monocular diplopia

To Dr. Hagen, Dr. Kutryb, JodieJ

Thank-you for your past advice which was extremely helpful and much appreciated.  I would like to ask you about a new problem - ghosting in my left eye after cataract surgery in August.  A plain spherical lens was implanted.  Despite limbal relaxing incisions, I have about 1 D left of the 1.2 D astigmatism in this eye, as well as an epiretinal membrane.  Glasses do correct the ghosting and I am waiting for some progressive glasses.

Because the occurence of the left eye ghosting might have implications for my right eye ghosting - which is not corrected by glasses and for which an ERM peel is being considered - I'm wondering what the mechanism is that causes the left eye ghosting:

1.  Is the ghosting probably caused by a combination of the astigmatism and the ERM?

2.  Is this a common occurence for people who have ERMs?
3.  Does the ERM somehow emphasize one of the multiple focal points created by the astigmatism - thereby creating a second strong focal point, i.e. ghosting, rather than the usual blur (from one main focal point) of astigmatism?
4.  Would an ERM peel possibly cure the ghosting?  

(As mentioned in previous posts, the ghosting after right eye cataract surgery, which is not corrected by glasses, may be caused by a combination of the ERM, irregular astigmatism from corneal HSV scarring and a toric lens that was implanted.  The left eye only has an ERM and regular astigmatism.  However, I've recently developed a large floater in my left eye which makes my central vision blurry a lot of the time.  I'm hoping that it won't prevent me from adjusting to progressive glasses.  A lot of challenges to my vision right now, am trying to stay positive.)

Thank-you very much for considering my questions.

[JodieJ]

Consider this a non-professional response.  If the ghosting in your left eye can be corrected with glasses, then it's probably due to astigmatism.  The ghosting in your right eye could certainly be caused by the ERM (and other factors, too).  (Double vision with one eye closed is listed as a common symptom of an ERM on several websites.)  I think that there's a very good chance that an ERM peeling would reduce/eliminate the ghosting.

Not all progressive lenses are equally good.  I hope you're getting the best quality available, which would probably be aspheric.  If you have difficulty adjusting to your progressive glasses, you might consider trying bi/trifocals.  I've heard that the quality of vision with these is a little better than with progressives.

I wish you the very best.

[naoye]

Thank-you very much for your helpful response, Jodie.

Do you have any idea of the mechanism by which an ERM could cause ghosting?  Would any of the websites you mentioned address this?

I'm told that the progressive lenses I'm getting are the best quality.  They're by Essilor and are called Varilux Physio 360.  It's really good to know that bi/trifocals would be an option if these don't work, even though I'm going to give them my best try of course.

[JodieJ]

If you google "epiretinal membrane,"  you'll pull up lots of links.  Basically, the scar tissue (ERM) causes the macula to contract and wrinkle.  This is what produces the distortions in vision.  According to Wikepedia, an ERM frequently causes binocular diplopia.  At www stlukeseye com, it's stated that an ERM is commonly associated with monocular diplopia.  (Both statements may be true.)  In any case, once the layer of scar tissue has been removed surgically, the macula begins to slowly smooth out (to the extent that it can).  I found that peeling the ERM brought about a dramatic improvement in my vision.  The slow improvement in my vision over the following months was much less striking.

I really like my progressive glasses with aspheric lenses.  They cost more than the progressives I got at Pearle Vision in an hour, but they don't distort images viewed from the outer edges of the lens.  An optometrist did tell me that bi/trifocals provide sharper vision than progressives.  I guess that's why some people prefer them.  

[naoye]

I really appreciate you sharing your experience with me, Jodie.  I'm pretty sure that I will opt for the ERM peel now, if the retinal surgeon offers this to me again when I see him next.  I'll find out whether my progressive glasses are aspheric and, if not, will try that next time.

I recall you mentioning some time ago that a good vision aid for grooming (cutting nails, etc.) would be a manifying glass on a string around the neck.  Have you ever tried or considered something like clip-on magnifying glasses and lamps - for example, on the daylightcompany website?  I saw some being sold for quilting and thought they might work well.

[JodieJ]

That wasn't me, but it might be a good idea.  I have progressive glasses and bifocal contacts.

If your retinal surgeon approves, go for the ERM peel.  You have a lot to gain.