A Functional Scoring Method for the Field of Binocular Single Vision

Sullivan, Tim; Kraft, Stephen P.; Burack, Cynthia; O'Reilly, Carole

doi:10.1016/s0161-6420(92)31931-1

Cited by 48 publications

(37 citation statements)

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“…Previous studies 3,9 have identified that torsion is not detected well with the circular III 4e light target and we confirmed this phenomenon in the present study. Some cases (e.g.…”

Section: Discussionsupporting

confidence: 91%

“…The Goldmann method uses a white light fixation target in the white bowl, and the CROM method uses a 20/200 'E' target in the clinic room. Inability to fuse the circular white light on the white background of the Goldmann bowl has been previously recognized 3,6 leading to possible overestimation of diplopia, especially in cases where fusion may be fragile. Using a circular white light target in an environment devoid of peripheral fusion cues does not represent the real life experience of the patient.…”

Section: Discussionmentioning

confidence: 99%

“…Using the current scoring systems, 3,6 achieving single vision in primary and downgaze reduces the potential diplopia score more using the CROM method than using the Goldmann. In addition, diplopia can be assessed in the Goldmann in up to 60 degrees of ocular excursion and in oblique planes whereas the current CROM method and scoring system only include up to 30 degrees and is limited to the horizontal and vertical planes.…”

Section: Discussionmentioning

confidence: 99%

“…The CROM method offers a good alternative to the Goldmann and currently may be the best method for quantifying diplopia in clinical practice and for clinical trials in strabismus. Scoring system for diplopia as measured using the Goldmann perimeter adapted from Sullivan et al (ref 3 ). Cases where the diplopia score was higher using the Goldmann (A, C, E, shaded area diplopic) than using the Cervical Range of Motion (CROM) method.…”

Section: Discussionmentioning

confidence: 99%

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Comparing Methods of Quantifying Diplopia

Hatt

Holmes

2007

Ophthalmology

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Purpose-Quantification of diplopia is important for describing severity of strabismus, measuring change over time and reporting surgical outcomes. The Cervical Range of Motion (CROM) method has been proposed as a simple, inexpensive alternative to the Goldmann perimeter for quantifying diplopia. The purpose of this study was to compare these two techniques and describe advantages and disadvantages. Design-Cohort study.Participants-Seventy six consecutive patients with binocular diplopia associated with any type of strabismus.Methods-Patients underwent diplopia assessment with the CROM and the Goldmann perimeter; diplopia was scored between 0 and 100 based on previously published scoring systems. Where CROM and Goldmann results were disparate by more than 20 points the medical record was reviewed independently by two clinicians to determine the most likely reason for the discrepancy.Main Outcome Measures-The two main outcomes were a measure of agreement between diplopia scores using the CROM and Goldmann using the Kappa test and the reasons for any disagreement between tests of greater than 20 points.Results-Overall agreement between the two tests was good (Intra-class correlation co-efficient= 0.65; 95% Confidence interval 0.50 to 0.77). In 49 out of 76 (64%) results using the CROM and Goldmann were within 20 points. Of the 27 (36%) showing a greater than 20 point discrepancy, 17 were worse using the Goldmann and 10 using the CROM. The most frequent reason for worse diplopia using the Goldmann was poorer ability to fuse or suppress in the Goldmann apparatus compared to the real world targets used in free space for the CROM. Worse diplopia using the CROM was most often due to the deviation being present for distance only. In some cases differences were due to the greater weighting of primary position using the current scoring system for the CROM.Conclusions-In the majority of cases the CROM and Goldmann provide equivalent measures of diplopia severity. However the Goldmann appears to overestimate diplopia in patients with fragile fusion or tenuous suppression, and underestimate diplopia in deviations present for distance only. The CROM method may be more representative of diplopia severity as experienced in everyday life.Quantifying diplopia is an important aspect of describing the severity of strabismus. Numerical quantification provides a means of assessing recovery, deterioration or change in response to treatment and is particularly useful when reporting treatment outcomes. Plotting a field of single binocular vision using the Goldmann perimeter 1-4 is currently considered the standard for quantifying diplopia, however Goldmann perimeters are expensive and are being replaced Correspondence and reprint requests to: Dr. Jonathan M. Holmes, Ophthalmology W7, Mayo Clinic, Rochester, MN 55905. Phone:

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“…Previous studies 3,9 have identified that torsion is not detected well with the circular III 4e light target and we confirmed this phenomenon in the present study. Some cases (e.g.…”

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparing Methods of Quantifying Diplopia

Hatt

Holmes

2007

Ophthalmology

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“…As described as part of a previous study, 6 we then tested the patients with the Goldmann perimeter (Haag-Streit AG, Keoniz, Switzerland) using the III4e light target as described by Woodruff et al 1 and scored with the weighting template suggested by Sullivan et al, 2 which places an emphasis on primary position and reading. The test was performed by a trained examiner, and the target was moved from any area of single vision outward along meridians at intervals of 30 degrees.…”

Section: Assessing Diplopia With the Goldmann Perimetermentioning

confidence: 99%

Comparison of a diplopia questionnaire to the Goldmann diplopia field

Adams

Hatt

Holmes

2008

Journal of American Association for Pediatric Ophthalmology and

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Purpose-We compared diplopia scores using a new Diplopia Questionnaire to the established Goldmann diplopia field.Methods-Seventy-five consecutive patients with binocular diplopia associated with any type of strabismus were assessed with the Diplopia Questionnaire and the Goldmann perimeter. Diplopia was scored, according to published protocols, from 0 to 100 where 0 is no diplopia and 100 is diplopia in all measured positions. Where there was a discrepancy of more than 20 points between the Goldmann diplopia field and the Diplopia Questionnaire, two observers classified the reasons for the discrepancies.Results-There was fair overall agreement between the Diplopia Questionnaire and the Goldmann diplopia field, with 44 (59%) of 75 patients having agreement within 20 points (intraclass correlation coefficient 0.53, 95% CI 0.35-0.68). Of the 31 (41%) of 75 patients who had a discrepancy of more than 20 points, 13 (42%) of 31 exhibited a higher diplopia score with the Diplopia Questionnaire than the Goldmann perimeter and 18 (58%) of 31 showed a higher diplopia score with the Goldmann diplopia field than the Questionnaire. The most frequent reason for a higher Diplopia Questionnaire score was the proximal test distance of the Goldmann diplopia field (6 of 13 cases). The most frequent reason for a higher Goldmann diplopia field score appeared to be patient adaptation to diplopia (9 of 18 cases).Conclusions-The Diplopia Questionnaire may better represent binocular diplopia in everyday life than the Goldmann perimeter, capturing adaptation to diplopia, suppression, fragile fusion, and diplopia at distance fixation.Quantification of diplopia provides a means of assessing severity of strabismus and allows evaluation of recovery or deterioration and response to treatment. Until recently, the Goldmann perimeter has been considered the standard for quantifying the field of diplopia, yielding a percentage score. 1-4 It is not clear how this method of measuring diplopia reflects daily experience or how the derived score correlates with patient's perception of severity. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Recently, a diplopia questionnaire has been designed which assesses diplopia in seven positions of gaze rating diplopia as sometimes, always, or never (Table 1). 5 The Diplopia Questionnaire is scored in an analogous manner to the Goldmann diplopia field, with primary and reading positions given more weight than other positions, and a percentage score is calculated for each patient. The purpose of this study was to compare the scores obtained using the Goldmann dip...

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Orthoptic Investigative Procedures

Rowe¹

2012

Clinical Orthoptics

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A Functional Scoring Method for the Field of Binocular Single Vision

Cited by 48 publications

References 4 publications

Comparing Methods of Quantifying Diplopia

Comparing Methods of Quantifying Diplopia

Comparison of a diplopia questionnaire to the Goldmann diplopia field

Orthoptic Investigative Procedures

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