Comparison of a diplopia questionnaire to the Goldmann diplopia field

PurposeTo compare diplopia scores obtained with a new diplopia questionnaire to the established Goldmann diplopia field.MethodsSeventy-five consecutive patients with binocular diplopia associated with any type of strabismus were assessed with the diplopia questionnaire and the Goldmann perimeter. Diplopia was scored, according to published protocols, from 0 to 100, where 0 is no diplopia and 100 is diplopia in all measured positions. Where there was a discrepancy of more than 20 points between the Goldmann diplopia field and the diplopia questionnaire, two observers classified the reasons for the discrepancy.ResultsThere was fair overall agreement between the diplopia questionnaire and the Goldmann diplopia field, with 44 (59%) of 75 patients having agreement within 20 points (intraclass correlation coefficient 0.53, 95% CI 0.35-0.68). Of the 31 (41%) of 75 patients who had a discrepancy of more than 20 points, 13 (42%) of 31 exhibited a higher diplopia score with the diplopia questionnaire than the Goldmann perimeter, and 18 (58%) of 31 showed a higher diplopia score with the Goldmann diplopia field than the questionnaire. The most frequent reason for a higher diplopia questionnaire score was the proximal test distance of the Goldmann diplopia field (6 of 13 cases). The most frequent reason for a higher Goldmann diplopia field score appeared to be patient adaptation to diplopia (9 of 18 cases).ConclusionsThe diplopia questionnaire may better represent binocular diplopia in everyday life than the Goldmann perimeter, capturing adaptation to diplopia, suppression, fragile fusion, and diplopia with distance fixation.