Major problems finding treatment for aniseikonia

[Emanuelle]

I had retinal surgery nine months ago to remove a macular pucker from my left eye.  One month post-surgery, I could read the bottom line of the eye chart with that eye, but I noticed that the image in my left eye was now about 10% larger than the image in my right eye.  When I told this to my retinal surgeon, he reacted as if it were insignificant.  Since my surgery, my binocular vision has been very uncomfortable.  I get headaches every day, my eyes tear a lot, and I sometimes get double vision with one image on top of the other.  My optometrist diagnosed aniseikonia, and she suggested that I get a referral to a strabismus specialist from my retinal surgeon.  He agreed to do this but never got back to me, and he doesn't respond to my phone calls or email.  I've called every ophthalmologist in my area listed as a strabismus specialist (more than a dozen), but each time I've been told that the doctor doesn't treat aniseikonia.  (Then who does?)  My optometrist suggested that I try the optometry school, but I struck out there, too.  My condition is making my life difficult, and I don't know where to get help.  

[John C Hagan III, MD, FACS]

Aniseikonia means that images are of different sizes. The condition is very common especially if the eyes have different refractive errors (one eye myopic and one eye hyperopic).  If one eye has had catararact and implant surgery and the other hasn't the image sizes will differ.  Most people can fuse or see singlely if the image are no more than 10-15 percent different. Macular surgery, macular pathology such as edema, retinal detachment surgery, cataract/implant surgery in one eye can all cause differences in image size.

There is really no treatment for aniseikonia per se. That does not mean you can't be helped. If there is a disease like macular edema if it disappears the images may be closer in size. If there is no disease to treat and the image size is permanent it can be helped.

We treat these conditions in our practice. Some of the methods involve: spectacles (glasses), contact lens on the eye with the 'biggest image', prism glasses and refractive surgery most often LASIK on one eye. The latter is what we use most.

Also a strabismus surgeon is what you need to evaluate your double vision.

I would make an appointment with a highly recommended strabismus surgeon and go in for an evaluation, I believe they will be able to help you.

JCH MD

[Emanuelle]

Thank you very much for your response.  When I've called the offices of highly recommended strabismus specialists, I've been told that the doctor doesn't treat aniseikonia.   But per your suggestion, I'll go ahead and set up an appointment anyway.

Please give me more information about how LASIK might help me.  I already have almost 20/20 vision in both eyes without glasses.

[John C Hagan]

The most common cause of aniseikonia is unequal refractive error. In that case lasik is done to reduce the myopia or hyperopia in the eye with the strongest refractive error. Since your problem is the macula/retina problem and you have no significant refractive error, lasik will not help you.

JCH MD

[Emanuelle]

Thank you for the information.  Finding a doctor who is knowledgeable about aniseikonia has proven to be very difficult and frustrating.  I'll try your suggestions.