Innovative nonsurgical treatment for central-peripheral rivalry-type diplopia

To evaluate whether a multifocal contact lens improves central-peripheral rivalry-type (CPR-type) diplopia in patients with epiretinal membrane and other maculopathies.

Seventeen consecutive adult patients with epiretinal membrane or macular hole and CPR-type diplopia were enrolled. A multifocal, center-distance contact lens, with +2.50 bifocal power, was applied to the eye with macular disease. Measurements of diplopia (optotype-frame test), metamorphopsia (M-Charts, Amsler grid), and aniseikonia (Awaya test) were obtained prior to contact lens placement on the affected eye and repeated 30 minutes after contact lens placement.

Median best-corrected visual acuity in the affected eye(s) was 20/20 Snellen before and after multifocal contact lens placement. Diplopia improved in 10 patients (59%), from describing double letters in a single frame or a single letter in a double frame (both indicating central-peripheral rivalry) to a single letter in a single frame. Sixteen patients (94%) reported subjective improvement in M-Chart metamorphopsia (mean of 0.46 before treatment to 0.19 with the multifocal contact lens [mean difference, 0.27; 95% CI, 0.15-0.33; P ≤ 0.001]). Thirteen (76%) showed improvement on the Amsler grid: perceived grid distortion changed from a mean of 111.8 boxes to 38.2 boxes (mean difference, 73.6; 95% CI, 16.67-30.5; P = 0.024). Additionally, 10 (59%) demonstrated improvement in Awaya test aniseikonia, with a mean change from 4.4% to 3.6% (mean difference, -0.82; 95% CI, -1.66 to 0.02; P = 0.53).

Multifocal contact lenses present a promising alternative for alleviating CPR-type diplopia and reducing metamorphopsia associated with epiretinal membrane and macular hole by functionally masking the periphery while maintaining clear central vision.