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Extreme monovision may reduce pre-existing diplopia after cataract surgery
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Extreme anisometropic pseudophakic monovision may be a viable alternative to spectacles or strabismus surgery after cataract surgery in patients with persistent diplopia, a study found.
The case series included patients older than 62 years who had pre-existing diplopia secondary to stable ocular misalignment.
Patients underwent bilateral micro-coaxial phacoemulsification and implantation of a single-piece monofocal acrylic IOL.
Two treatment options were presented to study participants. The first option was to target emmetropia in each eye, with likely long-term use of spectacles with prisms. The second option was to target plano in one eye and induce significant myopia in the fellow eye to eliminate spectacles and double vision.
Twelve patients chose the extreme myopia approach.
Investigators assessed visual acuity, biomicroscopy and IOP 1 day and 1 month after surgery.
In nine patients, a myopia defocus of at least 3 D was achieved and diplopia was eliminated. In three patients, a myopic defocus between –2 D and –3 D was achieved and diplopia symptoms were significantly reduced but occasionally present.
All patients had excellent uncorrected distance and near visual acuity, and all patients reported high levels of satisfaction with visual outcomes.
Further study is warranted to confirm that patients with symptomatic diplopia from longstanding acquired strabismus and bilateral cataract benefit from an extreme monovision approach, the authors said.
Perspective
Back to TopJohn A. Hovanesian, MD, FACS
I love the idea described by the international group of esteemed authors of this paper. They suggest that patients undergoing cataract surgery with preoperative diplopia can reduce diplopia symptoms and achieve spectacle independence by targeting emmetropia in one (not necessarily the dominant) eye and –3 D to –3.5 D in the other. This combination, they suggest, reduces visual rivalry while allowing uncorrected distance and (very) near vision. It is an approach that I am honestly a little afraid to try on my own patients for fear they would resent me not only for their diplopia, which I did not cause, but also for their anisometropia, which I did. As odd as it seems, it makes perfect sense that adding anisometropia to a pre-existing heterotropia would reduce stereopsis and therefore diplopia symptoms in carefully selected patients.
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