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Presbyopia complicating pre-existing strabismus.

Darren T Oystreck1, Christopher J Lyons

  • 1Department of Ophthalmology, University of British Columbia, British Columbia's Children's Hospital, Vancouver, BC.

Canadian Journal of Ophthalmology. Journal Canadien D'Ophtalmologie
|July 23, 2003
PubMed
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Presbyopia can cause new double vision in patients with existing strabismus or heterophoria. Early detection and management are key to restoring long-standing visual adaptations.

Area of Science:

  • Ophthalmology
  • Optometry
  • Vision Science

Background:

  • Presbyopia, the age-related loss of accommodation, can impact pre-existing sensory adaptations or exacerbate latent heterophoria.
  • This study investigates the novel association between presbyopia onset and new-onset strabismic symptoms in individuals with prior visual conditions.

Observation:

  • Eleven patients with pre-existing strabismus or heterophoria presented with new symptoms of double vision linked to presbyopic changes.
  • These symptoms arose from a recent decrease in accommodative amplitude, leading to near vision blur.

Findings:

  • The presbyopic change resulted in diverse manifestations including breakdown of heterophoria, altered fixation patterns, symptomatic alternating fixation, and intolerance to corrective lenses.
  • Specific findings included breakdown of pre-existing heterophoria (2 patients), altered fixation patterns (6 patients), symptomatic alternating fixation (2 patients), and intolerance to correction in restrictive strabismus (1 patient).

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Implications:

  • Ophthalmologists and orthoptists must carefully assess subtle and varied symptoms at presbyopia onset.
  • Establishing the patient's pre-existing fixation pattern is crucial for guiding management towards restoring their baseline sensory adaptation.
  • Consideration should be given to potential issues like undercorrection of hypermetropia post-refractive surgery and challenges with bifocals in vertical restrictive strabismus.