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To the Editor.
—I wish to question, in one respect, the estimation of the loss of visual efficiency as drawn by the Council on Industrial Health of the American Medical Association. I refer to their statement that diplopia within the central 20° represents 100% loss of motility efficiency in one eye.I recently examined a patient in a medicolegal case for an insurance company. As a result of an automobile accident the patient apparently suffered a blow-out fracture of the left orbital floor, which tethered the inferior oblique so that elevation of the eye was severely limited. There had been no surgical intervention, and when I saw her five years after the accident, diplopia occurred in most of the upper binocular field, but also involved the central to about 15° below the horizontal. Thus her diplopia met the AMA Industrial Health Council's definition for 100% loss of motility efficiency in
Epstein E. Motility Efficiency. Arch Ophthalmol. 1984;102(6):825. doi:10.1001/archopht.1984.01040030651009
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