Informational - Differentiating Between Monocular and Binocular Diplopia

An explanation by Dr. Aleksic.

Dr. Zoran Aleksic FCS (SA) Ophth, is an eye surgeon and Ophthalmologist specialising in cataract and laser refractive surgery (Lasik / PRK laser refractive surgery for short sightedness, far sightedness and astigmatism). Dr. Aleksic’s treatment centre is located in Sea Point in Cape Town.

Dr. Zoran Aleksic and his team have long been recognised both in South Africa and the rest of the continent for providing high quality eye care with a full spectrum of treatments, from prescribing glasses and contact lenses to complex and delicate eye surgery using the latest technological equipment, all in a relaxed and professional environment.

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Transcript:

We often get referrals in ophthalmology from optometrist, GPS or from friends saying that they're sending a patient with a double vision. Well, double vision is quite a broad definition. We would actually like to know: is this double vision proper double vision where you see two clear objects, or is it double vision with one eye or is it just blurred vision. And what we
would like to do is the following: differentiate these three.

It is extremely important that patients’ visual acuity gets tested with their best correction. Is that contact lens that they are wearing? Is that TV driving glasses, not reading, driving glasses. So we are going to put the best optical correction in front of them and ask them to look at the visual acuity chart. At that stage we'll ask the patient to cover one eye and look at the time. Now, the patient may say with the best correction that they see that largest letter or any target that we showed as a double image. Usually they would say it's ghosted image, that means one is reasonably clear and the other one in the background is like a shadow of a letter. That is monocular diplopia that means in one eye we see two images and that is often if we are not optically well corrected we have some media problems like a corneal problems or cataract forming that will potentially split our image.

There are generally saying three major areas where you need to think of when somebody comes: the cornea, a lens change, cataract (most common) or retina, macula problem. So those are the three things that you think of if somebody best corrected covered one eye
looks at the target and sees two target: monocular diplopia three most common causes, think cornea, lens, retina.

Then we will do the same thing with the other and patient sees single
or double. If they're seeing single with one and double with the other, you should have three: diplopia here so you should have triple image not double. If you see with one eye clear, let's say cover your left eye again, that should be clear. Now cover your right eye again that is clear. Open both let's double so each eye sees single image, both eyes open double image. That's a classic example of binocular diplopia so you can have a perfectly clear image in one perfectly clear image and the other and see 2 images.

It's very important to differentiate when somebody complains of double and from practical clinical experience most of the double vision complaints are Uni-ocular diplopia.