double vision 6 yrs after lasik and monovision

[mt316]

My eye doctor says there is possibility that my double vision is caused by one eye trying to help the other. I had lasik surgery in 2003 with monovision. I began having double vision about 4 months ago.
Why would I now have double vision in 2009? Is wearing a single soft contact lens to make the eyes more even the best solution? Was this possiblity of  double vision known in 2003?  What would you recommend? Why would more surgery be necessary?

[Ray T Oyakawa, MD]

Is there double vision with both eyes open?  Your tag says monocular double vision.

You probably had a phoria (eyes not aligned when fusion is broken) and with lack of complete fusion, this broke down to a tropia (constant double).  You probably can fixed this by wearing a contact lens to make your eyes equal.

Dr. O.

[JodieJ]

Yes, get that contact lens ASAP (hopefully tomorrow).  If it eliminates your double vision, consider yourself very lucky and NEVER do monovision again.  You should probably have a LASIK touch-up to bring your near vision eye to plano.  If your double vision persists with the contact lens, you should schedule an appointment with a strabismus specialist (AKA a pediatric ophthalmologist, but they see adults).  Your double vision can be corrected with either prisms or a painless outpatient procedure.

I'm knowledgeable about your condition because I developed double vision after several years of monovision contact lens wear.  Dr. B. Kushner at the University of Wisconsin has written a number of papers on this topic.  ("Recently acquired diplopia in adults with long-standing strabismus" can be downloaded free.)  The double vision can often be reversed in the early stages by eliminating the monovision.  (I was badly advised by the doctors I saw and eventually needed surgery to eliminate my double vision.)

Like me, you may have no known history of strabismus as a child.  My strab surgeon told me that it's possible to have a misalignment so subtle (called "micro strabismus") that it goes totally unnoticed.  Dr. Kushner has written several papers about the tests which should be done before surgical monovision (with LASIK or IOLs) to identify those who are vulnerable to developing double vision.  Probably they weren't done in your case.

[mt316]

Yes I have double vision with both eyes open. At the doctor's yesterday, I had the same headache I usually have with double vision. After putting in the contact, double vision did not happen. I was relieved and still concerned that I might now be wearing single contact when I'd had surgery so I wouldn't have to.

[mt316]

Yes, I did have 6 carefree years without contacts. Frustrating having to now have one contact and also glasses to read. Right back where I started- using glasses and contacts.  Makes me wonder why have surgery. I am blessed though to be able to see and to read.

[JodieJ]

If you send me a personal message with your email address, I'd be happy to send you a couple of Dr. Kushner's papers.  They explain the break-down process to double vision.

I'm very happy to know that your double vision can be reversed.  Unfortunately, I believe that you would be risking irreversible (except with prisms or eye muscle surgery) double vision if you continue with monovision.  It would probably be best to correct your near eye to plano with a LASIK touch up.  That would give you excellent distance vision without correction.  If you wanted to avoid glasses, you could get bifocal/multifocal contacts.  Just be sure that your contacts have both eyes focusing simultaneously at the same distance.  Many of the newer multifocal contacts involve using each eye for different distances.

It was my experience that many eye care professionals (both ophthalmologists and optometrists) were not aware of the potential hazards of monovision for a small percentage of the population.  You will probably want to consult an experienced strabismus specialist (rather than accept the advice of an unknown person who posts online.)  You can find a lot of links to information by googling combinations like "monovision diplopia," "LASIK diplopia," and "Burton Kushner, M.D."  In one paper, Dr. Kushner proposes a screening test which identifies those people who are vulnerable to a breakdown of fusion with monovision.  I suspect that neither of us would pass this screening.

It's been more than four years since I stopped doing monovision, but I still miss it.  Best wishes.      

[JodieJ]

One more positive point:  It sounds like you will be a wonderful candidate for multifocal/accommodating IOLs when you need cataract surgery (or perhaps sooner).  There have been significant improvements in these lenses recently, with even better ones on the market in the near future.  These IOLs promise excellent vision at all distances--without monovision.  You might want to get a personal copy of your eye measurements before LASIK--these measurements might be helpful in calculating the right power for your IOLs.