Cataracts and diplopia

[rayr]

I have monocular double vision in both eyes.  It comes and goes fairly quickly.  It lasts between a few hours and a couple days.  It occurs in both eyes at the same time, but not to the same degree.  Sometimes I see two images quite clearly focused, other times it can be multiple images.  The double vision goes away completely if I look through a pin hole.  I went to an MD opthamologist who recommended new glasses.  I tried them and it makes little difference.  I went to an OD who thinks it is probably cataracts and referred me to a cataract surgeon.  I have an appointment at the end of the month.

From my reading double vision can be a symptom of cataracts.  I don't think I have other symptoms.  With cataracts does the double vision come and go quickly?   Any ideas of what else it might be that I should have checked?

[carolf706]

Hi Nancy ,I to have congential cataracts. I had left eye surgery feb 2010 now in mid may having left one . I two have many question like how could I have had lasik 9 yrs ago and then seen perfect for 6 yrs then my eyes started getting fuzzy. More question than answers. Carolf706

[rayr]

AS you might remember I have intermittent monocular bilateral diplopia.  I was first diagnosed with cataracts and referred to an eye surgeon.  I went to an ophthalmologist who said nothing the matter and prescribed new eye glasses which did not change the condition.  Yesterday I went to the eye surgeon.  He said my cataracts were very small and not the cause of my problem.  He said that I had Fuch's Endothelial Corneal dystrophy.  This was based on seeing divots in the cornea and measuring the cornea thickness with some device that contacted my eye.


On looking the condition up I don't see diplopia as being one of the
symptoms.  I don't seem to have the symptoms attributed to the
condition.  Any insight would be appreciated.  

[Nancy T]

Thanks for the info, Ray. You are right about the downward slope!

Why not have fun with it?--lie sideways and just roll down it, like a kid! :)

My ophthalmologist never suggested putting in a contact. I really don't know what he thinks. You can come up with all kinds of ideas about what's causing your symptoms, but doctors just don't have the time or inclination to go so far afield (and it seems to depend a LOT on their own interests, training, and fixed beliefs). As long as they can find a way to alleviate the worst of your symptoms, that's what they're concerned about. Not finding the underlying cause.

Good luck,

Nancy

[rayr]

I read about "Symptomatic Corneal Topographic Change Induced by Reading in Downgaze":  Thank you for pointing it out to me.  My diplopia is also aggravated sometimes by reading.  Again I am not a doctor, but my understanding is that diplopia is usually caused by cataracts and occasionally by misshapen corneas.  If indeed you problem is the cornea than the solution is simpler then if it is cataracts.  A hard contact lens (gas permeable) will force the cornea back to the correct shape and the ghosting should go away.  Next time you go to an eye care specialist have them pop in a hard contact lens and see if the problem disappears.  Again my understanding is that the cornea problems are less likely to go away when looking through a pin hole.  For understandable reasons doctors first look at the most common causes that they know how to fix and sometimes overlook the less common ones, or that they don't know how to fix.  

As we age we start wearing out.  You are just starting on the long downward slope.

I have a condition that affects about 2% of the population (RBD), not all that rare.  Most doctors I been to never heard of it.  You can't expect anyone to have the answers to all questions.

Let me know how you make out.

[Nancy T]

P.S. What I don't understand is why this problem would only begin at age 46 or 47 (long after my presbyopia started), nor why I have it when other people don't. It can't be a common thing, because neither my ophthalmologist nor the neuro-ophthalmologist that he called in had ever heard of it.

[Nancy T]

Thanks for the explanation of what happens with tipped head, pinhole, bright light, etc. I don't have any understanding of optics, but it makes sense to me that when tipping my head up, I'm looking through a different part of the lens and thus the vision is different.

However, according to what the ophthalmologist said, I only have the cataract in one eye (the right), and it is not the cause of my problem. Anyway since it's a congenital cataract, that means presumably that I've had it since birth (though I never knew it or noticed it, and this eye problem only began a few years ago. And the ghosting is the same in both eyes.

The only difference is that SOMETIMES when I get the ghosting (after a spell of reading looking down), my left eye gets a very odd but distinct "weak" sensation--only a sensation, it doesn't affect my eyelid or my vision--that also goes away as the ghosting does.

I've had the new glasses for two years. They don't correct the problem over time--but they do prevent the ghosting from occurring when I read (the ghosting otherwise comes on after a couple minutes of continuous reading looking down), and if I've already been reading without the glasses, if I put them on, it improves partially right away.

I have no idea how the prescription was different from my previous reading glasses. I'm pretty sure it wasn't just a matter of strength. The ophthalmologist said that the optician would think, from the way he wrote the prescription, that it was for bifocals, but it wasn't. I honestly have never paid attention to the numbers of my Rx because even if I knew what they meant, I'd never remember them. So I can't tell you what it is.

In searching around the Internet for any possible explanation of why the ghosting occurs when I read looking down but not when I read looking straight ahead, I came across this article, and it really sounds a LOT like my situation--the ghosting begins after a short time of continuous eye use looking down, and it resolves in half an hour or so after I stop reading. It makes perfect sense to me--that the cornea shape changes due to the eyelid pressure when you're looking down. I mentioned this to my ophthalmologist next time I saw him, but he was noncommittal and didn't seem excited about my theory (even though he was never able to give me any explanation).

"Symptomatic Corneal Topographic Change Induced by Reading in Downgaze":
http://****.com/3odd92

I may possibly have some kind of very mild autoimmune condition, as I've had strange undiagnosed symptoms for 9 years, some suggestive of MS, but certainly nothing definite. I have no idea if this is related to the ghosting problem--presumably not, but who knows!

Nancy T.

[rayr]

Your condition sounds similar to mine.  I am not a doctor, but an engineer by training, so I look at things differently.  For the condition to go away looking through a pinhole means the problem is most likely optical, probably the lens.  My understanding is that areas of the lens with different index of refraction forms a lenslet that causes the lens to focus at more than one spot, hence the double vision or ghosting.  This can be a result of cataracts.  As you look through different parts of the lens, ie. tilting the head, you are using different parts of the lens changing the effect.  When you read the shape of the lens changes to focus closer and will affect the lenslet.  Also bright light will cause the aperture to get smaller and act more like a pinhole.  All of these are consistent with cataracts and make the condition come and go.

I was prescribe different glasses.  While they slightly improve my vision, they do not cure the diplopia.  Again no surprise.  I see the cataract surgeon in a week and a half and if he sheds any more light on the condition I will post back.  I also posted to the news group sce.med.vision.  You may want to look there for some more discussion.

Others have said the t different glasses have improved the diplopia, but it usually returns.  How long have you been using your new reading glasses?  How much of an improvement have they made?  How different was the prescription?

[John C Hagan III, MD, FACS, FAAO]

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[Nancy T]

Please post updates about what you find out about your condition. I have vertical ghosting in each eye separately that disappears through a pinhole or when I tip my head up, but it only occurs after reading looking down or when I'm very tired. Do you notice anything that brings on your double vision? I have a congenital cataract (big surprise to me) and a little astigmatism, but they say those aren't causing the problem, and otherwise my eyes are healthy.

I've seen ophthalmologist and neuro-ophthalmologist and they don't know what's causing my problem, but they DID prescribe some different reading glasses that prevent the problem from occurring when I read.

Best of luck,
Nancy T.

[John C Hagan III, MD, FACS, FAAO]

Monocular double vision can occur due to cataracts, corneal disease including keratoconus, astigmatism, and macular disease.  Pin hole might "cure' the first ones listed but not macular disease.

It can vary with different size pupils due to differences in ambient light. I would see what the cataract surgeon finds. If he/she recommends surgery then I would get a second opnion, it if second opinion also finds cataract cause then you may want to consider cataract surgery.

JCH III MD