Perspectives on Glaucoma

Diplopia frequently found in treated glaucoma patients

Researchers found diplopia in one-fifth of 195 medically and surgically treated adult patients with glaucoma, according to a prospective study in Ophthalmology.

Researchers utilized the Diplopia Questionnaire to collect data on symptoms of the condition.

Diplopia was reported in 41 of 195 patients (21%).

A total of 47 patients had undergone glaucoma drainage device (GDD) surgery using Baerveldt 350, Baerveldt 250 (Abbott Medical Optics, Abbott Park, Ill.) or Ahmed FP7 (New World Medical, Rancho Cucamonga, Calif.), 61 patients underwent trabeculectomy, and 87 patients were medically treated.

Binocular diplopia due to surgery occurred in 11 of 47 patients (23%) undergoing GDD placement and in 3% of patients undergoing trabeculectomy.

The most common type of strabismus associated with binocular diplopia due to glaucoma surgery was hypertropia, researchers said.

Binocular diplopia not due to surgery was found in similar proportions of GDD, trabeculectomy and medically treated cases of 6%, 8% and 11%, respectively.

Diplopia seems to be under-recognized in patients with glaucoma managed both medically and surgically, according to researchers.

Diplopia from surgery seems to be more common in patients after GDD, specifically patients receiving the Baerveldt 350, compared with patients after trabeculectomy, they concluded. The researchers suggest counseling patients on the occurrence of diplopia associated with GDD surgery.

“In addition, it may be helpful for patients undergoing glaucoma surgery to have a standardized assessment of diplopia and strabismus both before and after surgery,” according to researchers. – by Abigail Sutton

Disclosure: The researchers reported no relevant financial disclosures.

Researchers found diplopia in one-fifth of 195 medically and surgically treated adult patients with glaucoma, according to a prospective study in Ophthalmology.

Researchers utilized the Diplopia Questionnaire to collect data on symptoms of the condition.

Diplopia was reported in 41 of 195 patients (21%).

A total of 47 patients had undergone glaucoma drainage device (GDD) surgery using Baerveldt 350, Baerveldt 250 (Abbott Medical Optics, Abbott Park, Ill.) or Ahmed FP7 (New World Medical, Rancho Cucamonga, Calif.), 61 patients underwent trabeculectomy, and 87 patients were medically treated.

Binocular diplopia due to surgery occurred in 11 of 47 patients (23%) undergoing GDD placement and in 3% of patients undergoing trabeculectomy.

The most common type of strabismus associated with binocular diplopia due to glaucoma surgery was hypertropia, researchers said.

Binocular diplopia not due to surgery was found in similar proportions of GDD, trabeculectomy and medically treated cases of 6%, 8% and 11%, respectively.

Diplopia seems to be under-recognized in patients with glaucoma managed both medically and surgically, according to researchers.

Diplopia from surgery seems to be more common in patients after GDD, specifically patients receiving the Baerveldt 350, compared with patients after trabeculectomy, they concluded. The researchers suggest counseling patients on the occurrence of diplopia associated with GDD surgery.

“In addition, it may be helpful for patients undergoing glaucoma surgery to have a standardized assessment of diplopia and strabismus both before and after surgery,” according to researchers. – by Abigail Sutton

Disclosure: The researchers reported no relevant financial disclosures.

    Perspective
    Derek MacDonald

    Derek MacDonald

    The goal of glaucoma treatment is “… to enhance … quality of life by preserving visual function … at a sustainable cost … without causing untoward side effects …” (Weinreb and Khaw, 2004). At present, the principal means of treatment is the medical or surgical reduction of intraocular pressure. Optometrists treating glaucoma regularly encounter patients with ocular surface disease induced or exacerbated by topical medications, recognize that iatrogenic symptoms are a common reason for poor adherence to treatment and disease progression, and understand the importance of making treatment as convenient and tolerable as possible.

    Optometrists also manage patients following glaucoma surgery and must be prepared to address post-trabeculectomy tear film abnormalities, cataract formation and post-glaucoma drainage device diplopia. The latter, typically due to an incomitant restrictive hypertropia, can prove challenging; however, achieving fusion, even if only in primary and reading posture, can significantly improve quality of life for patients with advanced glaucoma, many of whom suffer from multiple ocular and systemic comorbidities.

    It is critical that optometrists manage patients, not specific conditions in isolation. This includes recognizing and addressing the adverse effects of treatment, some of which can have an immediate impact on quality of life that rivals or exceeds that of the disease itself.

    Reference:

    Weinreb RN, et al. Lancet. 2004;363(9422):1711-1720.

    • Derek MacDonald, OD, FAAO
    • Private practitioner Waterloo, Ontario

    Disclosures: MacDonald reports no relevant financial disclosures.