What Happens When I Still See Double! You Cover One Eye? 1 - - PowerPoint PPT Presentation

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Jan 07, 2023 345 likes •466 views

2/13/2015 The Battle for Binocular Vision No Financial Disclosures or Potential Conflicts of Interest Jonathan C. Horton, UCSF http://www.ucsf.edu/hortonlab 12 February 2015 What Happens When I Still See Double! You Cover One Eye? 1

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The Battle for Binocular Vision

Jonathan C. Horton, UCSF http://www.ucsf.edu/hortonlab 12 February 2015

No Financial Disclosures or Potential Conflicts of Interest

What Happens When You Cover One Eye? I Still See Double!

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Eject!

Journal of Neuro-Ophthalmology 19:1-6, 1999

Patient’s drawings of her monocular diplopia

Maddox Rod

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Maddox rod over my right eye: crossed diplopia = exophoria Human Ocular Dominance Columns (Adams et al, 2007) Convergence of Monocular Inputs Generates Binocular Cells Required for Fusion and Stereopsis Strabismus During Critical Period for Visual Development Disrupts Projections onto Binocular Neurons

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A phoria is a natural property of the oculomotor plant. It is overcome by a cortical drive to fuse images. Horizontal fusional amplitude: 10 to 20 prism-diopters Vertical fusion amplitude: 3 to 4 prism-diopters

5/3/67 Dear Dr. Kaye Your I’m very grateful for your kindness and your generous

ffer. Actually I’ve been wearing

corneal lens’s for many years quite

successfully. I carry a small pair
f reading glasses for the
ccasional run in’s with fine

print or a menu in a too dark cafe. But please know that your generous letter and of was a tremendous morale booster and something I’ll never forget. Sincerely

RR

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Monovision: focus @ near left eye, focus @ distance right eye

73-year-old with occasional horizontal diplopia

Refraction: -10.00 + 2.00 × 130° right eye

10.00 + 1.75 × 60°

left eye Visual acuity wearing gas permeable contact lenses: 20/20, J10 in right eye 20/60, J1 in left eye (-2.75 sphere improves to 20/20)

2 weeks after using glasses with full distance correction in each eye

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Hirschberg ratio: 1 mm of corneal light decentration equals 7° of eye deviation

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2/13/2015 7 Is it strabismus, or something neurological?

6-month-old baby with new onset of crossed eyes

Strabismus*:

Full range of eye movements Comitant deviation

Neurological:

Limited eye movements Incomitant deviationl

*exceptions: cranial dysinervation disorders, etc.

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2/13/2015 8 Right gaze full, centered pupil light reflexes Left gaze, limited abduction left eye Temporal displacement of pupil light reflex 35-year-old man with horizontal diplopia-

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81-year-old with progressive left eye esodeviation 41-year-old with 3 months of ptosis and limited ductions OS

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58-year-old with diplopia following a stroke 2 months ago Fresnel stick-on plastic prism

Diplopia Principles

Use muscle light or cover test to check for ocular

misalignment

Is it strabismus or neurological?
Comitant or incomitant?
Ocular nerve palsy or brainstem problem?
Image the orbits along with the brain
Ocular myasthenia – a clinical diagnosis
Most diplopia can be fixed
Prisms – find a good optometrist
Eye muscle surgery for appropriate cases