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Related Experiment Videos

Vertical diplopia onset with first-time bifocal.

G B Erickson1, E E Caloroso

  • 1Southern California College of Optometry, Fullerton.

Optometry and Vision Science : Official Publication of the American Academy of Optometry
|August 1, 1992
PubMed
Summary
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A 39-year-old woman developed constant double vision (diplopia) after starting bifocal glasses. This was due to a previously undetected superior oblique paresis, successfully managed with vision therapy and prism glasses.

Area of Science:

  • Ophthalmology
  • Neuro-ophthalmology
  • Binocular Vision

Background:

  • Superior oblique paresis is a common cause of vertical and/or torsional diplopia.
  • It can be congenital or acquired, and may present with a variety of symptoms.
  • Bifocal lenses can sometimes unmask or exacerbate pre-existing binocular vision anomalies.

Observation:

  • A 39-year-old female presented with new-onset constant diplopia coinciding with her first bifocal prescription.
  • Clinical examination revealed an esotropia and a longstanding, previously subclinical, nonconcomitant superior oblique paresis.
  • The onset of symptoms was directly associated with the introduction of bifocal correction.

Findings:

  • The patient's symptoms were attributed to the superior oblique paresis becoming manifest due to the accommodative and vergence demands of bifocal wear.

Related Experiment Videos

  • A treatment regimen combining horizontal vergence range training and a relieving vertical prism in the near correction was initiated.
  • The appropriate amount of prism was determined to achieve comfortable sensory-motor fusion across both distance and near visual tasks within the bifocal correction.

    • Implications:

    • This case highlights the importance of considering underlying binocular vision disorders when new-onset diplopia occurs with spectacle wear, particularly bifocals.
    • Differential diagnosis and careful management are crucial for patients presenting with diplopia and superior oblique paresis.
    • Successful management can be achieved through a combination of vision therapy and optical correction, such as prism prescription.