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Maculopathies affect point-to-point foveal correspondence causing diplopia. The effect that the maculopathies have on the interaction of central sensory fusion and peripheral fusion are different than the usual understanding of treatment for diplopia. This paper reviews the pathophysiology of macular diplopia, describes the binocular pathology causing the diplopia, discusses the clinical evaluation, and reviews the present treatments including some newer treatment techniques.

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The description of the orbital pulley system has changed the way we understand eye movements and ocular motility disorders. The presence of abnormalities in the orbital pulley system can complicate the assessment of vertical restrictive conditions. The standard tests for restriction are reviewed. These include version and duction testing, assessing saccades, differential intraocular pressure measurements, forced duction testing, and forced generation testing. We introduce the concept of situational restriction and how to look for it during your physical exam. Situational restriction is a limitation of ocular rotation that is dependent on the path that is taken to try to arrive at a tertiary position of ocular rotation. Specifically, it shows noncommutative movement that breaks Listing's Law. The presence of situational restriction denotes that a pulley abnormality is present.

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BACKGROUND: Evaluation of adults with a symptom of acquired double vision is a challenging diagnostic problem. This retrospective report reviews a series of adult patients who presented with a symptom of "double vision" but did not have diplopia related to a recently acquired or decompensated strabismus. The symptom of double vision was related mainly to blurred vision and often was not true binocular diplopia. METHODS: This is a retrospective study of medical records. RESULTS: 261 patients, age 40 years or older referred for a recent onset symptom of double vision were reviewed. Sixty-seven patients were included in the study. These patients presented with no findings that indicate a recent onset of incomitance or breakdown of a long-standing strabismus. The patients were divided into five groups with common etiologies and their findings were analysized. Group 1 (17 patients) had symptoms of double vision due to monocular blur without diplopia. Group 2 (21 patients) had symptoms of double vision related to monocular blur that caused a dissociation of a small phoria. Group 3 (10 patients) had symptoms of double vision related to superimposition of images due to a distorted image. Group 4 (13 patients) had symptoms of double vision related to convergence insufficiency. Group 5 (6 patients) had symptoms of double vision related to an induced tropia secondary to anisometropia correction. Options for treatment include improving vision and having the patient understand the nature of the problem. CONCLUSION: "Double vision" does not mean the same thing to the patient and the examiner. The examiner must distinguish true diplopia from other symptoms and be able to demonstrate this to the patient. Treatment is directed to the specific type of problem, but improvement of vision resolves the large majority of these complaints. Examination and treatment techniques are discussed.

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INTRODUCTION AND PURPOSE: To detect if dynamic visual acuity can be useful in the evaluation of a patient with vague asthenopic complaints including dizziness. METHOD: A review of the vestibular system and the vestibular ocular reflex as it relates to dynamic visual acuity. RESULTS: Ten patients with asthenopic symptoms and convergence insufficiency were tested with dynamic visual acuity. None were found to have a positive test despite a complaint of dizziness, indicating the lack of vestibular involvement. CONCLUSION: Testing for dynamic visual acuity may be useful in the examination of patients with vague complaints of dizziness. Patients who presents with vague asthenopic complaints often include dizziness. Dynamic visual acuity may be helpful in diagnosing vestibular problems so appropriate referral can be made.

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Assessment of refractive errors is an integral part of the treatment of ophthalmic problems. This is especially important in pediatric patients for early diagnosis of strabismus and amblyopia. In anisometropic amblyopia, careful monitoring of the refractive error is necessary. The following case history describes a patient who developed myopic axial anisometropia at age one. It suggests that the development of myopic axial anisometropia may be different than our present understanding. We reviewed the literature and found no description of the onset of myopic axial anisometropia.