Vision disturbances, may be just me?

[parkphan]

Thank you for providing this service.

I am a female, age 40, with myopia, newly diagnosed presbyopia (sp?), and tons of floaters.  I just had a very thorough eye exam in January, and the doctor pronounced my eyes "quite healthy", and told me to come back in 2 years.  I had been having quite a bit of anxiety prior to that exam, as I had experienced my first ever optic migraine in late November (which scared the daylights out of me at the time, let me tell you!).

The exam relieved my anxiety, and things have been fine until the past three weeks.  I noticed a spot in my left eye that appeared for a split second as I would open the eye.  It was quite disturbing, but upon studying the archives on this forum, I believe it may be a pressure phosphene (sp?).

I've also been noticing some double vision, or "ghosting".  So far, it occurs only at night, and with objects at quite a distance.  Example -- driving along, an orange construction sign in the distance would have a "ghost" image next to and slightly below it.  Tonight, when I looked up at the moon, there was a definitely double image (up and to the left).  Sometimes it occurs in both eyes, sometimes in only one.  It doesn't happen every night.

I am on two drugs that have "disturbances in vision" listed as side effects -- Xanax and Soma -- that I take only as needed.  (For example, I took a Soma tonight, as my back was killing me after doing yardwork.)  Could they be causing the problems?

Thanks again!

[John C Hagan III, MD, FACS]

Hello Parkphan     Its important to distinguish 'ghosting' from true 'double vision'. Ghosting can come from various causes such as uncorrected astigmatism at distance, cataracts, scars on the cornea, and a couple of other corneal problems, and abberations from glasses/contacts/bifocals. Ghosting is usually noted in one or both eyes.

Double vision is where you see two distinct objects (two cars, two people). It is problem with the two eyes being misaligned. It goes away when you shut either eye.

Almost all drugs list 'visual distrubance and blurred vision' as side effects. Neither should cause the ghosting. If you had a minor misalignment of your eyes which your fusion kept under control (phoria) and you took these medications all the time and they made you sleepy or drowsy that might cause you to have some double vision but since you take them as necessary and not all the time it is less likely they're the cause.

Since you're myopic and now have presybyopia if you're wearing bifocals, trifocals or progressive (no line) bifocals for the first time, looking through the areas where the lens are lined or blended together could cause both ghosting and some double vision, especially if your glasses have gotten bent or are out of alignment.

Things can and do often change quickly, especially after 40. Your examination was about 5 months ago. Things have changed so I would recommend that you either see your ophthalmologist (Eye MD) again or at least call the office and describe your new symptoms to your physician's staff and have them check with the EyeMD and see if he/she needs to see you again.

JCH MD

[parkphan]

First, I wanted to say thank you again for your time in responding to my post.  It was much appreciated!

I am very grateful that you pointed out the differences between ghosting and true double vision -- based upon what you wrote, I definitely do NOT have double vision.  The images I see are more like a slight shifting -- if that makes any sense?

I think what made me think that it was the medicines was because the ghosting or blurring doesn't occur with any type of regularity.  Last night, the moon was ghosted, but tonight (and the night before last), I saw it clear.  If my "condition" (if it can even be truly called that) was caused by cataracts/corneal defects/uncorrected astigmatism (and I do have astigmatism), wouldn't it show up every night?  Could dry eyes be a factor, also?  I do tend to get a little dry from time to time, too, with some resultant blurriness that clears up after several blinks.

Oh, and even though I have presbyopia, the doctor didn't feel it was bad enough (yet) to put me in bifocals, so I still have regular glasses (the prescription of which were increased slightly, BTW).

Thanks again for your time and expertise.    

[John C Hagan]

If it was dry eyes you should be able to clear the condition of the ghosting by blinking a couple of times or putting in a drop of artificial tears. If it were the medication then there should be a relationship to when you take the medication. That is it would occur in the 4 to 6 hours after you take the medicine and have a significant blood level.

If it were cataracts, cornea etc. It should be there most of the time.

When you look at the moon or a light or what ever you're using to test for ghosting look exactly through the center of your glasses with both eye. If you are looking "off axis" it will create abberations that could ghost. The center of your lens is the only place where you have your true prescription. This is called the "optical zone or center".  Thicker lens induce more abberations than thinner lens.

If it get worse then see your ophthalmologist.

JCH MD

[parkphan]

**slaps myself in the head**

I think you've hit the heart of the matter, Doctor.  As I read your latest post, it hit me like a ton of bricks -- I've just realized that the aberrations that I've been seeing have not been when I've been looking straight through my lenses -- the signs on the side of the road, the moon last night, etc., have all been viewed at an angle through my glasses (either through the side or the top of the lenses).  It didn't even occur to me that I'm not getting the full effect of my true prescription that way.  (And I really should have known better -- I've been in glasses since the fifth grade!)

And goodness knows, my lenses are thick!  (Especially the right one -- which now makes sense as that was the eye I saw most of the "ghosting" with!)

I am so sorry... I feel like an idiot and that I've wasted your time.  And I usually pride myself on having some reasonable intelligence.  *sigh*  

I will definitely heed your advice, though, about contacting my opthamologist if it gets worse (legitimately worse, not "looking out my thick glasses the wrong way" worse, of course!).

I am truly grateful for your wisdom in this matter.  You have helped me (and my stupid anxiety over this!) so very much tonight.

[John C Hagan]

You're welcome. Don't feel "dumb" it takes 13-14 years after high school to become an ophthalmologist (Eye MD).

Next time you get glasses ask the optician to help with with lens material, frame size selection to make your glasses thinner. If the ghost bugs you anti-reflective coating sometimes helps but it adds cost, they're hard to keep clean and the coating sometimes doesn't hold up well.

JCH MD

[Nancy T]

Hi Parkphan--do you ever get the ghosting when NOT wearing your glasses? Just curious. I have a very puzzling ghosting that has been going on for years (started around age 45 or 46, now I'm 50).

Mine occurs (in both eyes separately) after I've been reading or otherwise using my eyes looking down. It used to take 15-20 minutes of reading, but now it happens if I'm just writing a note to myself for a minute or two.

It also happens WITHOUT any reading when I'm very tired. Last week I had only 4 hours of sleep per night for two nights in a row, and the ghosting was very bad even without any reading.

My ophthalmologist finally figured out a solution (though he does not know the cause), namely, reading glasses that somehow prevent the ghosting from occurring, don't ask me how. The ghosting occurs when I read without glasses or when I would wear my old, "normal" reading glasses.

I asked the doctor here about this on 5/29 under "Shadow letters after reading" and he gave me a bunch of ideas. Glad that he pointed you to the reason for your ghosting! This is a very informative forum (thanks, docs!).

Oh, and I hear you about the scary optical migraine. I had my first one at age 42 and was clueless, thinking I was having a stroke!!

Nancy T.

[John C Hagan]

Hello Nancy, your problem sounds like 'convergence insuffiency'. This occurs when people have problems with converging or turning the eyes in to read or perform tasks at near (computer, crafts, etc). It can be due to weak fusion centers in the brain or uncorrected farsightedness.  Symptoms include eyestrain at near, mild headache or eye ache when reading, double vision or ghosting when looking up from near tasks, or blurred distance vision after reading or using the computer for a long time. Also causes fatigue and sleepyness when reading.

It's not anything serious and responds to reading glasses that often have minor corrections for astigmatism and/or farsightedness and base in prism. These glasses frequently blur distant vision.

So called "push-up' eye exercises have been tried but in my experience are like any exercise not done often enough by patients to be useful.

JCH MD

[Nancy T]

Thanks much for the info, Dr. Hagen--very interesting idea. I looked at a few sites on convergence insufficiency after reading your post and I do see some familiar things, though not everything.

Eyestrain per se isn't a problem for me unless I've been working like 16 hours (I'm a copyeditor, looking mostly straight ahead at the computer, for which I don't need glasses and which doesn't cause the ghosting). I don't get headaches, am never tempted to close one eye, don't have trouble with words "moving" or losing my place. I never had any eye problems in school, despite reading prodigiously all the time.

Dizziness, motion sickness, difficulty concentrating, and sleepiness while reading--bingo!! At least since around age 35-40 (I'm now 50). But we are a migraine family, which is associated with motion sickness, and I have some unexplained ear or ear/brain problem that is more likely the cause of those symptoms (sudden unilateral hearing loss, wooziness, BPPV, very abnormal auditory brainstem response bilaterally, etc.) Strattera, a selective norepinephrine reuptake inhibitor--actually an ADD medication--made my dizziness-related concentration problem GO AWAY like magic. I started it three years ago after being helped by Provigil and then Ritalin that the neurologist prescribed. Between Strattera and my "magic" reading glasses from the ophthalmologist, I can read forever!

(Another VERY weird thing since a few weeks after my sudden hearing loss is that when I move my eyes sideways, I sometimes hear a burst of "static" in my bad ear and get a "whump" feeling in my head, originally so strong that it felt like my eyes were starting to close involuntarily and I was going to conk out--but I never did. That has settled down and occurs rarely now, mostly in the twilight between sleep and waking or when I'm tired.)

(Oh, and a mention I just saw on some convergence-insufficiency site of coordination problems--interesting because for several months in 2001, I was constantly "undershooting" when reaching for flat vertical things like the refrigerator door handle, kitchen drawer handles, the backs of chairs, the top dishwasher rack, etc.--I would always come up slightly short and have to make a second try, unless I was looking deliberately at the object and paying attention. Also when bringing my hand to my face, such as to lick a finger to turn manuscript pages, I would miss my tongue slightly unless I was paying specific attention to where my finger was going. It never occurred to me that this could possibly have been an eye problem--who knows.)

My ghosting is strictly vertical--the shadow images are partway above the real ones. Would this be possible in convergence insufficiency? Otherwise things aren't blurry. I posted about this here on 5/29. The ghosting only occurs after I've been reading looking down (not straight ahead as on the computer) or when I'm very tired, and it disappears when I tip my head up far enough--my head reaches a certain upward angle and suddenly the ghost images are gone. Once I get them, the ghost images are everywhere, regardless of whether I'm looking near or far, straight ahead or down, and they take half an hour or so to go away after I stop reading. Very often, after a period of reading looking down, I get not only the ghost images but also a very weird, indescribable "weak" feeling in my left eye. Covering one eye or the other makes no difference in the ghosting.

Also, wouldn't the optometrist or ophthalmologist have caught it if I had convergence insufficiency when I was complaining about the ghosting? The optometrists always did a LOT of tests in their office, asking me about thickness of lines, when one image was above another, etc. but never mentioned any problem. I do remember at my first visit with the ophthalmologist, whom I saw for the ghosting problem that the optometrists didn't seem to care about, that he had me look steadily at his nose for a long time while he moved something like an eye cover back and forth like a metronome, blocking one eye and then the other, until finally after a while he said to his resident "see that" and later he said "ezophoria" ("phonetic" spelling--I don't know which one he was referring to). No idea what that meant.

You did already give me some "brainstorm"-type theories in my previous post about the ghosting on 5/29, but if you have any more thoughts I would welcome hearing them! Thanks so much!

Nancy T.