Case Report: Management of Retinally Induced Aniseikonia

Introduction Retinal aniseikonia can be caused by nonuniform changes to photoreceptor distribution, limiting the effectiveness of optical treatments in resolving symptoms. In patients with minimal refractive error, commonly after cataract extraction, contact lenses are ineffective in alleviating retinal aniseikonia. Even with iseikonic correction, patients can experience diplopia on vertical gazes due to induced prism. Evaluation and focus on the optical treatment of retinal aniseikonia will be discussed. Case Report A 61-year-old man presented with right eye macropsia and binocular diplopia. He had a history of epiretinal membrane peel in the right eye, pseudophakia in the right eye, and lamellar hole in the left eye. Single-vision distance iseikonic lenses were ordered based on the subjective refraction, ocular posture, and partial iseikonic correction. His diplopia was mitigated using lined bifocals, iseikonic correction, and slab-off prism. Conclusion Retinal aniseikonia can be difficult to manage due to nonuniform changes to retinal anatomy. Achieving treatment success with contact lenses is especially challenging when there is minimal refractive error. This case demonstrated functional success using iseikonic lenses, a bifocal design, and slab-off.