1. Dragged-Fovea Diplopia Syndrome

2. Purpose To identify clinical characteristics
To introduce a simple diagnostic test to aid evaluation of such patients
To provide simple treatment option
The Dragged-Fovea Diplopia Syndrome, Clinical Characteristics, Diagnosis and Treatment,
Guyton at al Ophthalmology 2005; 112:

3. Design Retrospective observational case series
95 eyes in 83 consecutive patients seen between 1 Jan 1993 to 9 Aug 2004 (>11yrs)

4. Methods
222 records reviewed of patients seen at Krieger Children’s Eye Center
Ave age – 67yrs (range 30-86yrs)
(Children’s Eye Center???)
Diagnosis:
Maculopathy
Internal Limiting Membrane
Dragged fovea
Recruited:
Reported binocular diplopia
Not amenable to prism therapy and
Not acquired strabismus

5. Outcome Measures Metamorphopsia on Amsler
Or other clinical evidence of macular wrinkling
Response to prism trial
Response to lights on-off test
Response to partial occlusion with Scotch Satin tape (3M)

6. Results 95 eyes in 83 patient
69 patients tested with lights on-off test – all positive
Demonstrates rapid central fusion with room lights off and
Recurrence of central diplopia with peripheral fusion with room lights on
46 patients (n=64 tested) receptive to monocular occlusion with Scotch Satin tape

7. Conclusions
Dragged-fovea diplopia syndrome consists of central diplopia in presence of peripheral fusion, secondary to dragging of fovea in one or both eyes by retinal disease
Competition between central and peripheral fusion
The central diplopia cannot be eliminated by prism therapy or eye muscle surgery
The lights on-off test “pathognomonic” for this syndrome
Patients benefit from monocular occlusion with Scotch Satin tape

8. Lights on-off test Small field fusion central fusion test
Universally positive in pts with demonstrable central vs peripheral fusion conflict
As evidenced by failure of prism to maintain initial central fusion
Easy to perform
Demonstrates nature of problem to patient cf to prism trial

9. Response to Monocular Occlusion
Documented in 58/83
Successful in 46
12 pts –
unable to tolerate, though diplopia eliminated

10. Criticisms 9/83 followed Aniseikonia not measured formally Due to
macular disease
Anisometropia
Cause-effect? Or authors postulate contributes to fusion instability