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• W2000431055 abstract "Intolerably diplopic patients have been treated with a variety of options, including frosted spectacles or contact lenses1–3 and occlusive black intraocular lenses (IOLs),4–7 and now Osher et al.8 report their experience with intentional anisometropia as a viable therapeutic option. We have treated 3 similarly afflicted diplopic patients with an intentionally induced high hyperopic extreme anisometropic refractive error in the operated eye. The diplopia in our 3 cases (ages 32, 84, and 40) had disconjugate strabismus originating from a cavernous sinus injury associated with unilateral complete ophthalmoplegia, a postcerebrovascular accident skew deviation, and a posttraumatic cranial nerve palsy, respectively. Our first case had a mature cataract that alleviated the diplopia, but she yearned for better peripheral vision, lost as the cataract progressed. The second patient required a frosted glass spectacle lens that only partially alleviated the diplopia, despite a brunescent cataract. The third failed conservative therapy and remained untreated. Each patient had cataract removal with placement of a −5.0 diopter posterior chamber IOL in the capsular bag. Patient 1, the 32-year-old frozen globe, had a cerclage iris suture for traumatic mydriasis coincident with her cataract procedure. In each case, 20/20 visual acuity was achieved with an extreme hyperopic correction. The first 2 patients had full relief of their diplopia and were thrilled with the outcomes. The third patient continued to notice a diplopic shadow image despite a functionally aphakic hyperopic refraction, although it improved over the preoperative status. The elderly patient was particularly happy about the improved cosmesis without the frosted lens in her spectacles, highlighting that importance of body image does not uniformly decline with senescence. Twelve of Osher et al.'s8 patients had no diplopia and a much more modest anisometropia than what we planned and achieved, and they also enjoyed monovision while 1 of our 3 cases with high hyperopic anisometropia failed to achieve full complete diplopic suppression, making us ponder what degree of anisometropia is necessary to allow diplopic suppression in a given individual. Perhaps our 2 successes may have been with “overkill,” while the necessary degree of anisometropia to suppress our third case remains unknown. We also wonder whether patients such as our 3 cases with disconjugate strabismus may be more or less likely to have their diplopic symptoms relieved with smaller degrees of anisometropic difference. We query whether it may be possible in diplopic strabismus patients to create an anisometropic-suppression curve in similarly afflicted individuals using contact lens trials and invite other investigators with access to an adequately sized cohort to consider testing this so that we can maximally use the valuable tool that Osher et al.8 describe." @default.
• W2000431055 created "2016-06-24" @default.
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• W2000431055 date "2013-02-01" @default.
• W2000431055 modified "2023-09-25" @default.
• W2000431055 title "Intentional anisometropia for diplopic suppression" @default.
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• W2000431055 doi "https://doi.org/10.1016/j.jcrs.2012.12.015" @default.
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