Screening Can Minimize Diplopia After LASIK

Laurie Barclay, MD

March 10, 2003

March 10, 2003 — Diplopia after laser-assisted in situ refractive surgery (LASIK) can be minimized with attention to risk factors, according to the results of a retrospective review of medical records published in the March issue of the Archives of Ophthalmology.

"Little has been written on the different causative mechanisms of diplopia after refractive surgery, stratification of patient characteristics that constitute different levels of risk for its occurrence, or recommended screening criteria," write Burton J. Kushner, MD, from the University of Wisconsin in Madison, and Lionel Kowal, from the University of Melbourne in Australia.

In 28 patients with persistent diplopia after LASIK surgery, the cause could be traced to technical problems, such as scarring or failure to achieve the desired optical effect; prior need of prisms, aniseikonia or perception of the same object as different in size in each eye, iatrogenic monovision, and improper control of accommodation for patients with strabismus.

Except for those cases related to technical problems, the authors concluded that the incidence of diplopia could be reduced "with proper attention paid to risk stratification and recommended screening criteria" including general history, basic ophthalmologic examination with distance and focus tests, and more advanced tests as indicated.

The authors offer screening guidelines to determine risk and recommendations for management of patients at moderate or high risk of diplopia. Although "many of these guidelines are arbitrary and cannot be supported by firm data at this time,...we feel that these guidelines, which are based on our combined experience in treating patients with strabismus, seem reasonable."

Arch Ophthalmol. 2003;121:315-321

Reviewed by Gary D. Vogin, MD