0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Clinicopathologic Reports, Case Reports, and Small Case Series |

Improved Binocularity After Laser In Situ Keratomileusis FREE

Barry N. Wasserman, MD; Chrishonda C. McCoy, MD
[+] Author Affiliations

Section Editor: W. Richard Green, MD

More Author Information
Arch Ophthalmol. 2007;125(9):1293-1294. doi:10.1001/archopht.125.9.1293.
Text Size: A A A
Published online

Refractive surgery can improve uncorrected vision over a wide range of refractive errors. However, impaired binocularity has been reported after refractive surgery.1 Decompensated strabismus and loss of stereopsis can be disturbing, even when visual acuity outcome is excellent. Improved stereopsis after refractive surgery is rarely reported and is usually found in the pediatric population.2 We present a case of improved stereopsis after laser in situ keratomileusis (LASIK) treatment of anisometropia in an adult.

A 32-year-old woman was first seen for LASIK evaluation, complaining that her eyes did not “work well together.” She had been prescribed glasses at age 6 years, but she did not wear them. She denied therapy for amblyopia or strabismus. She had no significant medical history and her medication included only birth control.

Uncorrected visual acuity was 20/150 OD and 20/30 OS. Preoperative best-corrected visual acuity was 20/25 OD and 20/20 OS. Cycloplegic refraction was + 2.75 – 4.50 × 116 OD and – 0.75 – 0.25 × 80 OS. Titmus stereoacuity testing without correction yielded 5 of 9 dots (100 seconds of arc). Pupil, extraocular motility, slitlamp, intraocular pressure, and dilated retinal examination results were all normal. No contact lens trial was performed.

The patient underwent LASIK surgery with the Moria CB manual microkeratome (Moria USA, Doylestown, Pennsylvania) and the VISX STAR S4 Laser (VISX USA Inc, Santa Clara, California). At postoperative week 1, the patient stated that her eyes were working better together. Uncorrected visual acuity was 20/25 OD and 20/20 OS. Stereoacuity testing results were now 8 of 9 dots (50 seconds of arc). At 1 month after the operation, the patient felt her depth perception was “perfect.” Her vision was unchanged and manifest refraction was plano – 0.50 × 146 OD and plano – 0.25 × 13 OS. Stereoacuity had improved to 9 of 9 dots (40 seconds of arc). At 7 months, she maintained Titmus stereoacuity (40 seconds of arc) and stated that the dots had become even easier to see.

Refractive surgery effectively improves visual acuity and reduces refractive error. However, it can adversely affect binocular function. Reports describe decompensation of strabismus following refractive surgery, with resultant esotropia, exotropia, or hypertropia.1 The strabismus can lead to asthenopia or even diplopia.3 In cases of monovision refractive surgery, some patients will lose subjective depth perception.4 Stereoacuity may be difficult to recover, even when monovision is reversed with correction.

This case presents improved stereopsis in an adult with long-standing anisometropia. Despite minimal amblyopia in the right eye (best-corrected visual acuity, 20/25), her subjective and objective binocularity improved within 1 week after LASIK. She further improved to 40 seconds of arc at 1 month after the operation, which was maintained at 7 months. She did have some optical correction as a child, which may have yielded her some increased stereoacuity potential. Her preoperative decreased stereoacuity may have been related to her not wearing corrective devices and may have improved with contact lens trial. However, she had a subjective and objective improvement with time after LASIK resolved her anisometropia. In a MEDLINE search, we were unable to find cases in which an adult patient had improved stereoacuity after refractive surgery.

Patients with a history of strabismus or undergoing monovision refractive surgery should be warned of decreased binocularity. However, some patients with anisometropia may experience an improvement in binocularity after refractive surgery.

Correspondence: Dr Wasserman, Department of Pediatric Ophthalmology, Wills Eye Hospital, 840 Walnut St, Philadelphia, PA 19107 (bwasserman@americansurgisite.com).

Financial Disclosure: None reported.

Godts  DTassignon  MJGobin  L Binocular visual impairment after refractive surgery. J Cataract Refract Surg 2004;30 (1) 101- 109
PubMed Link to Article
Phillips  CBPrager  TCMcClellan  GMintz-Hittner  HA Laser in situ keratomileusis for treated anisometropic amblyopia in awake, autofixating pediatric and adolescent patients. J Cataract Refract Surg 2004;30 (12) 2522- 2528
PubMed Link to Article
Kushner  BJKowal  L Diplopia after refractive surgery: occurrence and prevention. Arch Ophthalmol 2003;121 (3) 315- 321
PubMed Link to Article
Fawcett  SLHerman  WKAlfieri  CD  et al.  Stereoacuity and foveal fusion in adults with long-standing surgical monovision. J AAPOS 2001;5 (6) 342- 347
PubMed Link to Article

Figures

Tables

References

Godts  DTassignon  MJGobin  L Binocular visual impairment after refractive surgery. J Cataract Refract Surg 2004;30 (1) 101- 109
PubMed Link to Article
Phillips  CBPrager  TCMcClellan  GMintz-Hittner  HA Laser in situ keratomileusis for treated anisometropic amblyopia in awake, autofixating pediatric and adolescent patients. J Cataract Refract Surg 2004;30 (12) 2522- 2528
PubMed Link to Article
Kushner  BJKowal  L Diplopia after refractive surgery: occurrence and prevention. Arch Ophthalmol 2003;121 (3) 315- 321
PubMed Link to Article
Fawcett  SLHerman  WKAlfieri  CD  et al.  Stereoacuity and foveal fusion in adults with long-standing surgical monovision. J AAPOS 2001;5 (6) 342- 347
PubMed Link to Article

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 2

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Dry eye after laser in-situ keratomileusis. Semin Ophthalmol 2014;29(5-6):358-62.