| Sumario: | Background: Aniseikonia is a condition in which there are different image sizes in the two eyes. Post-surgical anisometropia from corneal transplant, cataract surgery, or epiretinal membrane peel continues to be the primary cause and sometimes is large enough to remain symptomatic even after contact lens (CL) correction. Clinical measurement of aniseikonia is rare and uses obsolete instrumentation long out of production. This case report details the diagnosis and treatment of a symptomatic patient with significant anisometropia, pseudophakia OS, and post-penetrating keratoplasty OU secondary to keratoconus. Treatment included using size lenses and common clinical equipment. Case Report: A 62-year-old female presented with diplopia and blurry vision. Due to her irregular astigmatism, the manifest refraction was unreliable. The patient was fit with a large-diameter corneal gas-permeable CL OD (-11.50 DS) and a scleral CL OS (-2.50 DS) to correct her irregular astigmatism OU. Best-corrected acuities were 20/20 OD and 20/30 OS. After contact lens correction, the patient noted poor depth perception, clumsiness, and non-specific asthenopia. Using the Brecher test, aniseikonia was diagnosed. Aniseikonia was measured at 6% larger retinal image OS using plano magnifiers (size lenses). A 6% size lens was prescribed for the OD with a 2 prism diopter base-in correction. A 10 D base curve (BC) spectacle lens in CR-39 (n=1.498) and standard 1.5 mm center thickness was prescribed OD, matching the BC of the plano magnifier accepted on trial framing over the patient's contact lens correction for residual post-surgical aniseikonia. The following year, the aniseikonia measured at 7%, but the patient preferred the thinner 6% magnifier since it still allowed fusion. Horizontal prism correction was changed to 4 prism diopters base out. Conclusions: The Brecher test combined with a size lens set, lens clock, and specialty CL can be used to diminish or to eliminate aniseikonia without requiring additional mathematical calculation of spectacle base curve or center thickness.
|
|---|