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Jonathan M. Holmes - One of the best experts on this subject based on the ideXlab platform.
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test retest reliability of the revised Diplopia questionnaire
Journal of Aapos, 2019Co-Authors: Sasha A Mansukhani, Sarah R. Hatt, David A. Leske, Jonathan M. HolmesAbstract:Purpose To evaluate misclassification of Diplopia “success” when using a standardized Diplopia questionnaire (DQ), and to report test-retest reliability of the DQ. Methods We retrospectively identified a cohort of 100 patients with stable strabismus ( Results When defining success as rarely or never diplopic for distance, misclassification occurred in 12 (12%) of 100 (95% CI, 6%-20%). When defining success as rarely or never diplopic for distance and reading, misclassification occurred in 14 (14%) of 100 (95% CI, 8%-22%). The 95% LOA for the DQ score were 35.2 points, and ICC was 0.85 (95% CI, 0.79-0.90). Conclusions We have quantified misclassification and test-retest variability when using the DQ dichotomously or as a continuous measure, equipping the clinician to better interpret DQ outcome data in practice and research.
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Diplopia after strabismus surgery for adults with nondiplopic childhood onset strabismus
Journal of Aapos, 2019Co-Authors: Jenny Y Wang, Sarah R. Hatt, David A. Leske, Jonathan M. HolmesAbstract:Purpose To describe frequency of postoperative Diplopia after strabismus surgery in nondiplopic adults with childhood-onset strabismus and to report health-related quality-of-life (HRQOL) outcomes. Methods We prospectively enrolled 79 adults with no Diplopia in any gaze who had childhood-onset strabismus and were scheduled for strabismus surgery. Diplopia was assessed preoperatively and at 6 weeks and 1 year postoperatively using a standardized Diplopia questionnaire with 5 response options in 7 gaze positions. HRQOL was assessed using the Adult Strabismus-20 (AS-20) questionnaire, with self-perception, interactions, reading function, and general function domains. Results Constant Diplopia in straight-ahead distance and reading gaze occurred in 1 patient (1% [95% CI, 0%-7%] at 6 weeks and 2% [95% CI, 0%-10%] at 1 year). Regarding the rate of any Diplopia (including rarely) in any gaze, 15 of 78 patients (19%) reported Diplopia at 6 weeks, of whom 13 had Diplopia in straight-ahead distance gaze; 8 (10%), in reading gaze. At 1 year, 8 of 51 patients (16%) reported any Diplopia (including rarely) in any gaze, of whom 7 had Diplopia in straight-ahead distance gaze and 4 (8%) in reading gaze. Mean AS-20 scores improved at 1 year overall (by 32, 19, 14, and 15 points, resp., per domain) and for the 8 diplopic patients (by 21, 13, 16, and 11 points). Conclusions In adults with nondiplopic strabismus, constant postoperative Diplopia is rare, although the rate of intermittent Diplopia is higher. Even when postoperative Diplopia occurs, HRQOL often improves.
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Treatment for Central-Peripheral Rivalry-Type Diplopia ("Dragged-Fovea Diplopia Syndrome").
American journal of ophthalmology, 2019Co-Authors: Sarah R. Hatt, David A. Leske, Raymond Iezzi, Lindsay D. Klaehn, Andrea M. Kramer, Jonathan M. HolmesAbstract:Purpose To report the effectiveness of treatments for central-peripheral rivalry (CPR)-type Diplopia due to retinal misregistration. Design Retrospective, interventional case series. Methods Fifty adults with retinal misregistration and CPR-type Diplopia (minimum frequency of “sometimes” at distance and/or for reading) caused by epiretinal membrane (n = 44) or other retinal disorders (n = 6) were enrolled in this study, conducted at adult strabismus clinics, Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, a tertiary medical center. Treatments included Bangerter filter, adhesive tape, Fresnel prism, clear prism (incorporated into glasses or loose prism in the office), iseikonic manipulation (using iseikonic lenses or contact lenses), a MIN lens, or epiretinal membrane (ERM) peeling (alone or in any combination). Not all patients underwent all of these treatments. Results Main outcome measurements were Diplopia frequency, evaluated using the Diplopia Questionnaire. Success was defined as “never” or “rarely” diplopic for distance and reading, using the Diplopia Questionnaire, at an outcome examination as close as possible to 6 months. Overall, 17 of 50 patients (34%; 95% confidence interval [CI], 21%-49%) were classified as successful. Fresnel prism was successful in 4 of 7 patients (57%; 95% CI, 18%-90%); Bangerter filter in 4 of 28 patients (14%; 95% CI, 4%-33%); ERM peeling in 8 of 18 patients (44%; 95% CI, 22%-69%); and iseikonic manipulation in 1 of 23 patients (using a contact lens; 4%; 95% CI, 0%-22%). Conclusions CPR-type Diplopia may be relieved in some patients using nonsurgical treatment options consisting of Fresnel prism or Bangerter filter. ERM peeling was surprisingly successful and should be considered.
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new onset vs resolution of central peripheral rivalry type Diplopia in patients undergoing epiretinal membrane peeling
JAMA Ophthalmology, 2019Co-Authors: Sarah R. Hatt, David A. Leske, Raymond Iezzi, Jonathan M. HolmesAbstract:Importance The peeling of an epiretinal membrane (ERM) is commonly performed for poor visual acuity and/or metamorphopsia, but to our knowledge, its influence on central-peripheral rivalry (CPR)–type Diplopia has not been rigorously studied. Objective To evaluate the occurrence of either resolution or new-onset CPR-type Diplopia in patients undergoing ERM peeling. Design, Setting, and Participants This prospective cohort study was conducted from July 2014 to April 2018 at a tertiary referral medical center and included 33 adults with ERM who were undergoing peeling surgery with planned preoperative to postoperative analysis. Interventions A standardized Diplopia questionnaire completed before undergoing and 6 months following ERM peeling. Main Outcomes and Measures For patients with CPR-type Diplopia before ERM peeling (rated “sometimes” or more for distance straight ahead or reading using the Diplopia questionnaire), we calculated the proportion with resolution of Diplopia postpeel (“never” for distance straight ahead and reading on the Diplopia questionnaire) and compared clinical characteristics between those with resolution and those without. For patients with no Diplopia prepeeling (“never” for distance straight ahead and reading on the Diplopia questionnaire), we calculated the proportion with new-onset CPR-type Diplopia postoperatively and compared clinical characteristics between those with new-onset Diplopia and those who remained without Diplopia. Results Of 33 patients (median age, 67 years [range, 51-87 years]; 18 men [55%]), 12 (36%) had CPR-type Diplopia preoperatively and 21 (64%) did not have Diplopia preoperatively. Six months postoperatively, 4 of 12 patients with Diplopia (33%; 95% CI, 10%-65%) had resolution of Diplopia, and 4 of 21 patients without Diplopia (19%; 95% CI, 5%-42%) had new-onset Diplopia. Better postoperative operated-eye visual acuity appeared somewhat associated with new-onset Diplopia postoperatively (mean [SD] visual acuity, 0.08 [0.10] logMAR; approximately 20/25 vs 0.34 [0.33] logMAR; approximately 20/40; difference, −0.27; 95% CI, −0.62 to 0.09;P = .07), as did greater postoperative aniseikonia (14% [5%] vs 6% [4%]; difference, 8%; 95% CI, 2%-13%;P = .04). Conclusions and Relevance These data suggest that epiretinal membrane peeling may result in resolution of Diplopia in some patients but new-onset Diplopia in others. These findings may be valuable when counseling patients regarding the risks of new-onset Diplopia.
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prevalence and associations of central peripheral rivalry type Diplopia in patients with epiretinal membrane
JAMA Ophthalmology, 2017Co-Authors: Kevin K. Veverka, Sarah R. Hatt, David A. Leske, William L. Brown, Raymond Iezzi, Andrew J Barkmeier, Jonathan M. HolmesAbstract:Importance The prevalence and clinical associations of patients with epiretinal membrane (ERM) who develop central-peripheral rivalry (CPR)–type Diplopia are unknown. Objectives To determine the prevalence of CPR-type Diplopia in retinal disease clinic patients with ERM and to determine clinical findings associated with CPR-type Diplopia. Design, Setting and Participants A prospective cross-sectional study of 31 patients with ERM from retinal disease clinics to determine the prevalence of CPR-type Diplopia. A retrospective case cohort of 25 additional patients with ERM, selected from adult strabismus clinics, was added (total = 56) to determine clinical associations with CPR-type Diplopia. All data were collected between June 2014 and November 2016; prospective cohort data were collected from June 2016 to November 2016. Main Outcomes and Measures The presence of Diplopia was determined by patient history and Diplopia questionnaire responses. Visual acuity and ocular alignment were recorded. Metamorphopsia was documented qualitatively by evaluation of the door frame and Amsler grid and measured quantitatively using M-charts and D-charts. Aniseikonia was determined by subjective description and results of the Awaya new aniseikonia test. Retinal misregistration testing consisted of optotype-frame test and synoptophore; CPR-type Diplopia was defined as Diplopia associated with evidence of retinal misregistration when other causes did not fully explain Diplopia. Outcomes were as follows: prevalence of CPR-type Diplopia in patients with ERM seen in retinal disease clinics, and whether or not clinical findings differed between patients with ERM and CPR-type Diplopia vs patients with ERM without CPR-type Diplopia. Results Of the 31 patients with ERM seen in retinal disease clinics, 16 were women and 15 were men; the mean (SD) age was 69 (10) years. The prevalence of any Diplopia was 23% (7 of 31; 95% CI, 10% to 41%), with CPR-type Diplopia present in 16% (5 of 31; 95% CI, 5% to 34%). For analysis of associations, 12 of 56 patients (21%) had CPR-type Diplopia and 37 (66%) had no Diplopia. Seven of the 56 patients were excluded for other types of Diplopia. Patients with CPR-type Diplopia had better worse-eye visual acuity (mean difference, −0.23; 95% CI, −0.37 to −0.09 logMAR,P = .003), and more severe quantitative metamorphopsia (mean M-score difference 0.6; 95% CI, 0.05 to 1.1,P = .01) than patients without Diplopia, but similar aniseikonia (Awaya new aniseikonia test; mean difference 0.6%; 95% CI, −2.9% to 4.0%,P = .33) and similar evidence of retinal misregistration (100% vs 73%;P = .09) by any test. Conclusions and Relevance Our findings suggest that CPR-type Diplopia is not uncommon in patients with ERM. On average, patients with CPR-type Diplopia have better visual acuity and more metamorphopsia than those without CPR-type Diplopia, but there is considerable individual variability. Aniseikonia and retinal misregistration are similar between patients with ERM associated with CPR-type Diplopia and those without CPR-type Diplopia. Retinal misregistration with coexistent metamorphopsia appears necessary but is not sufficient for CPR-type Diplopia.
Sarah R. Hatt - One of the best experts on this subject based on the ideXlab platform.
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test retest reliability of the revised Diplopia questionnaire
Journal of Aapos, 2019Co-Authors: Sasha A Mansukhani, Sarah R. Hatt, David A. Leske, Jonathan M. HolmesAbstract:Purpose To evaluate misclassification of Diplopia “success” when using a standardized Diplopia questionnaire (DQ), and to report test-retest reliability of the DQ. Methods We retrospectively identified a cohort of 100 patients with stable strabismus ( Results When defining success as rarely or never diplopic for distance, misclassification occurred in 12 (12%) of 100 (95% CI, 6%-20%). When defining success as rarely or never diplopic for distance and reading, misclassification occurred in 14 (14%) of 100 (95% CI, 8%-22%). The 95% LOA for the DQ score were 35.2 points, and ICC was 0.85 (95% CI, 0.79-0.90). Conclusions We have quantified misclassification and test-retest variability when using the DQ dichotomously or as a continuous measure, equipping the clinician to better interpret DQ outcome data in practice and research.
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Diplopia after strabismus surgery for adults with nondiplopic childhood onset strabismus
Journal of Aapos, 2019Co-Authors: Jenny Y Wang, Sarah R. Hatt, David A. Leske, Jonathan M. HolmesAbstract:Purpose To describe frequency of postoperative Diplopia after strabismus surgery in nondiplopic adults with childhood-onset strabismus and to report health-related quality-of-life (HRQOL) outcomes. Methods We prospectively enrolled 79 adults with no Diplopia in any gaze who had childhood-onset strabismus and were scheduled for strabismus surgery. Diplopia was assessed preoperatively and at 6 weeks and 1 year postoperatively using a standardized Diplopia questionnaire with 5 response options in 7 gaze positions. HRQOL was assessed using the Adult Strabismus-20 (AS-20) questionnaire, with self-perception, interactions, reading function, and general function domains. Results Constant Diplopia in straight-ahead distance and reading gaze occurred in 1 patient (1% [95% CI, 0%-7%] at 6 weeks and 2% [95% CI, 0%-10%] at 1 year). Regarding the rate of any Diplopia (including rarely) in any gaze, 15 of 78 patients (19%) reported Diplopia at 6 weeks, of whom 13 had Diplopia in straight-ahead distance gaze; 8 (10%), in reading gaze. At 1 year, 8 of 51 patients (16%) reported any Diplopia (including rarely) in any gaze, of whom 7 had Diplopia in straight-ahead distance gaze and 4 (8%) in reading gaze. Mean AS-20 scores improved at 1 year overall (by 32, 19, 14, and 15 points, resp., per domain) and for the 8 diplopic patients (by 21, 13, 16, and 11 points). Conclusions In adults with nondiplopic strabismus, constant postoperative Diplopia is rare, although the rate of intermittent Diplopia is higher. Even when postoperative Diplopia occurs, HRQOL often improves.
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Treatment for Central-Peripheral Rivalry-Type Diplopia ("Dragged-Fovea Diplopia Syndrome").
American journal of ophthalmology, 2019Co-Authors: Sarah R. Hatt, David A. Leske, Raymond Iezzi, Lindsay D. Klaehn, Andrea M. Kramer, Jonathan M. HolmesAbstract:Purpose To report the effectiveness of treatments for central-peripheral rivalry (CPR)-type Diplopia due to retinal misregistration. Design Retrospective, interventional case series. Methods Fifty adults with retinal misregistration and CPR-type Diplopia (minimum frequency of “sometimes” at distance and/or for reading) caused by epiretinal membrane (n = 44) or other retinal disorders (n = 6) were enrolled in this study, conducted at adult strabismus clinics, Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, a tertiary medical center. Treatments included Bangerter filter, adhesive tape, Fresnel prism, clear prism (incorporated into glasses or loose prism in the office), iseikonic manipulation (using iseikonic lenses or contact lenses), a MIN lens, or epiretinal membrane (ERM) peeling (alone or in any combination). Not all patients underwent all of these treatments. Results Main outcome measurements were Diplopia frequency, evaluated using the Diplopia Questionnaire. Success was defined as “never” or “rarely” diplopic for distance and reading, using the Diplopia Questionnaire, at an outcome examination as close as possible to 6 months. Overall, 17 of 50 patients (34%; 95% confidence interval [CI], 21%-49%) were classified as successful. Fresnel prism was successful in 4 of 7 patients (57%; 95% CI, 18%-90%); Bangerter filter in 4 of 28 patients (14%; 95% CI, 4%-33%); ERM peeling in 8 of 18 patients (44%; 95% CI, 22%-69%); and iseikonic manipulation in 1 of 23 patients (using a contact lens; 4%; 95% CI, 0%-22%). Conclusions CPR-type Diplopia may be relieved in some patients using nonsurgical treatment options consisting of Fresnel prism or Bangerter filter. ERM peeling was surprisingly successful and should be considered.
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new onset vs resolution of central peripheral rivalry type Diplopia in patients undergoing epiretinal membrane peeling
JAMA Ophthalmology, 2019Co-Authors: Sarah R. Hatt, David A. Leske, Raymond Iezzi, Jonathan M. HolmesAbstract:Importance The peeling of an epiretinal membrane (ERM) is commonly performed for poor visual acuity and/or metamorphopsia, but to our knowledge, its influence on central-peripheral rivalry (CPR)–type Diplopia has not been rigorously studied. Objective To evaluate the occurrence of either resolution or new-onset CPR-type Diplopia in patients undergoing ERM peeling. Design, Setting, and Participants This prospective cohort study was conducted from July 2014 to April 2018 at a tertiary referral medical center and included 33 adults with ERM who were undergoing peeling surgery with planned preoperative to postoperative analysis. Interventions A standardized Diplopia questionnaire completed before undergoing and 6 months following ERM peeling. Main Outcomes and Measures For patients with CPR-type Diplopia before ERM peeling (rated “sometimes” or more for distance straight ahead or reading using the Diplopia questionnaire), we calculated the proportion with resolution of Diplopia postpeel (“never” for distance straight ahead and reading on the Diplopia questionnaire) and compared clinical characteristics between those with resolution and those without. For patients with no Diplopia prepeeling (“never” for distance straight ahead and reading on the Diplopia questionnaire), we calculated the proportion with new-onset CPR-type Diplopia postoperatively and compared clinical characteristics between those with new-onset Diplopia and those who remained without Diplopia. Results Of 33 patients (median age, 67 years [range, 51-87 years]; 18 men [55%]), 12 (36%) had CPR-type Diplopia preoperatively and 21 (64%) did not have Diplopia preoperatively. Six months postoperatively, 4 of 12 patients with Diplopia (33%; 95% CI, 10%-65%) had resolution of Diplopia, and 4 of 21 patients without Diplopia (19%; 95% CI, 5%-42%) had new-onset Diplopia. Better postoperative operated-eye visual acuity appeared somewhat associated with new-onset Diplopia postoperatively (mean [SD] visual acuity, 0.08 [0.10] logMAR; approximately 20/25 vs 0.34 [0.33] logMAR; approximately 20/40; difference, −0.27; 95% CI, −0.62 to 0.09;P = .07), as did greater postoperative aniseikonia (14% [5%] vs 6% [4%]; difference, 8%; 95% CI, 2%-13%;P = .04). Conclusions and Relevance These data suggest that epiretinal membrane peeling may result in resolution of Diplopia in some patients but new-onset Diplopia in others. These findings may be valuable when counseling patients regarding the risks of new-onset Diplopia.
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prevalence and associations of central peripheral rivalry type Diplopia in patients with epiretinal membrane
JAMA Ophthalmology, 2017Co-Authors: Kevin K. Veverka, Sarah R. Hatt, David A. Leske, William L. Brown, Raymond Iezzi, Andrew J Barkmeier, Jonathan M. HolmesAbstract:Importance The prevalence and clinical associations of patients with epiretinal membrane (ERM) who develop central-peripheral rivalry (CPR)–type Diplopia are unknown. Objectives To determine the prevalence of CPR-type Diplopia in retinal disease clinic patients with ERM and to determine clinical findings associated with CPR-type Diplopia. Design, Setting and Participants A prospective cross-sectional study of 31 patients with ERM from retinal disease clinics to determine the prevalence of CPR-type Diplopia. A retrospective case cohort of 25 additional patients with ERM, selected from adult strabismus clinics, was added (total = 56) to determine clinical associations with CPR-type Diplopia. All data were collected between June 2014 and November 2016; prospective cohort data were collected from June 2016 to November 2016. Main Outcomes and Measures The presence of Diplopia was determined by patient history and Diplopia questionnaire responses. Visual acuity and ocular alignment were recorded. Metamorphopsia was documented qualitatively by evaluation of the door frame and Amsler grid and measured quantitatively using M-charts and D-charts. Aniseikonia was determined by subjective description and results of the Awaya new aniseikonia test. Retinal misregistration testing consisted of optotype-frame test and synoptophore; CPR-type Diplopia was defined as Diplopia associated with evidence of retinal misregistration when other causes did not fully explain Diplopia. Outcomes were as follows: prevalence of CPR-type Diplopia in patients with ERM seen in retinal disease clinics, and whether or not clinical findings differed between patients with ERM and CPR-type Diplopia vs patients with ERM without CPR-type Diplopia. Results Of the 31 patients with ERM seen in retinal disease clinics, 16 were women and 15 were men; the mean (SD) age was 69 (10) years. The prevalence of any Diplopia was 23% (7 of 31; 95% CI, 10% to 41%), with CPR-type Diplopia present in 16% (5 of 31; 95% CI, 5% to 34%). For analysis of associations, 12 of 56 patients (21%) had CPR-type Diplopia and 37 (66%) had no Diplopia. Seven of the 56 patients were excluded for other types of Diplopia. Patients with CPR-type Diplopia had better worse-eye visual acuity (mean difference, −0.23; 95% CI, −0.37 to −0.09 logMAR,P = .003), and more severe quantitative metamorphopsia (mean M-score difference 0.6; 95% CI, 0.05 to 1.1,P = .01) than patients without Diplopia, but similar aniseikonia (Awaya new aniseikonia test; mean difference 0.6%; 95% CI, −2.9% to 4.0%,P = .33) and similar evidence of retinal misregistration (100% vs 73%;P = .09) by any test. Conclusions and Relevance Our findings suggest that CPR-type Diplopia is not uncommon in patients with ERM. On average, patients with CPR-type Diplopia have better visual acuity and more metamorphopsia than those without CPR-type Diplopia, but there is considerable individual variability. Aniseikonia and retinal misregistration are similar between patients with ERM associated with CPR-type Diplopia and those without CPR-type Diplopia. Retinal misregistration with coexistent metamorphopsia appears necessary but is not sufficient for CPR-type Diplopia.
David A. Leske - One of the best experts on this subject based on the ideXlab platform.
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test retest reliability of the revised Diplopia questionnaire
Journal of Aapos, 2019Co-Authors: Sasha A Mansukhani, Sarah R. Hatt, David A. Leske, Jonathan M. HolmesAbstract:Purpose To evaluate misclassification of Diplopia “success” when using a standardized Diplopia questionnaire (DQ), and to report test-retest reliability of the DQ. Methods We retrospectively identified a cohort of 100 patients with stable strabismus ( Results When defining success as rarely or never diplopic for distance, misclassification occurred in 12 (12%) of 100 (95% CI, 6%-20%). When defining success as rarely or never diplopic for distance and reading, misclassification occurred in 14 (14%) of 100 (95% CI, 8%-22%). The 95% LOA for the DQ score were 35.2 points, and ICC was 0.85 (95% CI, 0.79-0.90). Conclusions We have quantified misclassification and test-retest variability when using the DQ dichotomously or as a continuous measure, equipping the clinician to better interpret DQ outcome data in practice and research.
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Diplopia after strabismus surgery for adults with nondiplopic childhood onset strabismus
Journal of Aapos, 2019Co-Authors: Jenny Y Wang, Sarah R. Hatt, David A. Leske, Jonathan M. HolmesAbstract:Purpose To describe frequency of postoperative Diplopia after strabismus surgery in nondiplopic adults with childhood-onset strabismus and to report health-related quality-of-life (HRQOL) outcomes. Methods We prospectively enrolled 79 adults with no Diplopia in any gaze who had childhood-onset strabismus and were scheduled for strabismus surgery. Diplopia was assessed preoperatively and at 6 weeks and 1 year postoperatively using a standardized Diplopia questionnaire with 5 response options in 7 gaze positions. HRQOL was assessed using the Adult Strabismus-20 (AS-20) questionnaire, with self-perception, interactions, reading function, and general function domains. Results Constant Diplopia in straight-ahead distance and reading gaze occurred in 1 patient (1% [95% CI, 0%-7%] at 6 weeks and 2% [95% CI, 0%-10%] at 1 year). Regarding the rate of any Diplopia (including rarely) in any gaze, 15 of 78 patients (19%) reported Diplopia at 6 weeks, of whom 13 had Diplopia in straight-ahead distance gaze; 8 (10%), in reading gaze. At 1 year, 8 of 51 patients (16%) reported any Diplopia (including rarely) in any gaze, of whom 7 had Diplopia in straight-ahead distance gaze and 4 (8%) in reading gaze. Mean AS-20 scores improved at 1 year overall (by 32, 19, 14, and 15 points, resp., per domain) and for the 8 diplopic patients (by 21, 13, 16, and 11 points). Conclusions In adults with nondiplopic strabismus, constant postoperative Diplopia is rare, although the rate of intermittent Diplopia is higher. Even when postoperative Diplopia occurs, HRQOL often improves.
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Treatment for Central-Peripheral Rivalry-Type Diplopia ("Dragged-Fovea Diplopia Syndrome").
American journal of ophthalmology, 2019Co-Authors: Sarah R. Hatt, David A. Leske, Raymond Iezzi, Lindsay D. Klaehn, Andrea M. Kramer, Jonathan M. HolmesAbstract:Purpose To report the effectiveness of treatments for central-peripheral rivalry (CPR)-type Diplopia due to retinal misregistration. Design Retrospective, interventional case series. Methods Fifty adults with retinal misregistration and CPR-type Diplopia (minimum frequency of “sometimes” at distance and/or for reading) caused by epiretinal membrane (n = 44) or other retinal disorders (n = 6) were enrolled in this study, conducted at adult strabismus clinics, Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, a tertiary medical center. Treatments included Bangerter filter, adhesive tape, Fresnel prism, clear prism (incorporated into glasses or loose prism in the office), iseikonic manipulation (using iseikonic lenses or contact lenses), a MIN lens, or epiretinal membrane (ERM) peeling (alone or in any combination). Not all patients underwent all of these treatments. Results Main outcome measurements were Diplopia frequency, evaluated using the Diplopia Questionnaire. Success was defined as “never” or “rarely” diplopic for distance and reading, using the Diplopia Questionnaire, at an outcome examination as close as possible to 6 months. Overall, 17 of 50 patients (34%; 95% confidence interval [CI], 21%-49%) were classified as successful. Fresnel prism was successful in 4 of 7 patients (57%; 95% CI, 18%-90%); Bangerter filter in 4 of 28 patients (14%; 95% CI, 4%-33%); ERM peeling in 8 of 18 patients (44%; 95% CI, 22%-69%); and iseikonic manipulation in 1 of 23 patients (using a contact lens; 4%; 95% CI, 0%-22%). Conclusions CPR-type Diplopia may be relieved in some patients using nonsurgical treatment options consisting of Fresnel prism or Bangerter filter. ERM peeling was surprisingly successful and should be considered.
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new onset vs resolution of central peripheral rivalry type Diplopia in patients undergoing epiretinal membrane peeling
JAMA Ophthalmology, 2019Co-Authors: Sarah R. Hatt, David A. Leske, Raymond Iezzi, Jonathan M. HolmesAbstract:Importance The peeling of an epiretinal membrane (ERM) is commonly performed for poor visual acuity and/or metamorphopsia, but to our knowledge, its influence on central-peripheral rivalry (CPR)–type Diplopia has not been rigorously studied. Objective To evaluate the occurrence of either resolution or new-onset CPR-type Diplopia in patients undergoing ERM peeling. Design, Setting, and Participants This prospective cohort study was conducted from July 2014 to April 2018 at a tertiary referral medical center and included 33 adults with ERM who were undergoing peeling surgery with planned preoperative to postoperative analysis. Interventions A standardized Diplopia questionnaire completed before undergoing and 6 months following ERM peeling. Main Outcomes and Measures For patients with CPR-type Diplopia before ERM peeling (rated “sometimes” or more for distance straight ahead or reading using the Diplopia questionnaire), we calculated the proportion with resolution of Diplopia postpeel (“never” for distance straight ahead and reading on the Diplopia questionnaire) and compared clinical characteristics between those with resolution and those without. For patients with no Diplopia prepeeling (“never” for distance straight ahead and reading on the Diplopia questionnaire), we calculated the proportion with new-onset CPR-type Diplopia postoperatively and compared clinical characteristics between those with new-onset Diplopia and those who remained without Diplopia. Results Of 33 patients (median age, 67 years [range, 51-87 years]; 18 men [55%]), 12 (36%) had CPR-type Diplopia preoperatively and 21 (64%) did not have Diplopia preoperatively. Six months postoperatively, 4 of 12 patients with Diplopia (33%; 95% CI, 10%-65%) had resolution of Diplopia, and 4 of 21 patients without Diplopia (19%; 95% CI, 5%-42%) had new-onset Diplopia. Better postoperative operated-eye visual acuity appeared somewhat associated with new-onset Diplopia postoperatively (mean [SD] visual acuity, 0.08 [0.10] logMAR; approximately 20/25 vs 0.34 [0.33] logMAR; approximately 20/40; difference, −0.27; 95% CI, −0.62 to 0.09;P = .07), as did greater postoperative aniseikonia (14% [5%] vs 6% [4%]; difference, 8%; 95% CI, 2%-13%;P = .04). Conclusions and Relevance These data suggest that epiretinal membrane peeling may result in resolution of Diplopia in some patients but new-onset Diplopia in others. These findings may be valuable when counseling patients regarding the risks of new-onset Diplopia.
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prevalence and associations of central peripheral rivalry type Diplopia in patients with epiretinal membrane
JAMA Ophthalmology, 2017Co-Authors: Kevin K. Veverka, Sarah R. Hatt, David A. Leske, William L. Brown, Raymond Iezzi, Andrew J Barkmeier, Jonathan M. HolmesAbstract:Importance The prevalence and clinical associations of patients with epiretinal membrane (ERM) who develop central-peripheral rivalry (CPR)–type Diplopia are unknown. Objectives To determine the prevalence of CPR-type Diplopia in retinal disease clinic patients with ERM and to determine clinical findings associated with CPR-type Diplopia. Design, Setting and Participants A prospective cross-sectional study of 31 patients with ERM from retinal disease clinics to determine the prevalence of CPR-type Diplopia. A retrospective case cohort of 25 additional patients with ERM, selected from adult strabismus clinics, was added (total = 56) to determine clinical associations with CPR-type Diplopia. All data were collected between June 2014 and November 2016; prospective cohort data were collected from June 2016 to November 2016. Main Outcomes and Measures The presence of Diplopia was determined by patient history and Diplopia questionnaire responses. Visual acuity and ocular alignment were recorded. Metamorphopsia was documented qualitatively by evaluation of the door frame and Amsler grid and measured quantitatively using M-charts and D-charts. Aniseikonia was determined by subjective description and results of the Awaya new aniseikonia test. Retinal misregistration testing consisted of optotype-frame test and synoptophore; CPR-type Diplopia was defined as Diplopia associated with evidence of retinal misregistration when other causes did not fully explain Diplopia. Outcomes were as follows: prevalence of CPR-type Diplopia in patients with ERM seen in retinal disease clinics, and whether or not clinical findings differed between patients with ERM and CPR-type Diplopia vs patients with ERM without CPR-type Diplopia. Results Of the 31 patients with ERM seen in retinal disease clinics, 16 were women and 15 were men; the mean (SD) age was 69 (10) years. The prevalence of any Diplopia was 23% (7 of 31; 95% CI, 10% to 41%), with CPR-type Diplopia present in 16% (5 of 31; 95% CI, 5% to 34%). For analysis of associations, 12 of 56 patients (21%) had CPR-type Diplopia and 37 (66%) had no Diplopia. Seven of the 56 patients were excluded for other types of Diplopia. Patients with CPR-type Diplopia had better worse-eye visual acuity (mean difference, −0.23; 95% CI, −0.37 to −0.09 logMAR,P = .003), and more severe quantitative metamorphopsia (mean M-score difference 0.6; 95% CI, 0.05 to 1.1,P = .01) than patients without Diplopia, but similar aniseikonia (Awaya new aniseikonia test; mean difference 0.6%; 95% CI, −2.9% to 4.0%,P = .33) and similar evidence of retinal misregistration (100% vs 73%;P = .09) by any test. Conclusions and Relevance Our findings suggest that CPR-type Diplopia is not uncommon in patients with ERM. On average, patients with CPR-type Diplopia have better visual acuity and more metamorphopsia than those without CPR-type Diplopia, but there is considerable individual variability. Aniseikonia and retinal misregistration are similar between patients with ERM associated with CPR-type Diplopia and those without CPR-type Diplopia. Retinal misregistration with coexistent metamorphopsia appears necessary but is not sufficient for CPR-type Diplopia.
Raymond Iezzi - One of the best experts on this subject based on the ideXlab platform.
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Treatment for Central-Peripheral Rivalry-Type Diplopia ("Dragged-Fovea Diplopia Syndrome").
American journal of ophthalmology, 2019Co-Authors: Sarah R. Hatt, David A. Leske, Raymond Iezzi, Lindsay D. Klaehn, Andrea M. Kramer, Jonathan M. HolmesAbstract:Purpose To report the effectiveness of treatments for central-peripheral rivalry (CPR)-type Diplopia due to retinal misregistration. Design Retrospective, interventional case series. Methods Fifty adults with retinal misregistration and CPR-type Diplopia (minimum frequency of “sometimes” at distance and/or for reading) caused by epiretinal membrane (n = 44) or other retinal disorders (n = 6) were enrolled in this study, conducted at adult strabismus clinics, Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, a tertiary medical center. Treatments included Bangerter filter, adhesive tape, Fresnel prism, clear prism (incorporated into glasses or loose prism in the office), iseikonic manipulation (using iseikonic lenses or contact lenses), a MIN lens, or epiretinal membrane (ERM) peeling (alone or in any combination). Not all patients underwent all of these treatments. Results Main outcome measurements were Diplopia frequency, evaluated using the Diplopia Questionnaire. Success was defined as “never” or “rarely” diplopic for distance and reading, using the Diplopia Questionnaire, at an outcome examination as close as possible to 6 months. Overall, 17 of 50 patients (34%; 95% confidence interval [CI], 21%-49%) were classified as successful. Fresnel prism was successful in 4 of 7 patients (57%; 95% CI, 18%-90%); Bangerter filter in 4 of 28 patients (14%; 95% CI, 4%-33%); ERM peeling in 8 of 18 patients (44%; 95% CI, 22%-69%); and iseikonic manipulation in 1 of 23 patients (using a contact lens; 4%; 95% CI, 0%-22%). Conclusions CPR-type Diplopia may be relieved in some patients using nonsurgical treatment options consisting of Fresnel prism or Bangerter filter. ERM peeling was surprisingly successful and should be considered.
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new onset vs resolution of central peripheral rivalry type Diplopia in patients undergoing epiretinal membrane peeling
JAMA Ophthalmology, 2019Co-Authors: Sarah R. Hatt, David A. Leske, Raymond Iezzi, Jonathan M. HolmesAbstract:Importance The peeling of an epiretinal membrane (ERM) is commonly performed for poor visual acuity and/or metamorphopsia, but to our knowledge, its influence on central-peripheral rivalry (CPR)–type Diplopia has not been rigorously studied. Objective To evaluate the occurrence of either resolution or new-onset CPR-type Diplopia in patients undergoing ERM peeling. Design, Setting, and Participants This prospective cohort study was conducted from July 2014 to April 2018 at a tertiary referral medical center and included 33 adults with ERM who were undergoing peeling surgery with planned preoperative to postoperative analysis. Interventions A standardized Diplopia questionnaire completed before undergoing and 6 months following ERM peeling. Main Outcomes and Measures For patients with CPR-type Diplopia before ERM peeling (rated “sometimes” or more for distance straight ahead or reading using the Diplopia questionnaire), we calculated the proportion with resolution of Diplopia postpeel (“never” for distance straight ahead and reading on the Diplopia questionnaire) and compared clinical characteristics between those with resolution and those without. For patients with no Diplopia prepeeling (“never” for distance straight ahead and reading on the Diplopia questionnaire), we calculated the proportion with new-onset CPR-type Diplopia postoperatively and compared clinical characteristics between those with new-onset Diplopia and those who remained without Diplopia. Results Of 33 patients (median age, 67 years [range, 51-87 years]; 18 men [55%]), 12 (36%) had CPR-type Diplopia preoperatively and 21 (64%) did not have Diplopia preoperatively. Six months postoperatively, 4 of 12 patients with Diplopia (33%; 95% CI, 10%-65%) had resolution of Diplopia, and 4 of 21 patients without Diplopia (19%; 95% CI, 5%-42%) had new-onset Diplopia. Better postoperative operated-eye visual acuity appeared somewhat associated with new-onset Diplopia postoperatively (mean [SD] visual acuity, 0.08 [0.10] logMAR; approximately 20/25 vs 0.34 [0.33] logMAR; approximately 20/40; difference, −0.27; 95% CI, −0.62 to 0.09;P = .07), as did greater postoperative aniseikonia (14% [5%] vs 6% [4%]; difference, 8%; 95% CI, 2%-13%;P = .04). Conclusions and Relevance These data suggest that epiretinal membrane peeling may result in resolution of Diplopia in some patients but new-onset Diplopia in others. These findings may be valuable when counseling patients regarding the risks of new-onset Diplopia.
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prevalence and associations of central peripheral rivalry type Diplopia in patients with epiretinal membrane
JAMA Ophthalmology, 2017Co-Authors: Kevin K. Veverka, Sarah R. Hatt, David A. Leske, William L. Brown, Raymond Iezzi, Andrew J Barkmeier, Jonathan M. HolmesAbstract:Importance The prevalence and clinical associations of patients with epiretinal membrane (ERM) who develop central-peripheral rivalry (CPR)–type Diplopia are unknown. Objectives To determine the prevalence of CPR-type Diplopia in retinal disease clinic patients with ERM and to determine clinical findings associated with CPR-type Diplopia. Design, Setting and Participants A prospective cross-sectional study of 31 patients with ERM from retinal disease clinics to determine the prevalence of CPR-type Diplopia. A retrospective case cohort of 25 additional patients with ERM, selected from adult strabismus clinics, was added (total = 56) to determine clinical associations with CPR-type Diplopia. All data were collected between June 2014 and November 2016; prospective cohort data were collected from June 2016 to November 2016. Main Outcomes and Measures The presence of Diplopia was determined by patient history and Diplopia questionnaire responses. Visual acuity and ocular alignment were recorded. Metamorphopsia was documented qualitatively by evaluation of the door frame and Amsler grid and measured quantitatively using M-charts and D-charts. Aniseikonia was determined by subjective description and results of the Awaya new aniseikonia test. Retinal misregistration testing consisted of optotype-frame test and synoptophore; CPR-type Diplopia was defined as Diplopia associated with evidence of retinal misregistration when other causes did not fully explain Diplopia. Outcomes were as follows: prevalence of CPR-type Diplopia in patients with ERM seen in retinal disease clinics, and whether or not clinical findings differed between patients with ERM and CPR-type Diplopia vs patients with ERM without CPR-type Diplopia. Results Of the 31 patients with ERM seen in retinal disease clinics, 16 were women and 15 were men; the mean (SD) age was 69 (10) years. The prevalence of any Diplopia was 23% (7 of 31; 95% CI, 10% to 41%), with CPR-type Diplopia present in 16% (5 of 31; 95% CI, 5% to 34%). For analysis of associations, 12 of 56 patients (21%) had CPR-type Diplopia and 37 (66%) had no Diplopia. Seven of the 56 patients were excluded for other types of Diplopia. Patients with CPR-type Diplopia had better worse-eye visual acuity (mean difference, −0.23; 95% CI, −0.37 to −0.09 logMAR,P = .003), and more severe quantitative metamorphopsia (mean M-score difference 0.6; 95% CI, 0.05 to 1.1,P = .01) than patients without Diplopia, but similar aniseikonia (Awaya new aniseikonia test; mean difference 0.6%; 95% CI, −2.9% to 4.0%,P = .33) and similar evidence of retinal misregistration (100% vs 73%;P = .09) by any test. Conclusions and Relevance Our findings suggest that CPR-type Diplopia is not uncommon in patients with ERM. On average, patients with CPR-type Diplopia have better visual acuity and more metamorphopsia than those without CPR-type Diplopia, but there is considerable individual variability. Aniseikonia and retinal misregistration are similar between patients with ERM associated with CPR-type Diplopia and those without CPR-type Diplopia. Retinal misregistration with coexistent metamorphopsia appears necessary but is not sufficient for CPR-type Diplopia.
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Causes of Diplopia in Patients With Epiretinal Membranes.
American journal of ophthalmology, 2017Co-Authors: Kevin K. Veverka, Sarah R. Hatt, David A. Leske, William L. Brown, Raymond Iezzi, Jonathan M. HolmesAbstract:Purpose To describe the causes of Diplopia in patients with an epiretinal membrane (ERM) and presenting Diplopia. Design Retrospective observational case series. Methods We reviewed patients diagnosed with an ERM, who had been seen by both retinal and strabismus specialists in a tertiary medical center. Data recorded: orthoptic evaluation, retinal misregistration (optotype-frame test, and synoptophore central peripheral superimposition slides at 5 and 10 degrees), and cause of any Diplopia (retinal misregistration vs strabismus vs optical/refractive error). We defined central-peripheral rivalry–type Diplopia as presenting symptomatic Diplopia with evidence of retinal misregistration, and where other causes did not fully explain Diplopia. The frequency of each cause of Diplopia in patients with ERM was determined. Results Of 50 patients with ERM, 25 had symptomatic Diplopia and 25 had no Diplopia. Eleven of 25 diplopic patients (44%) had retinal misregistration as the sole cause (central-peripheral rivalry–type Diplopia), 7 (28%) strabismus (1 of 7 initally appeared to have central-peripheral rivalry–type Diplopia), 1 (4%) optical/refractive error (monocular Diplopia), 2 (8%) mixed retinal misregistration (central-peripheral rivalry–type Diplopia) and strabismus, and for 4 (16%) Diplopia cause was indeterminate. Unexpectedly, 15 of 25 patients without Diplopia (60%) had evidence of retinal misregistration. Conclusions Patients with ERM and presenting Diplopia may have 1 of several causes of Diplopia, most commonly retinal misregistration (central-peripheral rivalry–type Diplopia). Nevertheless, diplopic patients with retinal misregistration may also have treatable strabismus or optical/refractive error as the primary barrier to single vision and therefore many potential barriers to single vision should be considered.
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prevalence and associations of central peripheral rivalry type Diplopia in patients with epiretinal membrane
JAMA Ophthalmology, 2017Co-Authors: Kevin K. Veverka, Sarah R. Hatt, David A. Leske, William L. Brown, Raymond Iezzi, Andrew J Barkmeier, Jonathan M. HolmesAbstract:Importance The prevalence and clinical associations of patients with epiretinal membrane (ERM) who develop central-peripheral rivalry (CPR)–type Diplopia are unknown. Objectives To determine the prevalence of CPR-type Diplopia in retinal disease clinic patients with ERM and to determine clinical findings associated with CPR-type Diplopia. Design, Setting and Participants A prospective cross-sectional study of 31 patients with ERM from retinal disease clinics to determine the prevalence of CPR-type Diplopia. A retrospective case cohort of 25 additional patients with ERM, selected from adult strabismus clinics, was added (total = 56) to determine clinical associations with CPR-type Diplopia. All data were collected between June 2014 and November 2016; prospective cohort data were collected from June 2016 to November 2016. Main Outcomes and Measures The presence of Diplopia was determined by patient history and Diplopia questionnaire responses. Visual acuity and ocular alignment were recorded. Metamorphopsia was documented qualitatively by evaluation of the door frame and Amsler grid and measured quantitatively using M-charts and D-charts. Aniseikonia was determined by subjective description and results of the Awaya new aniseikonia test. Retinal misregistration testing consisted of optotype-frame test and synoptophore; CPR-type Diplopia was defined as Diplopia associated with evidence of retinal misregistration when other causes did not fully explain Diplopia. Outcomes were as follows: prevalence of CPR-type Diplopia in patients with ERM seen in retinal disease clinics, and whether or not clinical findings differed between patients with ERM and CPR-type Diplopia vs patients with ERM without CPR-type Diplopia. Results Of the 31 patients with ERM seen in retinal disease clinics, 16 were women and 15 were men; the mean (SD) age was 69 (10) years. The prevalence of any Diplopia was 23% (7 of 31; 95% CI, 10% to 41%), with CPR-type Diplopia present in 16% (5 of 31; 95% CI, 5% to 34%). For analysis of associations, 12 of 56 patients (21%) had CPR-type Diplopia and 37 (66%) had no Diplopia. Seven of the 56 patients were excluded for other types of Diplopia. Patients with CPR-type Diplopia had better worse-eye visual acuity (mean difference, −0.23; 95% CI, −0.37 to −0.09 logMAR,P = .003), and more severe quantitative metamorphopsia (mean M-score difference 0.6; 95% CI, 0.05 to 1.1,P = .01) than patients without Diplopia, but similar aniseikonia (Awaya new aniseikonia test; mean difference 0.6%; 95% CI, −2.9% to 4.0%,P = .33) and similar evidence of retinal misregistration (100% vs 73%;P = .09) by any test. Conclusions and Relevance Our findings suggest that CPR-type Diplopia is not uncommon in patients with ERM. On average, patients with CPR-type Diplopia have better visual acuity and more metamorphopsia than those without CPR-type Diplopia, but there is considerable individual variability. Aniseikonia and retinal misregistration are similar between patients with ERM associated with CPR-type Diplopia and those without CPR-type Diplopia. Retinal misregistration with coexistent metamorphopsia appears necessary but is not sufficient for CPR-type Diplopia.
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Causes of Diplopia in Patients With Epiretinal Membranes.
American journal of ophthalmology, 2017Co-Authors: Kevin K. Veverka, Sarah R. Hatt, David A. Leske, William L. Brown, Raymond Iezzi, Jonathan M. HolmesAbstract:Purpose To describe the causes of Diplopia in patients with an epiretinal membrane (ERM) and presenting Diplopia. Design Retrospective observational case series. Methods We reviewed patients diagnosed with an ERM, who had been seen by both retinal and strabismus specialists in a tertiary medical center. Data recorded: orthoptic evaluation, retinal misregistration (optotype-frame test, and synoptophore central peripheral superimposition slides at 5 and 10 degrees), and cause of any Diplopia (retinal misregistration vs strabismus vs optical/refractive error). We defined central-peripheral rivalry–type Diplopia as presenting symptomatic Diplopia with evidence of retinal misregistration, and where other causes did not fully explain Diplopia. The frequency of each cause of Diplopia in patients with ERM was determined. Results Of 50 patients with ERM, 25 had symptomatic Diplopia and 25 had no Diplopia. Eleven of 25 diplopic patients (44%) had retinal misregistration as the sole cause (central-peripheral rivalry–type Diplopia), 7 (28%) strabismus (1 of 7 initally appeared to have central-peripheral rivalry–type Diplopia), 1 (4%) optical/refractive error (monocular Diplopia), 2 (8%) mixed retinal misregistration (central-peripheral rivalry–type Diplopia) and strabismus, and for 4 (16%) Diplopia cause was indeterminate. Unexpectedly, 15 of 25 patients without Diplopia (60%) had evidence of retinal misregistration. Conclusions Patients with ERM and presenting Diplopia may have 1 of several causes of Diplopia, most commonly retinal misregistration (central-peripheral rivalry–type Diplopia). Nevertheless, diplopic patients with retinal misregistration may also have treatable strabismus or optical/refractive error as the primary barrier to single vision and therefore many potential barriers to single vision should be considered.