Epiretinal Membrane May Cause Patients to Close One Eye to See Better

By David Douglas

September 21, 2020

NEW YORK (Reuters Health) - Patients with epiretinal membranes often close one eye to improve vision and this may impact their quality of life, according to a new record review.

"Although many such patients close one eye to avoid double vision caused by common types of treatable strabismus (ocular misalignment) or from retinal misregistration specifically due to an epiretinal membrane, other patients close one eye to avoid interference of the distorted image from one eye blurring the other clearer image - we call this 'binocular interference,'" Dr. Jonathan M. Holmes of the University of Arizona-Tucson told Reuters Health by email.

In their study, published in JAMA Ophthalmology, Dr. Holmes and his colleagues aimed to describe the frequency of binocular interference associated with monocular epiretinal membranes (ERM) and to examine the impact on quality of life.

The team examined data on 279 patients with ERM who, as part of their evaluation questionnaire, had responded to the statement, "I cover or close one eye to see things better;" 44% reported monocular eye closure.

This was associated with binocular interference in 36 (29%) and central-peripheral rivalry-type diplopia in 34 patients (27%). In the remaining 54 patients (44%) the cause was primarily strabismus.

Compared to the 11 control patients with ERM and no binocular interference, those with binocular interference had significantly lower quality of life scores. They also had poorer worst-eye visual acuity and a larger interocular difference than patients with central-peripheral rivalry-type diplopia.

"Binocular interference likely occurs in many other types of eye disease," said Dr. Holmes, "but we first recognized it in patients with epiretinal membranes."

"Recognizing binocular interference as a distinct entity will help us develop future treatments for this troubling condition," he concluded.

Dr. Hilda Cap of the University of Miami Miller School of Medicine, in Florida, who wrote an accompanying editorial, told Reuters Health by email, "Unequal visual input may degrade visual acuity and contrast sensitivity test results under binocular viewing as compared to monocular conditions due to binocular inhibition. A patient's subjective awareness of a poorly sighted eye interfering with vision of the better sighted eye during binocular viewing, a phenomenon known as binocular interference, may cause symptomatic monocular eye closure."

She observes in her editorial that future studies "may help determine whether binocular interference is the subjective expression of binocular inhibition or a distinct clinical entity."

SOURCE: https://bit.ly/3ktTGye and https://bit.ly/2FC4VpK JAMA Ophthalmology, online September 10, 2020.