To paraphrase, Foreigner’s “Double Vision,” optometrists don’t have to let it get the best of them. This was the message of yesterday’s lecture, “Approaching Diplopia,” which took place at 8 a.m., and was given by Kristine Hopkins, OD, MSPH, FAAO. Specifically, Dr. Hopkins discussed the interventions for diplopia according to patient candidacy.

Prism
Relieving prism is best for diplopia patients with comitant, mild-to-moderate angle strabismus. The magnitude of the prism needed may be determined by associated phoria measures, balancing fusion reserves, or determining the least amount of prism necessary to eliminate diplopia awareness. Dr. Hopkins noted that yoked prism may also be an option for diplopic patients who have incomitant deviations with a mild compensating head position. She recommended splitting prism equally unless the strabismus is paretic or mechanical. Dr. Hopkins suggested an uneven split for paretic and no splitting of the prism for mechanically restrictive strabismus.  

“I would suggest that doctors recommending prism consider prescribing a Fresnel Prism trial, so that patients can test out the prism before finalizing the glasses prescription,” she said, of her lecture.

Added lenses
Added near plus lenses, Dr. Hopkins noted, work well for diplopia resulting from high AC/A esotropia at near.

Vision therapy
Patients who present with intermittent diplopia and reduced vergence reserves may benefit from vision therapy, Dr. Hopkins explained. The therapy itself is comprised of training vergence reserves (small-to-moderate angle, intermittent strabismus with fusion potential).

Occlusion
When the diplopic patient lacks fusion potential or has been unsuccessful with the interventions mentioned, attenuation with a Bangerter Occlusion Foil comes next, Dr. Hopkins said. Bangerter foils may be used to occlude an entire lens or only sections of the lens where the diplopia is bothersome. 

Other highlights
In addition to her discussion on patient candidacy for diplopia interventions, Dr. Hopkins’ “Approaching Diplopia” lecture also included information on the differential diagnoses for diplopia, recognizing when diplopia requires imaging and comanagement (e.g. cranial nerve palsy, brain tumor, etc.), and testing diplopic patients. OM