Comatic aberration as a cause of monocular diplopia

Three patients (5 eyes) presented with complaints of monocular diplopia and no history of ocular trauma or surgery. The patients had comprehensive neuroophthalmic evaluation including manifest refraction, anterior segment and dilated fundus examination, and corneal topography. All patients also had wavefront analysis using the LADARWave system (Alcon). Two patients (4 eyes) also had hard contact lens overrefraction. The patients had a normal initial examination including corneal topography. One patient (2 eyes) did not experience resolution of diplopia with pinhole. No eye improved with manifest refraction or hard contact lens overrefraction. However, each patient had a significant amount of coma on wavefront analysis. Moreover, eyes with horizontal diplopia had horizontal coma and eyes with vertical diplopia had vertical coma as measured with the wavefront device. Higher-order optical aberrations such as coma may be associated with monocular diplopia. Wavefront technology may be useful in the workup of monocular diplopia.