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Cycloplegic Refraction and Ghosting
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Cycloplegic Refraction and Ghosting

Dr Hagan: I want to know your opinion about a "theory" i have regarding the ghosting that a lot of people claim to have but cannot be corrected by glasses (when other causes wre ruled out, such as corneal, macular disease, etc) and they dont know whats causing it.

You see, yesterday i had my chalazion surgery. 2 small chalazia were removed. The MD asked me to see him today in the morning to check if everything is going well. After he checked me, i told him about a ghosting issue that i have in my right eye (were the 2 chalazia were located). I told him that this ghosting issue is new and appeared after the chalazia, that is always there, being slight in the morning but veeeery noticeable in the night, because there is when the ghosting is completely separated from the original and not "just a little up" like in the mornings.

So, I said to him that i was suspecting that maybe it was caused by 1.- The chalazia causing temporal astigmatism and/or 2.- Dry eyes caused by blepharitis (because the ghosting worsens as the day goes by, just like dry eyes). He responded "I have never seen a chalazion big enough to cause astigmatism" and "Dry eyes? You are very young to have that (im 30), so forget about it. I think it is caused by uncorrected astigmatism so lets check your eyes right now".

I have to say, this was my first eye exam since i was 14 years old (16 years ago), and then the doctor told me i had a slight ammount of hyperopia in my left eye and gave me glasses that didnt do a thing so i never used them. My right eye, which is my dominant eye, always "worked extra" so when both my eyes were opened my vision was identical as if only my right eye was opened, so i never visited an ophtalmologist again, until today.

So, i had to look an image trough a machine, both eyes separately, and the machine printed the results. Then, the "Number 1 or 2" test. He concluded that i have hyperopia+astigmastism in my left eye (+1.75) and astigmatism in my right eye (+0.50). He said that is very likely that my ghosting is caused by this small astigmatism in my right eye. Now, with the "Number 1 or 2" test, even with the best prescription i couldnt see clearly. The MD suspects i have a small ammount of Amblyopia that was caused in my childhood because of the difference between the two eyes, so even with the best prescription possible or even surgery, my left eye will never be as clear as my right one.

Then i told the MD about something i can do at least since i was a teenager. I can "blur" both my eyes on command, and when i do so, i feel some kind of "relief" in my eyes. In fact, when I am at the computer working for several hours, my eyes tend to blur themselves, without "my command", like if they were looking for relief. I also told him that i have tested this with the pinhole test. If Im performing the pinhole test and try to blur my sight on command, then my sight doesnt change at all.

Now, if i blur my vision on command, the ghosting in the right eye dissapears, without the need of the pinhole (because with the pinhole the ghosting always goes away, blur or no blur), but my vision is blurred so that is not a solution.

The MD said "OK, im going to put this drops in your eyes, and in 30 minutes we will repeat the tests."

The test was repeated. +4.00 left eye, +2 right eye. Big difference.

He explained that im constantly accommodating my eyes in order to see well, non stop, and this can cause strain in my eyes. He said that every year that passes my accommodative power will be weaker and that i will notice it specially after 40, when the presbyopia kicks in.

So, he said "You can start to wear glasses, but i cannot give you the ammount you need right away, because this is going to confuse your brain that is already trained to do the focusing, so we will need to gradually make the change, and that means 1 year with one type of glasses, and another year with other glasses with more correction, and so on, until we reach the goal: Another option is surgery, so its your decisition."

Im pretty sure that the glasses will not fix the ghosting. This, because i've read several posts of young adults claiming a sudden onset of ghosting that cannot be fixed with glasses and all other causes ruled out (corneal disease, macular, etc).

So, finally, this is my question to you. Lets imagine for a moment that, when my glasses arrive and i put them on, the ghosting doesnt dissapear. So, considering that when i "relax" my vision and everything is "blurred" the ghosting dissapears, is there a chance that if i go trough eye surgery with the cyclopegic refraction and then i learn to have my eyes completely relaxed and not trying to focus all the time, that thet ghosting will dissapear then? Could it be possible that the ghosting is related to all the stress i put in my eyes in order to focus all the time?

I have my next apointment in a week in order to check my eyelid surgery, so its possible to try that "Numer 1 or 2" machine with my eyes relaxed ("blurred") and see if with the correct refraction the ghosting goes away? Because i saw the ghosting all the time during this test, from start to finish, and that is why im starting to think that when my new glasses arrive the ghosting will stay there. I mean, my vision was sharp and all, but the ghosting didnt change at all.

Thanks in advance and sorry for the lenght of the post.
5 Comments Post a Comment
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233488_tn?1310696703
Sorry I do not have the time to carry this discussion any further.
JCH MD
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Avatar_m_tn
Is not about "having time to carry on this discussion". I know my post was long but i thought i needed to elaborate not only to make myself more clear but also to leave a personal experience registered for future posters, which is one of the reasons for this board to exist.

All i needed was an answer to "is there a relation between the overuse of the ciliary muscle/accommodation and ghosting?", yes or no, based on your personal experience.

I was looking for an opinion from you, since you are the MD and you have the authority to respond. Even if you say "I dont know", "Maybe" or "Of course not", they are far better answers than "I dont have time", which is the same as saying "I dont care".

The only one who did lose time and effort was me, for making such a long post and receiving nothing but an "i dont care".

Have a good day.
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233488_tn?1310696703
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Avatar_f_tn
If there is a chance that dry eye could be causing your the ghosting issue in your right eye, why don't you try a course of moisturizing eyedrops, Restasis or other treatment to see if that makes a difference?

The worst that happens is that the ghosting doesn't change even if your eyes are well hydrated.  If you have a job or pasttime where you spend hours staring at a screen or otherwise focusing hard (when patient's blink rates often slow way down), I think it's possible you could have dry eye despite your age.

As far as the ghosting not being there when you deliberately 'blur' your eyes it could just be that you can't see it when things are so out of focus.

You might also ask a different eye doctor about the need for a schedule for training your eyes to use the actual amount of correction you need in eyeglasses or contacts.  I wonder what the harm would be in trying the actual prescription that's correct for you, and then just 'backing it down' a bit and having the lenses remade (which the doctor can request at no cost to you) if the actual prescription you need isn't comfortable for you?

Lastly, please be kind to the posters and doctors on this forum.  We all are volunteers who try to help as many people as we can.

Also FYI, there is a forum specifically for people who are looking for eye care experts (i.e. doctors) to answer their questions.  In the future if you want an eye doctor to respond to your question, you might try posting in that forum.  It's call the Eye Care Expert Forum.  Here is a link: http://www.medhelp.org/forums/Eye-Care/show/90

This forum, the Eye Care Community, is principally for patients although some professionals like Dr. Hagan do volunteer time to check in on this forum in addition to the Eye Care Expert Forum where he and other doctors regularly answer questions.  

Good luck in the future; I hope you find a solution to the ghosting problem and that the new glasses help relieve a lot of your eye strain.
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Avatar_m_tn
Thank you very much, flossy93. I will start with eye drops to see if that can help. In fact, recently i've found in an ophtalmologist blog that he received a patient with very similar issues. He discovered that the patient had blepharitis associated with MGD, and his tears where of a very low quality because of this. He prescribed a short curse of Azithromycin and hot compresses, and then daily lid hygine, and the ghosting disappeared. So, i think im going to start with eye drops, then Azithromycin, and then discuss other optims with the doctor.

Thanks again and have a good day.
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