What features are associated with monocular eye closure in epiretinal membrane?
In this medical record review of patients with epiretinal membrane, monocular eye closure (sometimes or more; n = 124) was associated with binocular interference (reduced monocular vs binocular visual quality, no diplopia or strabismus) in 36 (29%), central-peripheral rivalry (CPR)–type diplopia in 34 (27%), and other (primarily strabismus) in 54 (44%). Patients with binocular interference were more likely to have reduced quality of life compared with epiretinal membrane patients who never close 1 eye.
Study findings suggest binocular interference is a distinct entity and can be associated with epiretinal membrane.
Patients with epiretinal membrane (ERM) sometimes close 1 eye for improved vision, but associations have not been rigorously studied.
To evaluate associations with monocular eye closure in patients with ERM, and to report binocular interference (closing 1 eye to improve visual quality).
Design, Setting, and Participants
Retrospective medical record review of an adult strabismus clinic at a tertiary referral center. Patients with ERM referred from retina clinicians between June 2010 and October 2019 who completed the Adult Strabismus (AS)–20 questionnaire, including the question: “I cover or close one eye to see things better.” Two groups were identified: (1) patients reporting eye closure sometimes or more, and (2) patients reporting no eye closure (as control patients).
Main Outcomes and Measures
Frequencies of (1) central-peripheral rivalry (CPR)–type diplopia (dragged fovea diplopia); (2) binocular interference (monocular eye closure but no diplopia or strabismus); and (3) other, associated with monocular eye closure. Visual acuity, metamorphopsia, aniseikonia, and AS-20 quality of life domain scores (self-perception, interactions, reading function, and general function) compared between binocular interference, CPR-type diplopia, and control patients.
A total of 124 patients with ERM (58 of 124 were women [47%]; mean [SD] age, 70  years) reported monocular eye closure. Associations were binocular interference in 36 (29%; 95% CI, 21%-38%), CPR-type diplopia in 34 (27%; 95% CI, 20%-36%), and other (primarily strabismus) in 54 (44%). Compared with control patients with ERM (n = 11), patients with ERM and binocular interference had worse quality of life on AS-20 reading function (95 vs 62; mean difference, 22 points; 95% CI, 7-27 points; P = .007) and general function (89 vs 68; mean difference, 23 points; 95% CI, 13-34 points; P = .01) domains. Compared with CPR-type diplopia, patients with binocular interference had poorer worst-eye visual acuity (median 0.50 vs 0.30 logMAR [20/63 vs 20/40]; mean difference, 0.13 logMAR; 95% CI, 0.00-0.25 logMAR [20/20 to 20/35]; P = .03), and a larger interocular difference (0.46 vs 0.19 logMAR [20/58 vs 20/30]; mean difference, 0.15 logMAR; 95% CI, 0.03-0.28 logMAR [20/21 to 20/38]; P = .004).
Conclusions and Relevance
Study findings suggest that binocular interference, manifesting as monocular eye closure (without diplopia or strabismus), is a distinct entity affecting quality of life in patients with epiretinal membrane.
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Hatt SR, Leske DA, Iezzi R, Holmes JM. Binocular Interference vs Diplopia in Patients With Epiretinal Membrane. JAMA Ophthalmol. Published online September 10, 2020. doi:10.1001/jamaophthalmol.2020.3328
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