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Eye and Vision Care

Treatment for long term diplopia

06/30/2009

Question:

Around 20 months ago I developed sudden diplopia. Within 10 minutes my vision went from more-or-less normal (very near sigheted, but normal otherwise) to fairly severe diplopia. I was eventually diganosed with decompenstated phoria. If the diplopia is corrected with prisms, my vision drifts past it. It always seems to settle 7-8 prisms past fusion (within 2 weeks of applying 7 prism glasses, I`m at 14, etc). At one point I was up to 48 prisms, before being directed to stop using prism glasses. However, once I stopped with the prism glasses I adjust back to requiring 7 prisms for fusion.

I cannot achive fusion for anything more than 4-5 feet distance (have not been wearing prisms for 6 months now and stay at 7-8). I can achieve fusion for reading, etc. However, for anything beyond 5 feet I end up having to close one eye (or patch). It is also worse when tired.

Are there any treatement options available? I have been told Surgery is out of the question because (1), it is not bad enough (no one would do surgery to correct at 7) and two they feel it would not yield good results since I drift beyond the 7 when it is corrected with prisms.

Answer:

Managing double vision in cases like you describe can be challenging. Without having examined you I cannot give any specific recommendations; however, here are a couple of treatment options that you and your doctors may consider.

1) Vision Therapy (orthoptics) consists of different forms of eye exercises. These exercises can often increase the range of fusion and decrease diplopia.

2) A second option may be placing a prism just in the top portion of your glasses (the area typically used for distance vision). The hope would be that since the prism would not be used for reading and other near work, you would not adapt to the prism and not require continual increases in the prism amount.

If you have not already, I recommend that you schedule an appointment with an eye doctor that specializes in binocular vision disorders to explore these or other treatment options.

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Response by:

Andrew J Toole, OD, PhD, FAAO
Clinical Assistant Professor of Optometry
College of Optometry
The Ohio State University