Undiagnosed Visual Symptoms

[acnenoodle]

Hi Eye Care / Neurology,

Since Feb 2022 I have been having some strange visual symptoms which are hard to describe;

- I cannot focus my attention on something in particular to take in fine details anymore (for example trying to focus on a single letter in this sentence), nothing is blurry but I just kind of zone out and feel as if I can't process the same as I used to. The best way to describe it would be to say that my vision used to be sharp like a laser
when I focused on something, now it feels as if my vision is more diffused like the light coming from a torch.

- I get a kind of dizzy, nauseous feeling which 100% feels visually triggered, the feeling is around my eyes but is also hard to describe.

- I cannot wear my glasses anymore as my eyes just feel strained, this happens whenever I wear them no matter the time. Strangely I do not get the same strain with my contact lenses but I still get the other symptoms mentioned above.

I originally ignored it and thought it was just stress however it went on for so long I went back to my optician and he found that my eyes have developed 1 point of astigmatism which I have never had before, I was glad he found something and when reading that astigmatism is a refraction issue I thought it made sense considering my symptoms. I got astigmatism correction in my glasses but that did not resolve the symptoms and 3 months later I went back and he found 1 more point of astigmatism in each eye (he said it was slightly unusual to develop another point of astigmatism in a short space of time) but equally said it's nothing to worry about.

After getting a second set of lenses for the 2 points of astigmatism and still having the same symptoms I went to my GP and asked for an MRI to rule out anything sinister, I got a brain MRI which came back clear apart from a 7mm pineal cyst which was repeated with a contract injection and did not enhance. I then read that pineal cysts can cause visual disruption, vertigo etc I went to see a neuro-ophthalmologist who has seen many people with Pineal problems and was sure that I don't have a pineal problem (don't show signs of Parinaud's Syndrome) etc and referred me to an orthoptic for a binocular vision assessment and eye movement / convergence tests which he did not find any issues.

It has been 6 months since and my symptoms have not got better and I still can't even wear my glasses without immediate strain, I struggle to watch tv and comfortably drive as well as working on a computer. Someone said my symptoms could be jaw / TMJ related and I went to my dentist and he found a problem with my bite, got my top 2 wisdom teeth removed and saw a TMJ specialist who wasn't convinced I have an issue which could cause these symptoms.

I am beginning to worry again that my pineal cyst may be causing these symptoms as I feel as if I have tried everything now, would all vision related pineal problems be detected by a specialist in person or is there a chance that my eyes are fine but I have some processing issues?

Is there any other tests that may be beneficial for me or any over avenues to try which could be causing these symptoms?

Is there a chance that even with astigmatism correction I have symptoms which could potentially be resolved by laser eye surgery?

Should I get a second opinion from another neuro-ophthalmologist / orthoptic?

Thanks

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

Astigmatism is measured in diopters not points,  The spherical power is also in diopters. The amount of astigmatism you have 0/75 diopters is extremely mild. I have no idea what your eye doctor was talking about.  Also when a person wears contast: soft, toric or especially gas permeable they often do not see as well with the glasses. This is because the contact lens after being worn for several hours temporarily changes the shape of the cornea. The glasses were prescribed usually after 8 hrs of not wearing contacts. This trouble with glasses and contacts is called 'spectacle blur'   If the neuro-ophthalmologist was not concerned at the present with the pineal cyst, you should not be either unless something changes.  Perhaps a better course to take is to see someone about your anxiety.

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

1. what is your age?
2. post your glasses prescription.
3 Do you still wear contact lens? If so hard or soft, spherical or toric/astigmatis contacts.

[acnenoodle]

1. 25
2. -2.25 D -0.75 CYL 170 Axis (RIGHT EYE) / -2.25 D -0.75 CYL 180 Axis (LEFT EYE)
3. Yes, I am not sure they are Acuvue Oasys with HydraLuxe for Astigmatism (senofilcon A)

Thanks

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

See above for my response