Strabismus, ophthalmoplegia, gaze palsy, and decompensated binocular skills are some of the visual sequelae to head injury, stroke and other neurologically compromising conditions. If the patient does not have and organic loss of vision, or does not suppress, diplopia ensues. Vision therapy and/or prisms and lenses can sometimes help the patient achieve fusion and alleviate the diplopia. When these are not successful and fusion cannot be achieved, intractable diplopia results.
Various methods have been tried to eliminate diplopia. These include constant patching, alternate patching, and a fogging lens. Although these are all effective methods to eliminate the diplopia, there are side effects. They seriously impair peripheral vision and peripheral fusion which in turn impairs orientation, mobility, balance and peripheral field of view. A new method that does not have these limitations has been successfully evaluated.
The "spot patch" is a method to eliminate intractable diplopia without compromising peripheral vision. It is a round patch made of Transpore tape, 3-M blurring film (or another such translucent tape). A mirror coating, or tint can be placed on the lens to improve cosmesis and reduce other people’s ability to see the spot patch. The spot patch is placed on the patient’s glasses and directly in the line of sight contributing to the diplopia. The diameter is generally about one centimeter, but will vary on the individual angular subtense required for the particular strabismus, or gaze palsy. Final size and placement is determined by evaluating different sizes and shapes to arrive at the smallest one, which effectively eliminates the diplopia. If the patient is a constant unilateral strabismic, or has a unilateral gaze palsy, then the spot patch can be placed before that eye. Otherwise, an alternate spot patch is indicated.
This method has now been used on hundreds of patients with resounding success. It has allowed these people improved balance, mobility, field of vision, and, certainly not least of all, better cosmesis. Given these advantages, the spot patch should become a first option of choice for patients with intractable diplopia.
