Effects of scleral search coil wear on visual function.

PURPOSE The scleral search coil is widely regarded as the gold standard measurement technique for eye movements. The effect of wearing scleral search coils on human vision has not been systematically studied. However, there are anecdotal reports of degraded visual acuity, mild eye irritation, and an increase rise in intraocular pressure (IOP). The current study was conducted to investigate the effect of scleral search coil use on visual acuity and ocular integrity. METHODS Six subjects were examined; all had previously worn search coils. Two drops of topical anesthetic were administered before insertion of the coils. Coils were inserted by hand and secured by applying mild pressure. The coils were removed after 45 minutes or on request of either the subject or the clinician. Before, during (at 15-minutes intervals), and after the coil was worn, the following measurements were taken for both eyes: tonometry (noncontact), corneal topography, biomicroscopic examination, visual acuity (monocular Snellen), and an eye-discomfort rating. RESULTS Scleral coils produced a variety of effects, including ocular discomfort, hyperemia of the bulbar conjunctiva, increased IOP, buckling of the iris, grade 2 and 3 corneal staining, and reduction in visual acuity. Effects appeared as early as 15 minutes after insertion of the coils. All observed effects seemed to be transient and dissipated after coils were removed. CONCLUSIONS Scleral coils may not be appropriate for all subjects. The findings suggest that there is a need for thorough subject prescreening and that clinicians should consider the risk/benefit ratio. Acute reduction in visual acuity may confound search coil findings. More research is needed to determine the maximum wearing time for properly screened subjects.