Optometric Management of Persistent Diplopia Status Post Scleral Buckle Surgery: Two Case Studies

Yutaka Maki, OD, MS
M.H. Esther Han, OD

 Background: A scleral buckling procedure repairs retinal detachments by indenting the sclera under the retinal breaks. One of the complications is diplopia, which typically subsides once the muscle heals. Persistent diplopia lasting longer than three to six months is reported in 0.5% - 25% of patients.

Case Reports: The cases presented demonstrate the use of optometric vision therapy and/or prisms as effective treatment options for patients experiencing persistent diplopia and manifesting different magnitudes and directions of deviation.

Conclusion: It is important to know when prisms and/or optometric vision therapy is indicated for patients with persistent diplopia secondary to scleral buckle surgery. Given the non-comitancy of the resultant deviations, optometric vision therapy activities modified to expand fusional reserves in all positions of gaze will help to minimize the diplopia and the final amount of prism prescribed for the patient. The two case reports suggest that patients with smaller vertical deviations could respond to passive optical treatment with compensatory prisms, while patients with larger vertical deviations may benefit from both optometric vision therapy and prism.


Keywords: diplopia, optometric vision therapy, prism, retinal detachment, scleral buckling, strabismus