Diplopia in Medically and Surgically Treated Patients with Glaucoma

Abstract

Purpose To report prevalence, type, and etiology of diplopia in medically and surgically treated glaucoma patients. Design Cohort study Participants 195 adult glaucoma patients treated in a glaucoma referral practice. Methods 195 adult glaucoma patients who had undergone surgical or medical management were prospectively enrolled. Forty-seven patients had undergone glaucoma drainage device (GDD) surgery (Baerveldt 350, Baerveldt 250, and/or Ahmed FP7), 61 had undergone trabeculectomy, and 87 were medically treated. All patients completed the Diplopia Questionnaire to assess diplopia. We defined presence of diplopia as “Sometimes,” “Often,” or “Always” in distance straight ahead and/or reading positions on the Diplopia Questionnaire. A chart review was performed jointly by a strabismus and glaucoma sub-specialist to characterize the type and etiology of the diplopia. Main Outcome Measures Frequency, type, and etiology of diplopia. Results Diplopia was reported in 41 (21%) of 195 medically and surgically treated glaucoma patients. Binocular diplopia attributable to the glaucoma procedure was present in 11 of 47 (23%) post-GDD patients (95% CI; 12%–38%), which was significantly greater than in post-trabeculectomy patients (2 of 61 (3%), 95% CI; 0.4% –11%; P=0.002). The most common type of strabismus associated with binocular diplopia attributable to glaucoma surgery was hypertropia (10 out of 11 GDD patients, 2 out of 2 trabeculectomy patients). Monocular diplopia was found in a similar proportion of medically treated, post-trabeculectomy, and post-GDD (4 of 87 (5%), 4 of 61 (7%), and 2 of 47 (4%) respectively) patients. Binocular diplopia not attributable to surgery was found in similar proportions of GDD, trabeculectomy, and medically treated patients (3 of 47 (6%), 5 of 61 (8%), and 10 of 87 (11%) respectively). Conclusions Diplopia may be under-recognized in medically and surgically treated glaucoma patients and standardization of ascertaining patient symptoms using the Diplopia Questionnaire may be useful in these patients. Diplopia was more commonly seen after GDD than trabeculectomy, typically a non-comitant restrictive hypertropia. The prevalence of monocular diplopia and binocular diplopia unrelated to glaucoma surgery was similar among medical and surgical groups. It is important to counsel patients on the higher occurrence of diplopia associated with GDD surgery.

Performance and Safety of a New Ab Interno Gelatin Stent in Refractory Glaucoma at 12 Months

“…During the 12-month follow-up, there were no cases of suprachoroidal hemorrhage, diplopia, severe corneal issues, retinal detachment, flat anterior chamber, choroidal effusion requiring drainage, loss of light perception, blebitis, iritis, endophthalmitis, hypotony maculopathy, or device obstruction, all of which have been reported with other glaucoma aqueous shunts. 29,[39][40][41][42][43][44][45][46][47][48][49] The AEs most commonly reported in this study were needling, BCVA loss of > _2 lines (of which 81% self-resolved), transient hypotony (requiring no surgical intervention but captured as AEs per protocol regardless of outcome), increased IOP, and glaucoma-related secondary surgical intervention. None, however, were unexpected in this population of patients with refractory glaucoma.…”

Factors Associated With Health-Related Quality of Life in Medically and Surgically Treated Patients With Glaucoma

“…We prospectively enrolled 195 consecutive patients with glaucoma as part of a previous study 16 at their regularly scheduled follow-up glaucoma visits between August 2014 and April 2015. As previously described, 16 surgical patients were required to have at least 1 month (range, 1-229 months) of postoperative follow-up. Patients with multiple tubes, previous cataract surgery, failed glaucoma surgery, scleral buckle, or penetrating keratoplasty were not excluded.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] We reported in 2017 that diplopia and strabismus are common in patients with glaucoma and more frequent when treated with glaucoma drainage devices (GDD) than when treated with trabeculectomy or when medically treated. 16 Associations with diplopia and strabismus may be important for HRQOL in patients with glaucoma because diplopia and strabismus can profoundly influence HRQOL. [17][18][19] Therefore, in this study of prospectively enrolled patients with glaucoma, we evaluated factors associated with reduced HRQOL using instruments that are sensitive to diplopia and strabismus (the Adult Strabismus-20 Questionnaire [AS-20] 20,21 ) in addition to the commonly used 25-item National Eye Institute Visual Function Questionnaire (VFQ-25).…”

Motility Changes and Diplopia After Baerveldt Glaucoma Drainage Device Implantation or After Trabeculectomy

“…Diplopia is a known complication of implanted glaucoma drainage devices (GDDs), such as the Baerveldt glaucoma implant (BGI). 1 – 4 In daily life, our eyes move in unison to maintain binocular vision and to avoid diplopia. However, glaucoma patients with a GDD may show a motility disturbance, possibly resulting in diplopia.…”

“…By contrast, trabeculectomy (TE), an alternative surgical procedure for lowering the intraocular pressure (IOP) in the management of glaucoma, shows a lower incidence of diplopia after surgery. 2 , 3 …”