aniseikonia (micropsia) 2 weeks after vitrectomy

[rwmock]

I'm a relatively healthy 48 yo male who had cataract surgery with ReStor lens on 11/19. On 12/12 I suffered a retinal detachment and underwent vitrectomy w/gas bubble on 12/24. I'm now ~2 weeks post op with ~20% of the gas bubble left. Doc says retina has reattached nicley and is healing well. My operative eye seems to have no loss of visual field but images through this eye are slightly distorted and much smaller than images viewed through my other eye (which, BTW, had cataract surgery with ReStore IOL on 11/10) Doctor says that the smaller image size in my operative eye is normal and should be able to be corrected once the eye has stabilized after the vitrectomy. My questions are -

1) is anisekonia common after vitrectomy?
2) can/should I expect that the anisekonia will improve over time?
3) can refractive surgery, like LASIK, be used to correct aniseikonia?

Thanks

[Ray T Oyakawa, MD]

The distortion and small image size suggest a macular problem.  There is a good chance this will get better.  I am sure your retinal doctor will do a OCT of the macula if symptoms persists.

Anisekonia can occur after vitrectomy if a scleral buckle is used.  If the anisekonia was caused by the surgery, it will not improve over time.  Yes, LASIK can correct anisekonia.

However, see the first paragraph.

[JodieJ]

I also suffer from anisekonia related to post-vitrectomy macular damage, and I have researched this topic extensively.  Your micropsia is thought to be related to a re-distribution of photoreceptors in the retina.  I do not believe that it can be corrected with LASIK.  The very best description of an optical correction for aniseikonia following retinal detachment can be found in a recent article by Gerard de Witt, "Retinally Induced Aniseikonia."  The article can be downloaded from Dr. de Witt's website (www opticaldiagnostics com) if you search for it.  (Try using the products link, then click "background information" and scroll down to the bottom of the page.)  Please feel free to contact me if you need more information.

  

[rwmock]

First off - many thanks to Dr. Oyakawa and JodieJ for your comments.

No scleral buckle was used. I'll be sure to ask about the OCT scan of the macula. I also want to ask if the IOL is still postioned properly. I've read Dr. Witt's papers and also an additional paper on myopic shift after vitrectomy. I'm not scheduled to see my doctor until 1/19/08, which will be ~3.5 weeks post op, but I'm gettting my questions together daily.

JodieJ - have you been able to releive the aniseikonia? If so then would you mind sharing what worked for you?

Thanks again to all for your time.

[JodieJ]

I developed aniseikonia three years ago following a vitrectomy to peel an epiretinal membrane.  In addition to the image size difference, my affected eye teared continuously and I was very sensitive to light.  My retinal surgeon ignored my complaints about the image size difference and kept prescribing different dry eye treatments.  After a year of this (and a medicine cabinet filled with eye drops that didn't help), I also began to notice that distant images were on the verge of doubling.  I panicked and started researching my symptoms online.  I ended up diagnosing myself with aniseikonia and then called just every practitioner who specialized in binocular vision problems in the metro Chicago area.  The only place that would see me was the local optometry school, who ultimately classified my condition as "untreatable".  I found Gerard de Witt online through a Yahoo support group and begged him to do online aniseikonia testing.  It turned out to be money well spent.  I've worn his glasses-over-contact lens correction most of the time since then--it controls my aniseikonia symptoms pretty well.

I believe that the symptoms of aniseikonia are listed on the opticaldiagnostics website.  If you're not having any symptoms and your vision with both eyes is comfortable, then you don't have a problem.  Your eye is still early in the healing process, but your micropsia may not resolve.  (If the image size difference remains noticeable, you probably will have other symptoms, too.)  Since you chose ReStor lenses, I suspect that being spectacle free is a priority for you.  Unfortunately, glasses may be the only way to maximize the image size in your affected eye.  I'm really curious about the type of correction your doctor has in mind for addressing your smaller image size--please let me know about that.

I believe that any surgical intervention for a detached retina (not just a scleral buckle) can result in aniseikonia.  It would be wonderful if some research were focused on comparing the binocular vision outcomes of different surgical techniques.  (The retinal surgeons I've seen seem to measure success by the ability to read a line on an eye chart with one eye only.)  I've tried very hard to create interest in treating aniseikonia among the local doctors, but I can't say that I've been successful.

Keep me posted on your progress.