Department of Ophthalmology (RGS, NL, HL, TP), Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine (RGS, NL, HL, TP, DR), Hebrew University of Jerusalem, Jerusalem, Israel; Goldschleger Eye Institute (RH-B), Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine (RH-B), Tel Aviv University, Tel Aviv, Israel; and Department of Ophthalmology (DR), Shaare Zedek Medical Center, Jerusalem, Israel.
J Neuroophthalmol. 2024 Sep 1;44(3):394-399. doi: 10.1097/WNO.0000000000001988. Epub 2023 Sep 1.
Despite the impact of new-onset diplopia on the quality of life, there are few studies concerning new-onset diplopia in seniors. This study aimed to describe the epidemiology, etiology, prognosis, and outcome of different treatments in the older adults compared with younger adult patients presenting with new-onset binocular diplopia.
A retrospective chart review of patients ≥18 YO with new-onset binocular diplopia presenting between 2010 and 2021. Data collected included age at presentation, gender, duration of time since diplopia onset, imaging results, known trigger, etiology, treatment, and follow-up.
Two hundred ten patients were included. Of them, 75 patients were ≤65 YO (35.7%, the "younger adult group") and 135 > 65 YO (64.3%, the "older adults group"). The common etiology in both groups was neurogenic (54.7% ≤ 65 vs 62.2% >65, P = 0.29). Cranial nerve palsies were more commonly microvascular in the older adults (96.0% vs 74.1%, P = 0.005), whereas tumor-related cranial nerve palsies were more frequent in younger adults (14.81% vs 2.04%, P = 0.03). A restrictive etiology was observed in 20% of younger adult compared with 11.1% of older adults group ( P = 0.08). Sagging eye syndrome (SES) was the second most common etiology in the older adults group at 11.9%, compared with 1.3% in the younger adult group ( P = 0.01). Decompensated phoria/tropia appeared in 16% of younger adult group compared with 11.9% of older adults ( P = 0.4), with an obvious trigger (mostly cataract surgery) in the latter (80% older adults vs 20% younger adults, P = 0.019). Positive imaging findings were found in 46.7% of patients ≤65 compared with 25.3% of >65 ( P = 0.01) and complete spontaneous resolution of diplopia was noted in 32.1% of the older adults compared with 11.8% of younger adults ( P = 0.003).
Neurogenic diplopia was the most common etiology for both groups, but is more prominent in the older adults. Noticeable findings in the older adults were SES diagnosis, identification of triggers for impaired fusion/diplopia, and a paucity of positive findings in imaging results. It is important to know these differences not only for managing seniors better, but also to minimize symptoms of binocular diplopia after lens-related procedures.
尽管新发性复视会影响生活质量，但关于老年人新发复视的研究较少。本研究旨在描述与年轻成年新发双眼复视患者相比，老年患者新发复视的流行病学、病因、预后和不同治疗方法的结果。
回顾性分析 2010 年至 2021 年间新发性双眼复视的≥18 岁患者的病历。收集的数据包括发病时的年龄、性别、复视发病后时间、影像学结果、已知诱因、病因、治疗和随访。
共纳入 210 例患者。其中，75 例患者≤65 岁（35.7%，“年轻成年组”），135 例患者>65 岁（64.3%，“老年组”）。两组的常见病因均为神经源性（54.7%≤65 岁与 62.2%>65 岁，P=0.29）。老年组更常见微血管性颅神经麻痹（96.0%与 74.1%，P=0.005），而年轻组更常见与肿瘤相关的颅神经麻痹（14.81%与 2.04%，P=0.03）。年轻成年组有 20%的患者为限制型病因，而老年组为 11.1%（P=0.08）。在老年组中，第二大常见病因是松垂眼综合征（SES），占 11.9%，而在年轻成年组中为 1.3%（P=0.01）。年轻成年组有 16%的患者出现代偿性斜视/复视，老年组为 11.9%（P=0.4），后者有明显的诱因（主要为白内障手术）（80%的老年组与 20%的年轻组，P=0.019）。≤65 岁患者的阳性影像学发现占 46.7%，而>65 岁患者为 25.3%（P=0.01）。老年组有 32.1%的患者完全自发缓解复视，而年轻组为 11.8%（P=0.003）。
神经源性复视是两组患者最常见的病因，但在老年患者中更为突出。老年患者的显著特征是 SES 诊断、发现影响融合/复视的诱因以及影像学结果阳性发现较少。了解这些差异不仅有助于更好地管理老年人，还可以最大限度地减少与晶状体相关手术相关的双眼复视症状。
