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Original Investigation
September 10, 2020

Binocular Interference vs Diplopia in Patients With Epiretinal Membrane

Author Affiliations
  • 1Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
  • 2Department of Ophthalmology and Vision Science, University of Arizona-Tucson
JAMA Ophthalmol. Published online September 10, 2020. doi:10.1001/jamaophthalmol.2020.3328
Key Points

Question  What features are associated with monocular eye closure in epiretinal membrane?

Findings  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.

Meaning  Study findings suggest binocular interference is a distinct entity and can be associated with epiretinal membrane.


Importance  Patients with epiretinal membrane (ERM) sometimes close 1 eye for improved vision, but associations have not been rigorously studied.

Objective  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.

Results  A total of 124 patients with ERM (58 of 124 were women [47%]; mean [SD] age, 70 [9] 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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