Double vision after cataract surgery

I had cataract surgery on my left eye six days ago and have been having double vision when I look to my left with both eyes open. If I close my right eye then I don't get the double vision. When I look to my right with both eyes open I don't get double vision. Is it possible that the reason why I get double vision when I look to the left with both eyes open is that right eye became so dominant during the many months before the surgery when I couldn't see much with my left eye because of the cataract? If so, is there some kind of exercise that I could do to get the two eyes to work better together?

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

Exercise will not help. There is extended discussion of double vision after cataract surgery you can access with the search feature.

Ask your surgeon about it.

JCH MD

[Skylink]

Dr. Hagan,

Thanks for your response. I can't see my surgeon until mid January, and besides, it's probably his incompetence that caused this in the first place, so I guess I will have to look for someone who might be able to fix it. I should have searched for a good cataract surgeon initially. I have found some discussion of this problem, including yours, that provides some helpful explanation of the condition.

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

Where do you live that you do not have access to your surgeon? When we do surgery if a patient has a problem we see them the same day. How can they put you off that long?
JCH MD

[Lerbea]

You have to tell the "Receptionist" that it is a complication with the surgery.  Be adamant about it.  Usually the schedulers are just out of high school and can't determine appropriateness for such things.

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

If you live in the USA there's no reason to put up with that. We don't have socialized medicine yet. Ask to speak to the surgeon's nurse. You can demand to come in and be seen before Janauary.  If socialized medicine comes to the USA this will be the norm or worse.

JCH MD

[Skylink]

How did you know that I live in Canada? I agree that a private medical system is superior to socialized medicine. The big problem here is not so much the quality of service, which in many areas is excellent, but the incredibly long wait times. Governments just cannot anticipate patient needs like the market can, and even when the government knows about a need, it is usually loathe to invest sufficient money in addressing it. When what should be a medical and/or economic decision becomes a political decision, the results are usually not so good. I believe that eye surgery is one of area of greatest physician shortage here. The typical waiting room at an eye clinic evokes images of the Saigon Airport at the end of the Viet Nam War.

Getting to my eye situation, I want to thank you - and Lerbea - for prodding me to seek attention. I phoned this morning, and to my surprise I was told to come right in. Of course that was easier said than done, because of a raging blizzard. But after an hour  and half drive and a two and half hour wait, I got to see one of the other eye doctors at the clinic. I should say that the area of my double vision had gotten a little smaller in the past few days. If I look straight ahead and then roll my eyes to the left, I start seeing double images at about 30 degrees to the left, and when I get to about 75 degrees, the double image is gone. Besides the usual things, the eye doctor tested my vision with what looked like a set of prisms, and some replicated the condition, and some made it go away. His diagnosis was that it was due to an inflammation of a muscle, caused by the needle inserted for freezing. He thought that it was not serious and would go away.
If this condition does go away, it will do so in more than 10 days from the surgery. I mention that because in one of your posts you said that if double vision persists more than 7-10 days it is likely to be permanent. I hope there is some margin of tolerance around that 7-10 day estimate.

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

I don't want to seem like I'm bragging but I've written more articles on double vision following cataract surgery than any other surgeon. You can probably read this on the internet.

81. “Diplopia Cases After Peri-bulbar Anesthesia without Hyaluronidase”, Hagan III JC, Whittaker TJ, Byars SR Journal of Cataract & Refractive Surgery, 25:1560-61, 1999

82. “Diplopia and Ptosis Following Injection of local Anesthesia Without Hyaluronidase”, Jehan FS, Hagan III JC, Whittaker T, Subramanian M. Journal of Cataract & Refractive Surgery, 27:1876-1879, 2001

84. “Use of a Compounding Pharmacy Hyaluronidase for Ophthalmic Injection Anesthesia”, Hagan III JC, Hill WE. Journal of Cataract & Refractive Surgery, 27:1712-1714, 2001

90. “Permanent Diplopia Following Cataract Surgery”, Journal of Cataract & Refractive Surgery, 27: 341-342, 2001

103. “Persistent Vertical Binocular Diplopia After Cataract Surgery”, American Journal of Ophthalmology, 133:860-861, 2002 (correspondence)


All I can say is time will tell. The problem is much less common if hyaluronidase was used in the injection. Next time in you might ask them.

I guessed you were from a country with socialized medicine because that would never fly in private practice. We see any caller the same day for urgent and emergency care, we answer every call from every patient, we can get same day CT and MRI scans, same day hospitalizations. Cataract surgery can be done in one to two weeks of scheduling. Our offices are clean, modern, not crowded and full of smiling helpful people.

Even the "good" care of the UK and Canada becomes bad care if its unavailable or you have to wait too long for it (as all the Canadians coming to the USA for MRI/CT  and neurosurgery, orthopedic surgery, heart surgery, eye surgery, etc attest.

JCH MD

[Old_goat]

What part of the USA can you get to speak with your eye doctor?.  I live in Sarasota, FL and I've had double vision since my surgery almost 5 weeks ago. I have been dismissed as a perfectionist by the Dr's assistants, but now need glasses to read, use the computer, watch TV, play tennis and drive.  I don't know what I'll do if I get caught out driving and it starts to rain.  I was terrified before I had the second eye done 2 weeks after the first but fortunately that one turned out very well.  I've read on the 'net that any corrective work on the IOL should be done quickly before scar tissue builds on the device.  What do you think?
John Ramsay

[JodieJ]

I think that you should demand an appointment with the doctor.  If your doctor is unable or unwilling to help you, then get another opinion from someone experienced with your IOL.

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

As always I agree with JodieJ

JCH MD

[Lerbea]

A definate 2nd opinion is in order here.  

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

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