v. Bad N-sightedness/Doub vision/headache/prism??

I'm a 66 y.o. w. m. in good health. I'm v. nearsighted and recently got a new Rx for glasses. The Rx had changed a lot.  DURING the exam  after seeing excellent in each eye, independently, when the doc let me see the final Rx with BOTH eyes, I saw 2 eye charts one lower to the left and one higher to the right (i.e. double vision). That had NEVER happened before. The doc decided to place a prism in one lens and noted there had been quite a change in one eye (cyl increase). I got the new glasses and can see GREAT but have since experienced some slight double vision when tired; some  slight disorientation/nauseousness & dull headaches all the time now!  I've worn the new glasses 4 weeks now thinking I would get use to them, especially since I seem to see so well with them, but the symptoms remain. Anyway, a couple of questions, please:  1) I wear contact lenses for a few hrs most days; in the past I just left them out a FEW DAYS before my eye exam - this time I had not worn them for a MONTH before the exam -- could that have allowed the eye shape to more fully return to its natural curvature & explain the big Rx change (especially in the reduction from minus 15.25 to 14.25 but increase in cylinder to 2.0)?  2) The doublevision occurs ONLY with the new glasses not my previous glasses or w/o glasses; thus, is it likely that this is an "optics" type of issue & not a more nasty type of symptom re: a more serious physical problem?   My G.P is aware of the issue & yields to the eye doc to sort out for now. Could this type of Rx be an early warning sign that my eyes/brain are not converging properly on objects & it's more than glasses... or given the optics involved is it still PROBABLY a combination of my poor vision & trying to find the exact Rx needed? Do you think more tweaking is needed w/new Rx? - below:
O.D.  -14.25 (sph) -2.00 (cyl) 70 (ax)
O.S.  -13.25 (sph) -1.25 (cyl) 95 (ax) 1/2 BD, OS; match old base curve, pd, etc.
Thank you ever so much for your insights!

[Houman Vosoghi, MD]

1)  No, it is more likely that you are starting to develop early cataracts.  Go see an ophthalmologist to have a complete medical eye exam and make sure all is well.

2)  It's more likely that the new glasses were either not made or perscribed correctly or as JodieJ pointed out are causing issues with the new cylinder power you are not used to.  Either case the person who made your glasses owes you a repeat refraction and a new pair of glasses.

HV

[JodieJ]

I'm not an eye care professional, but glasses that cause double vision, disorientation, nausea, and headaches are NOT giving you good vision.  These are all symptoms of aniseikonia (an image size difference between the eyes), although there doesn't seem to be a big difference between the script for your right vs. left eye.  Possibly, the lenses are not properly centered over your pupils.  I'd suggest that you return to whoever prescribed them and have them checked.  If the glasses are made correctly, then your prescription needs to be adjusted to give you more comfortable vision.

[JodieJ]

I did a little research into your problem, and I suspect that you are suffering from "meridional aniseikonia" related to the increase in cylindrical correction for your right eye.  According to one source (Milder & Rubin), a cylindrical lens causes magnification (or minification) to vary in every meridian, which can produce spatial distortion when using both eyes together.  Most people can reportedly learn to adapt.  For those who cannot adapt, one way to alleviate the distortion and related symptoms is to "reduce the cylinder power, maintain the axis, and alter the sphere so that the spherical equivalent remains unchanged."  In practical terms, this means going back to your old glasses prescription.    

[naoye1]

My optometrist has been trying to help me implement Dr. Gerard de Wit’s contact lens/glasses correction for retinally-induced aniseikonia (mentioned by Jodie in other posts), as I have previously had epiretinal membrane peels and cataract surgery in both eyes.

However, after reading these posts, I’m wondering whether my right eye aniseikonia could be mostly meridional – caused by extra astigmatism correction in the toric lens that was inserted during the cataract surgery, rather than caused by changes to the retina. The cataract surgeon had calculated the power of the toric lens based on the total astigmatism in the right eye because he didn’t realize that part of the astigmatism was irregular (caused by corneal scarring and not correctable by the inserted lens).  So the toric lens, like jmjr77’s glasses, has too much astigmatism correction.  I have always wondered about the effect of this extra astigmatism correction and the meridional aniseikonia explanation makes a lot of sense.  It was right after the cataract surgery that my right eye saw thinner, elongated images and I started to have eye strain and symptoms similar to those experienced by jmjr77 (slight nausea, dull headaches, some double vision).

I do have retinally-induced aniseikonia in the left eye (images bulge out slightly to the upper right despite a non-toric IOL).   However, I think it’s the right eye aniseikonia that causes the most strain.   It’s too late to explant the toric IOL (have had YAG) even though I’d really like to do this.  jmjr77, it's too bad that you're having these difficulties but you’re lucky that you can just change the glasses that are causing your problems.  I’ve also experienced glasses that sharpened my vision but were not comfortable to wear, and they just got more uncomfortable the longer I wore them.

Should there be a glasses only correction if the meridional aniseikonia is induced by the toric lens? On the other hand, it sounds as if Dr. de Wit’s contact lens/glasses arrangement will help all kinds of aniseikonia so maybe it’s fine to just continue on this course?