with Scotch Satin tape

Conclusions Dragged-fovea diplopia syndrome consists of central diplopia in presence of peripheral fusion, secondary to dragging of fovea in one or both eyes by retinal disease Competition between central and peripheral fusion The central diplopia cannot be eliminated by prism therapy or eye muscle surgery The lights on-off test “pathognomonic” for this syndrome Patients benefit from monocular occlusion with Scotch Satin tape

Lights on-off test Small field fusion central fusion test Universally positive in pts with demonstrable central vs peripheral fusion conflict As evidenced by failure of prism to maintain initial central fusion Easy to perform Demonstrates nature of problem to patient cf to prism trial

Response to Monocular Occlusion Documented in 58/83 Successful in 46 12 pts – unable to tolerate, though diplopia eliminated

Criticisms 9/83 followed Aniseikonia not measured formally Due to macular disease Anisometropia Cause-effect? Or authors postulate contributes to fusion instability