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Pathological suppression of binocular vision in stroke
Kevin E Houston1,2,3,4,5, Mariam Labib3, Daniel H Baker6
1Department of Veteran Affairs, Central Western Massachusetts Health Care System, Optometry Service, Worcester, Massachusetts, USA.
Summary
Patients with spatial neglect are more likely to deny double vision, suggesting pathological suppression of binocular vision. This finding is linked to age and parietal lobe injury.
Area of Science:
- Neuroscience
- Ophthalmology
- Rehabilitation Medicine
Background:
- Spatial neglect, a condition often following stroke, can impact binocular vision.
- Previous research suggests a link between spatial neglect and reduced reporting of diplopia (double vision).
- This phenomenon may involve pathological binocular suppression, where visual information from the neglected side is suppressed.
Purpose of the Study:
- To investigate the relationship between spatial neglect and the denial of diplopia.
- To identify predictors of reduced diplopia reporting in patients with stroke-induced strabismus.
- To assess the prevalence and predictors of pathological binocular suppression.
Main Methods:
- Retrospective review of 155 patient charts from an inpatient rehabilitation hospital vision clinic.
- Logistic regression analysis to identify predictors of denying double vision in patients with strabismus.
- Clinician ratings of suppression likelihood (1-10) and cumulative logit modeling to identify predictors of these ratings.
Main Results:
- Only 9.7% of patients passed all suppression tests.
- 53% of patients with strabismus denied diplopia.
- Patients with spatial neglect had 3.9 times greater odds of denying diplopia (OR 3.91).
- Parietal lobe injury was associated with a high likelihood of suppression (OR 3.40).
- Five patients (3.2%) were flagged for likely pathological suppression.
Conclusions:
- Denial of diplopia in stroke patients is significantly associated with spatial neglect and age.
- Pathological suppression of binocular vision is a likely mechanism in some cases of denied diplopia.
- Findings highlight the importance of comprehensive binocular vision assessment in patients with spatial neglect.
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