Taylor & Francis publishes Strabismus – a quarterly journal online out of the UK that frequently contains thought-provoking articles. The current issue is no exception, and features free access to an article on Assessment of the Density of Suppression to Identify Risk of Intractable Diplopia in the United Kingdom. (For those not familiar with the term, intractable diplopia is double vision that won’t go away.)
The article is noteworthy for multiple reasons. One is the widespread disparity among orthoptists in assessing the relative risks for intractable diplopia, both in terms of methodology and age factors. Even more insightful are the speculations at the conclusion of the article, and I’ll list a number of them:
- Although the risk of intractable diplopia induced by treatment is modest, the reported incidence may be underestimated due to the reluctance of respondents to admit to having induced intractable diplopia.
- For the individuals involved, however, intractable diplopia has substantial quality-of-life implications.
- It is possible that “latent” cases may be caused where a reduction in density of suppression occurs during treatment without diplopia, but patients then present later in life with intractable diplopia.
- The issue of intractable diplopia and amblyopia treatment may take on greater significance given the impetus to treat teenagers and adults in light of visual neuroplasticity.
- When improving acuity in older children and adults with amblyopia via dichoptic methods to reduce suppression and improve binocularity, there is no evidence that the increase in plasticity reported will enable suppression to be regained if fusion is not possible.
- It is likely that in current practice, amblyopia treatment in some children is either being unnecessarily withheld due to the perception of a risk that does not exist, or perhaps more likely some are at risk yet the true extent is not yet known.