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Assessing Ocular Dominance: Rethinking the Current Paradigm
Jay S Pepose1, Vance Thompson, Phillip Hoopes
1From the Pepose Vision Institute, Chesterfield, Missouri, USA and the Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA (J.S.P.), University of South Dakota Sanford School of Medicine and Vance Thompson Vision, Sioux Falls, South Dakota, USA (V.T.), Hoopes Vision Research Center, Draper, Utah, USA (P.H.), Waring Vision Institute, Mount Pleasant, South Carolina, USA (G.W.Iv), ClearSight Lasik, Oklahoma City, Oklahoma, USA (R.L.R.), Department of Ophthalmology, Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, New York, USA (S.M.M.), Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA (K.E.D.), KU Medical Center, Kansas City, Kansas, USA and Durrie Vision, Overland Park, Kansas, USA (D.S.D.), Instituto de Óptica 'Daza de Valdés', Consejo Superior de Investigaciones Científicas (IO, CSIC), Madrid, Spain, USA (S.M.) and The Institute of Optics and Flaum Eye Institute, Center for Visual Sciences, University of Rochester, Rochester, New York, USA (S.M.).
Purpose:
To assess the concordance of a binary, motor sighting test of ocular dominance with a new sensory test using a simultaneous, binocular, head-mounted visual simulator to both identify and quantify the strength of eye dominance (EDS) at near and far.
Setting:
5 U.S. Private Practices.
Design:
Prospective, multicentered, double masked, non-interventional, comparative study.
Methods:
Prospective participants underwent sighting dominance testing using a 'hole-in-the-card' method through their distance refraction. Sensory testing was performed using a wearable, head-mounted, binocular, see-through visual simulator activating an optotunable lens on pupil conjugate plane, set to introduce monocular defocus for masked determination of both ocular preference and eye dominance strength (EDS) at far and at near (correcting the vergence with positive lenses).
Results:
Of 326 subjects, strong ocular dominance was found at far and at near in 50% (N=163) and 56% (N=183), respectively, with roughly equal remaining distribution between weak and equidominance. In 41% (N=134), the eye chosen to be the dominant eye with the 'hole-in-the-card' sighting method did not match the results from the sensory dominance test. In addition, in 26% (N=85), the subject changed from right eye dominance with the 'hole-in-the-card' to left eye dominance with the sensory EDS test; and 15% (N=49) changed from left to right.
Conclusions:
Assignment of ocular dominance with the commonly used 'hole-in-the card' test often does not align with the patient's preferred eye using sensory testing with a visual simulator simulating monovision. Further investigation will determine whether both strength and localization of ocular dominance in planning monovision are important factors in predicting patients' satisfaction and adaptation to monovision.
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