monocular triplopia

[triplopia2]

In the last 6 months my distance vision has become blurry in my right eye.  I normally wear eyeglass for myopia and have some middle age presbyopia correction to that.  The optometrist says he can not correct the right to 20/20.  Already it has gone up one diopter from -2.5 to -3.5 in the last year.  The problem as I see it is triplopia.  With the -3.5 correction I am still seeing three copies of things at a distance.  A traffic light looks like three lights from two blocks away.  As I get closer the lights come together like in a Venn diagram (three overlapping circles).  The problem seems correctable at short distances (reading) but not for distance.  

I go see an opthalmologist this week.  Curious to know what I should ask about.  Problem improves with pinhole.  All other optometrist tests were negative. No color distortion.  No haze.  I have had minor issues with night vision/glare for years but no noticeable changes there recently.  Family history of many common eye diseases.  Cataracts, glaucoma, optic nerve damage of unknown cause.  So far I have not been diagnosed with any of these.  But two siblings, mother, father each have one of these things.  Sister had cataracts in late 30s.  I am mid 40s.  Father in mid 60s. Other sibling with optic nerve damage. I have no obvious related medical conditions except possibly allergies.  Would like to correct it so I can go back to reading street signs with my right eye.  Fortunately left is fine, 20/20, with -3.5 correction.

[alandoe]

I have a very similar symptom which has been driving me crazy for years. Bi-lateral cataract operations did nothing to resolve my problems. Luckily I was introduced to Dr. Guyten at the Wilmer Clinic at Johns Hopkins by a friend. In a very short time he diagnosed me with having an irregular periphery on my corneas (bilateral). Light entering on the edges of the cornea was being redirected to create separate images from that created by light entering the middle. A simpler drop of Pilocarpine solution causes my iris to contract permitting only the light from the middle to enter and excluding the extra (refracted) images. This gives me normal vision lasting 3-4 hours at a time.

[triplopia2]

This is over one year later.  Not too surprisingly, there was a cataract in my OD and in spring 2011 it progressed significantly.  Eventually I needed an IOL implant.

I just had that done two weeks ago and bingo I can see again.  It's better than I have seen in years because they corrected the myopia as well.  The lens is a single vision lens.

Now I have another problem.  I am close to plano in the OD and the OS is still very nearsighted approximately -3.75 distance with a +1.5 add for near.  The OD is still settling down but it seems to be around +1.25 near field based on drugstore glasses and it is very slightly nearsighted in the far.  So we are talking about a significant anisometropia between OS and OD roughly 2.5 to over 3 diopter difference between the eyes.

OS is still showing clear the script has not changed much in years I do not have evidence of a cataract and I am 46.  I am reluctant to have another IOL implant on a functional eye.
I have been trying out some soft contact lenses in OS.  Vision is good but comfort is not good.  I can not tolerate them for long periods of time although we have not tried too many products yet.  It has been years since I have regularly worn soft contacts and I have always had allergies and needed unpreserved everything in order to wear contacts and even then I had to be careful and not overwear them.  The last few months I wore a booster contact in OD with great success it was very comfortable.  It was a daily wear moist lens.  But the OS is not responding similarly to the same brand of contact.

I would like to find a non-contact lens spectacle solution - the prior reading glasses with OD lens removed work reasonably well for reading but they give me eyestrain when I wear the same spectacles for regular activities - the vision is OK but they feel like they are pullling my OS to center and there is eyestrain.  That said they are basically monovision spectacles with reasonable vision as long as I try to mainly use the central part of the lens.  They were built for only reading so it is not surprising they give eyestrain for distance.

The OD is by far my dominant eye so I am very happy with the good vision in this eye.  Sometimes I can tool around the house and outdoors with no correction the right eye takes over.  

But my job requires a lot of computer and reading and switching back and forth between these and blackboards frequently.  So I need some sort of flexible vision option.

I have no idea when/if the OS might get a cataract.  They seem to run in the family somewhat but at different ages for each family member.

Suggestions are welcome.  Summary is : Mid 40s, female, IOL lens implant in one eye due to single cataract.  2.5-3 D anisometropia.  OD lens is close to plano and is dominant eye.  Allergies and contacts are a problem.  OS still sees well only nearsighted.  Family history of cataracts at various ages starting late 30s into 70s.  Job requires a lot of near and computer work switching frequently.  I tolerate monovision well in both contacts and spectacles provided the latter does not induce eyestrain.

[triplopia2]

Just got back from JSEI.  Good news is I don't need a lens replacement.  It seems that the optometrist had my script wrong.  At JSEI the put me in front of a bunch of machines that measured all sorts of distortions in my eye/cornia/vision and then put me in the chair where they do the prescriptions.  They verified that the new glasses were not correcting well on the right but they were able to find a setting on the machine that could correct me to 25 in the right and 15 in the left, which is great.  Moreover no triple vision in the right I was able to read the letters well.  The revised R script was off by over a diopter compared to my new glasses.  Also the revised R script is off by -2.5 from about 1.5 years ago so some marked changes to the myopia.  But otherwise the eyes are supposed to be fine.

[triplopia2]

Thanks Dr. O.  I see you are in Torrance.  Am going to the Jules Stein Eye Institute at UCLA on Wed this week.  Will see what they say.  

[Ray T Oyakawa, MD]

This is most likely due to a cataract.

Dr. O.