Purpose. This case report presents the management of symptomatic retinally induced aniseikonia and a short review of the literature pertaining to two clinical tests used in the measurement and management of aniseikonia. The clinician is also provided a review of how to design eikonic lenses.
Case Report. A 30-year-old white male presented with symptoms of perceived image size difference after scleral buckle repair for retinal detachment in the right eye. Three measures of aniseikonia resulted in markedly different values, but all indicated larger perceived left eye image. Stereopsis was measured before and after placing an afocal magnifying lens over the right eye. Stereopsis improved immediately upon placement of the afocal lens, with further improvement after 20 minutes, and stereopsis decreased upon removal. The patient reported improved visual comfort for near work with the afocal lens. Eikonic glasses were designed, and the patient reported improved comfort for near work that has remained for over 1 year of wear. Studies evaluating the validity and reliability of the New Aniseikonia Test and the Aniseikonia Inspector are reviewed. Most studies report that induced aniseikonia is underestimated. This case report illustrates that despite the problem with underestimation, these tests are useful clinical tools to identify whether aniseikonia exists and which eye has the larger perceived image. Results can be used as a starting point when making clinical decisions about managing aniseikonia. The Aniseikonia Inspector also assists in the design of eikonic glasses.
Conclusions. Even when aniseikonia is substantial, variable in magnitude, and irregular due to retinal disease, reducing the overall aniseikonia can improve binocularity and patient's comfort noticeably for the long term. The underestimation of induced aniseikonia in clinical tests does not preclude their use as a tool in the management of symptomatic aniseikonia.