What could cause magnified image in one eye W

Objects in my right eye which had crystalens implant have been magnified since the day after surgery.  
Could it be the lens? My surgeon said no.   I also have macular pucker and CME.  Some of the retinal swelling has gone down after  a steroid injection 2 1/2 months ago, but objects seem even more magnified than in the beginning --I may be wrong....  Any idea what could be causing this and what the treatment would be?  Thank you.

[JodieJ]

It's likely that the larger image in your right eye is related to the macular pucker.  The wrinkling from the pucker pulls the underlying macular tissue toward the fovea.  As a result, the light image is spread over more cones, causing a larger image size.  Frequently, the image size disparity is not perceived until after cataract surgery, when vision is sharper.

I also have a larger image size in my right eye associated with a macular pucker (epiretinal membrane).  Your best chance for a "cure" is to have surgery to peel the pucker.  Peeling the ILM (without the use of dye) might also be helpful.  Having surgery within a few months of developing the pucker greatly increases your chances of a good outcome.

There's good information about correcting the image size disparity by means of optical solutions (contacts/glasses) at Dr. Gerard de Wit's opticaldiagnostics website.  You can also download his paper "Retinally Induced Aniseikonia."  You can send me a personal message if you have questions.

[Ray T Oyakawa, MD]

I have nothing to add to JodieJ's comment except that it is very uncommon.

Dr. O.

[caren123]

Does anybody know a way to measure size difference?   4  weeks post-Vitrectomy - no more pucker -,no more vitreous gel - and happily no complications -  my retina surgeon is interested in the size image problem, saying if it is improved by this surgery it will be the first time he's seen it  --- but  he's been surprised before. I have trouble answering.  It seems the magnification has improved somewhat, but how can I measure it? Objects were so magnified they "hit you in the eye" and now they just seem larger. I'm not sure if it is too soon to see a difference. It is all so subjective.  He did say "there's still some swelling".  Also said some macular puckers cause people no problems at all,

Bifocals make it worse.  I had refractive exam awhile back and got bifocals. Distance correction is -3.75 and -1.50 in the  eye w. larger image.   When I wear them the problem returns because the -3.75 correction for distance makes objects appear smaller than the naked eye sees them, which compounds my problem. A  contact lens in that eye seems to be  better.   I wonder if this makes sense.  Would appreciate any comments.

[JodieJ]

An image-size difference caused by retinal problems is field dependent.  This means that the amount of the size difference varies according to the visual field angle--with a greater size difference for smaller/more distant images.  (Yes, I know this is counter-intuitive, but it's true!)

Dr. Gerard de Wit has written 2 brilliant papers about this.  "Retinally Induced Aniseikonia" can be downloaded (free) from his website at www opticaldiagnostics com.  "Field Dependent Aniseikonia" can be downloaded (free) from the google Aniseikonia support group.

Dr. de Wit has developed a special version of his Aniseikonia Inspector test to measure retinally-induced aniseikonia.  The test involves making a series of size comparisons, and the testing can be done online.  (See the above-mentioned website for more information about this.)  This is the only instrument which can accurately measure a retinally-induced image size difference.  It's the test I've used to measure my own image size difference before and after my second ERM surgery.

Obviously, I have a personal interest in this topic, and I have done extensive research about it.  There is no published research (that I could find) which indicates who might improve with surgery or the timing of improvement.  In my own case, I experienced about a 50% reduction in my image size disparity (as measured by the Aniseikonia Inspector) during my 5th month post-op.  A British researcher wrote me that improvement can take place even years after surgery.  The factor most correlated with a favorable prognosis is a short duration of the size difference.  (Less than 10 months is considered "short.")  Presumably, a longer duration of symptoms is associated with permanent macular damage.

I wish that your retinal surgeon were in Chicago--I'd love to be able to talk with him.  None of the local specialists here have any interest in this problem.  

[JodieJ]

BTW, it makes sense that a contact lens would work better than glasses for you, since a contact lens would eliminate the image size difference due to the difference in refractive error between your eyes.  It would probably also help to wear a plus contact in your surgical eye with a minus glasses lens worn over; this would reduce your image size difference.

[caren123]

Thank you so much for the great info.  I am not sure the test is offered online any more, but I will check it out.

[steveinjapan]

Aniseikonia after epiretinal peeling and lens implant can't be THAT rare. My symptoms are identical to some posted here and on other threads - approx. 10% larger image size in the operated eye. It is not field dependent as far as I can tell, nor does it give me headaches or dizziness. And my retina surgeon also basically blows it off saying he can't explain it.
My question is this: Dr. DeWit's site and other books show that aniseikonia can be corrected using "size lenses", which I gather can be added to normal diopter corrections by altering the inner and outer curves. No doubt these would be expensive, but I am willing to pay to reduce this annoyance. I had good results from the retinal peel and want to enjoy the best vision possible now, but it seems that few optometrists know about the appropriate correcting lenses.
Has anyone found an optometrist who knows how to do this?

[oboist]

My cataract surgeon says that many of the ERM peel patients she sees for cataracts report, in particular, a vertical rather than horizontal image size difference.  I have both remaining distortion (image is pulled downward and toward the right) and vertical aniseikonia.  My optometrist told me that about ten years ago there was a company that make the corrective lenses you describe, but they were so expensive, and the market so small that they discontinued them.  I would think that if this is as common as it's beginning to sound, it might be worth investigating.  Given the amount of difficulty I've had getting the right prescription for lenses post surgeries, I hate to think what kind of struggle it would be adding in another factor.  I also have prisms in my glasses because of double vision post ERM peel.  I have been encouraged by the degree to which my brain is adapting to both the distortion and the aniseikonia.  The resulting image is somewhat stretched, but not distored - as if my brain is willing to accept a composite that's dimensionally reasonable, but cancels out the Dali effect.  (Jodie, sorry I took so long for an update - didn't really get this resolved (such as it is) until about a month ago - took a long time!)

[WoodyStrings]

Last month I had cataract surgery, 7 months after having surgery related to a retina detachment.  Long story short, I have magnified and stretched vision in my right (surgical) eye.  When I change fields quickly, as when cycling around town, my vision goes double.  I have to close one eye.

The doctor who removed the cataract says that it is not related to the lens implant.  It's related to the macula damage.  Either way, I was not prepared for this outcome.  Reading is very tedious.  I am an engineer and must read drawings in both electronic and paper formats.
  
I guess all I want to say is, Keep Posting.  I need to know more about what I've got, the cause and how to cope.  This is new to me, I wasn't ready.   At least it's good to know that I have company.  If I learn anything, I will post here.  

[caren123]

You have my sympathy.  My problems have not been resolved yet; I shelved them to do other things.  What I have been doing is using one eye at a time because the images do not match and I gave up driving at night unless I have to.  Blurriness and floaters are no longer a problem since the ERM.  Things are clear, but distorted.  Size difference is not such a problem any more as is distortion.  When I look at a line of print with operated eye, it looks like a roller coaster doing uphill, with the other eye the roller coaster is doing downhill.  The latest visit the retina surgeion said I seem to be describing vertical diplopia and he gave me a referral to a neuroophthalmologist.     Not sure what can be done lets  keep in touch.   I had cataract removed, then ERM peel quite a while afterward.  Before all this happened, I wore contact lenses, one for reading, one for distance, with no apparent problems.

[WoodyStrings]

Caren123,
     Interesting to hear your comments re: aniseikonia, et.al.  Your magnified vision issues are sooooo similar to mine.  Like you, I am just learning to cope.  The DIFFERENCE in vision between my two eyes is the biggest problem.  My brain cannot blend the large and small images, so I see both.  (Thanks a lot brain!)
     I also have taken to covering one eye to read and type... like right now.  For me, it's a toss up on which eye to cover.  The vision in my surgical eye is larger and brighter but wavy and stretched.  The other eye is not as bright, and fonts appear about 2/3 the size but undistorted.  Either way, covering one eye is more comfortable than double vision when reading.  I haven't quite thought through the eye-patch remedy.  I wear progressive lenses in standard frames now and really need both eyes for driving.
     I intend to stay in touch with this board and appreciate any information about your progress.