Bitemporal hemianopia; its unique binocular complexities and a novel remedy

Bitemporal hemianopic visual field impairment frequently leads to binocular vision difficulties. Patients with bitemporal hemianopia with pre-existing exophoria complain of horizontal diplopia, sometimes combined with vertical deviation (with pre-existing hyperphoria). The symptoms are a result of the phoria decompensating into a tropia (hemi-slide) due to the lack of retinal correspondence between the remaining nasal fields of both eyes. We measured these effects using a dichoptic perimeter. We showed that aligning the eyes with prisms could prevent diplopia if the bitemporal hemianopia is incomplete. We also describe the successful use of a novel fusion aid - the 'stereo-typoscope' - that utilizes midline stereopsis to prevent diplopia resulting from hemi-sliding in patients with complete bitemporal hemianopia.