Two images not fusing properly after surgery in one eye

Dear Doctor:  

When reading a printed page, using the un-operated left eye, the line of print looks like a roller coaster heading slightly uphill; with the right operated eye,  the rollercoaster is starts below and to the left and heads more sharply downhill.  In no place do the two lines meet and to the right they move farther and farther away from each other.  When I am driving, a rectangle shape such as the car in front of me,  looks fairly normal with the un-operated left eye, and with right eye looks like it has been stepped on, and it slants down towards 5 o’clock, .  Because these two images do overlap,  I see a larger object - - the shape of the normal car as well as the shape of the car if it had a flat tire on right side.

My eyesight was normal before I had a cataract operation and a Crystalens was implanted in  the right eye. Afterwards, in that one eye, I had blurred vision which could not be corrected with prescription lens, I saw wavy lines on the Amsler grid, and had huge floaters.  .  A vitrectomy was performed 1 ½ years ago to treat macular pucker and persistent edema, after which my vision became clearer.  I should mention that my operated eye is now -1.50 and the unoperated eye is -3.75.

Now that the vision is clearer, I’m trying to address the fusion problem.  It may have started after the crystalens operation because I complained of objects “jumping around”.  Recently, my doctor told me that prism glasses would add to the confusion and said my brain will adjust (it hasn’t).  A second doctor saw a secondary cataract and wants to do YAG to polish the lens, saying the lens may shift and correct the problem.  I would appreciate any thoughts or suggestions.   Thank you.

[JodieJ]

I think that your problems are related to some residual retinal damage in your right eye due to your macular pucker and the surgery to peel it.  Your photoreceptors have not quite returned to a normal distribution.  According to what I've read in the medical literature, prism glasses don't help such problems.  Unfortunately, I don't think that it's necessarily true that your brain will adjust.  YAG might improve your acuity, but it's not going to change your retina.

There are a few potential treatment options.  Please let me know your email address (by personal message) so that I can send you a couple of papers:  "Dragged Fovea Syndrome" by De Pool et al and "Non-Surgical Management of Binocular Diplopia Induced by Macular Pathology" by Silverman et al.  (The first paper was obtained through personal communication with a co-author and is not available online without a fee.)  Basically, these papers suggest slightly blurring the vision in the affected eye in order to get more comfortable binocular vision.  Such techniques apparently work very well for some people, but I have to admit that they did not work for me (probably because my retinal problem involves an image size difference rather than a position difference.)

Improving your binocular vision will probably involve a trial-and-error process.  If you're interested, I could put you in touch with another woman who has a macular pucker in both eyes and has made some progress making her binocular vision more comfortable.

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

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[caren123]

I am so grateful to both of you for your help.  Jodie J, I am very interested in your research and will be in touch with you.  If I might, I would like say that I wish I had not chosen the Crystalens.  What I dream about is that the crystalens could be replaced with a standard lens.  This is because I have heard so many times about people who receive the standard lens do not need glasses at all except for small print.  Does that depend on one’s eye measurements?  I need glasses for both small print and distance due to the  -1.50 refractive error after a measurement error.

A major problem with crystalens, in my opinion, is that if there is no distance vision and lasik is done to change it to distance, the close vision is lost.   However, although I do not have the wide range of vision I had hoped for (and paid for) I will accept it if a lens exchange risks include more serious problems to the retina.  By the way, a crystalens center of excellence doctor said the reason he would not recommend the lens to those with retina issues is that they would not be able to receive the full benefits the crystalens has to offer.
Thanks again.

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

JodieJ is so knowledgible that I rarely find it necessary to add additional comments.

Thanks JJ

JCH MD