Macular Pucker and Double Vision

[tyblossom]

My Mom has a macular pucker, but her main complaint is not the wavy, but double vision. She's been going to the doctors for this double vision and has since had glaucoma surgery, cataract surgery and now they are saying macular pucker surgery. She asked her doctor would this fix the double vision and he said he didn't know why she had double vision. Now she is thinking she shouldn't risk such a serious surgery if this isn't even related to the double vision.

I've read on a couple sites that it could cause this, but it doesn't seem to be what most describe as the symptoms. Any and all help would be greatly appreciated.

Thanks in advance,

Stephanie

[JodieJ]

Yes, double vision can definitely be the result of a macular pucker.  It's thought that the "puckering" changes the photoreceptor distribution in the macula, thereby changing the image size in the affected eye.  (In the case of a macular pucker--aka epiretinal membrane or epimacular membrane, the image size is generally larger than in the fellow eye.)  The image size disparity between the eyes is called "retinally-induced aniseikonia."  It can produce such symptoms as headaches, photophobia, excessive tearing, nausea, distorted space perception, and (of course) double vision.  You can read up-to-date information about all this on Dr. de Witt's website at www.opticaldiagnostics.com (see the section "about aniseikonia".)  There is also an aniseikonia support group on Yahoo.

I became knowledgeable about retinally-induced aniseikonia through my efforts to diagnose and treat my own symptoms following ERM surgery (mainly excessive tearing and photophobia.)  It was my experience that even the finest retinal surgeons are unaware of the condition or the associated problems/symptoms.  Unfortunately, surgery to remove the pucker doesn't necessarily eliminate the double vision or other symptoms.  (There is preliminary evidence, however, that including ILM peeling in the surgery may be helpful in this regard.)  Treatment options include blurring the vision in the affected eye or wearing prescription lenses (contacts, glasses) to minimize the image size difference.  I've read that prisms ground into glasses aren't terribly successful at eliminating the double vision.

Please feel free to send me a personal message through this website for additional information, references in the medical literature, etc.  As you can guess, raising awareness about the condition has become a pet project of mine.

I    

I became aware  

  

[John C Hagan III, MD, FACS]

---