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Impaired Vertical Phoria Adaptation in Patients with Cerebellar Dysfunction

¹ From the Departments of Ophthalmology and ² Neurology, Okayama University Medical School, Okayama, Japan.

PURPOSE. To determine whether phoria adaptation to a vertical prism disparity is altered in patients with cerebellar dysfunction.

METHODS. With a computer-aided haploscope, adaptive responses of fusion-free eye position to a 10- or 30-minute period was measured in subjects wearing a 3-prism diopter vertical prism over one eye. Thirteen patients with well-documented cerebellar diseases who did not have manifest ocular misalignment or limited versional eye movement and age-matched healthy subjects participated.

RESULTS. The mean ± SD percentage of vertical phoria adaptation was 13% ± 22% and 20% ± 16% for the 10- and 30-minute adaptations, respectively. These levels were significantly smaller than the respective ones in the age-matched control group (P < 0.001, repeated measures MANOVA). Seven (54%) of 13 patients, including two with genetically confirmed pure cerebellar lesions (spinocerebellar ataxia type 6), showed markedly reduced responses to both the 10- and 30-minute adaptations. In all three patients with acute cerebellar ataxia, the adaptive response was improved at the same time as remission of cerebellum-associated neurologic deficits.

CONCLUSIONS. Phoria adaptation to vertical binocular disparity is frequently impaired in patients with cerebellar dysfunction. These results bolster the hypothesis that phoria adaptation is a cerebellar-dependent response.

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