occlusive contact lens for Diplopia

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Soft contact lenses can be used to help people with intractable diplopia. The use of a contact lens that occludes the center of the contact lens will stop double vision. The occlusion is black and looks like the patient’s natural pupil.

A novel scotogenic contact lens may be as effective in eliminating binocular diplopia and superior in preserving patients’ visual fields compared with standard occlusion, according to a study.

Binocular diplopia requires immediate symptomatic control, usually with eye patches or opaque contact lenses. In eliminating symptoms, current standard occlusion techniques reduce peripheral vision between 48% and 76%, the study said.

Parashkev Nachev, PhD, MRCP, and colleagues introduced a prototype for a soft contact lens device that creates a monocular central scotoma inversely mirroring the physiological variation in spatial acuity across the monocular visual field, which simply blurs the image in the corresponding pattern.

“The theoretically optimal occlusive treatment for diplopia is not complete occlusion of one eye, but a graded pattern of degradation of the image in one eye, corresponding to the inverse of the spatial acuity function across the monocular visual field. We have created a prototype contact lens that achieves this,” Nachev told Ocular Surgery News.

Novel device vs. conventional patching

The prototype scotogenic lens was created by precipitating barium sulfate within a soft contact lens with radially thinning edges of an overall approximate diameter of 7 mm.

“The device preserves the patient’s peripheral visual field in the occluded eye. This means that the binocular visual field remains essentially normal, preserving the aspects of visual function that are sensitive to having a full field,” Nachev said.

The study evaluated the lens in 12 subjects with artificially induced diplopia and 12 subjects with symptomatic diplopia of varying causes compared with conventional eye patching. Subjects were randomized to wear the scotogenic lens or a black eye patch on one eye for 30 minutes of free reading and room exploration. Comfort, aesthetics, effectiveness in eliminating the symptom and overall success were rated on a 10-point scale questionnaire.

Questionnaire results

The 12 normal subjects graded both methods equally effective in symptom control and comfort, with scores of 8.42 and 6.5, respectively, for the eye patch, and scores of 8.75 and 6.17, respectively, for the scotogenic lens. The lens was rated significantly superior in aesthetics and overall assessment, with scores of 2.33 and 6.42, respectively, for the eye patch, and scores of 8.75 and 8.67, respectively, for the scotogenic lens.

In the patient group, both methods were effective in abolishing symptoms, with the eye patch receiving a score of 9.73 and the scotogenic lens receiving a score of 9.27. The scotogenic lens was significantly superior in all other measures, with scores of 7.45 for comfort, 9.45 for aesthetics and 8.54 for overall assessment, compared with scores of 4.36 for comfort, 2.0 for aesthetics and 4.18 for overall assessment in the eye patch ratings.

“Though seemingly peripheral in significance as well as location, the peripheral visual field is actually crucial to navigation in everyday life, and so preserving it is far more important than seems at first glance,” Nachev said. “The device is also cosmetically more attractive than a patch, for it is no different from a colored contact lens, though of course this is something it shares with fully occlusive contact lenses.”

Marketing the scotogenic lens

Nachev recommended the device for anyone with double vision of any cause in whom contact lenses are not contraindicated and prismatic or other symptomatic correction that aligns the two images is ineffective.

“It could be used long term or as an interim solution while waiting for definitive treatment (eg, surgery),” he said. “It could be particularly helpful for those especially sensitive to changes in their visual field, such as those who live and work in environments that are complex to navigate.”

Nachev and colleagues are currently working on implementation of the device with an industrial partner, with hopes to market the scotogenic lens worldwide in the future.

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