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Preoperative Binocular Considerations

Correspondence: Requests for reprints should be addressed to: Lisa Morris, C.O., The University of Michigan, Kellogg Eye Center-Pediatric Clinic, 1000 Wall St., Ann Arbor, MI 48105. email: lisamor{at}umich.edu

The development of normal binocular vision is a complex and delicate process that begins during the early critical period of vision development in infancy. Any insult to the immature visual system, such as improper alignment of the visual axes, or asymmetric retinal images, will result in specific sensory adaptations designed to provide the best possible binocularity in spite of the underlying result. One such adaptation is anomalous retinal correspondence (ARC), the detection of which is a critical step in the preoperative testing process. While the presence of ARC is not necessarily a contraindication to strabismus surgery, evaluation of retinal correspondence is necessary to determine the risk of postoperative paradoxical diplopia or the likelihood of repeat muscle surgery. ARC can be detected using equipment found in every ophthalmologist’s office; however, a small but worthwhile investment in a pair of Bagolini glasses is recommended for easy and reliable testing.

Key words: anomalous retinal correspondence (ARC), binocular vision, diplopia, prism adaptation