Cause of Monocular Diplopia Diagnosed by Combining Double-pass Retinal Image Assessment and Hartmann-Shack Aberrometry

Journal of Refractive Surgery
Guillermo M. Pérez; Salomé Abenza; Alvaro de Casas; Jose M. Marín; Pablo Artal

Purpose: To report an advanced optical procedure developed for the diagnosis of a particular case of diplopia.
Methods: This approach combined the quantifi cation of the level of intraocular scattering by using an Objective Scatter Index provided by a double-pass instrument (Optical Quality Analysis System) with the analysis of higher order aberrations using a Hartmann- Shack wavefront sensor.
Results: The value of the Objective Scatter Index revealed increased intraocular scattering; the Hartmann- Shack images showed the existence of an optically differentiated area at the upper region of both crystalline lenses. Simulation of retinal images computed from the wavefront maps confi rmed that, under low luminance conditions, this inhomogeneous region of the lens was included in the pupil, generating a secondary image and therefore the diplopia.
Conclusions: This report demonstrates the potential of combining two objective optical methods to show the presence of minor lens opacities that may severely degrade quality of vision.