Dragged-Fovea Diplopia Syndrome

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Dragged-Fovea Diplopia Syndrome
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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
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Design

• Retrospective observational case series
• 95 eyes in 83 consecutive patients seen between 1
  Jan 1993 to 9 Aug 2004 (gt11yrs)

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Methods

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

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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)

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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 (n64 tested) receptive to monocular
  occlusion with Scotch Satin tape

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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

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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

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Response to Monocular Occlusion

• Documented in 58/83
• Successful in 46
• 12 pts
• unable to tolerate, though diplopia eliminated

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Criticisms

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