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Aniseikonia after vitrectomies and developing cataract

I had vitrectomy  for ERM and macular hole on left eye in May 2014 and vitrectomy for ERM on right eye in July 2014. Surgeries were successful except vision in my right eye is larger and proportionally taller in my right eye causing double vision especially at a distance. I just had an appointment with HMO optometrist who said to wait until after cataract surgery. Is this the usual procedure. He said that cataract surgery is performed after best corrected vision is 20/40. At earlier appointments, surgeon said to see optometrist about aniseikonia and optometrist said to see surgeon about aniseikonia. Double vision is my most annoying visual concern. I have a follow-up appointment with surgeon in January. I also read that there is an eye drop being tested for cataracts. I have also read that in post-vitrectomy patients, the less dense saline/water in the eye rather than Vitreous gel can make cataract surgery  more difficult. I live in Madison WI which has a medical college. Any suggestions or advice. Thank you
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Avatar universal
I would NOT wait until after cataract surgery. If the image in one eye is larger, so far as I know the only way to fix that would be to make the other eye farsighted, and then wear glasses for distance over that eye which would make the image in the farsighted eye larger as well, so both eyes would now see an image the same size, one being larger because the inside of the eye has  been changed by the vitrectomy and the image on the retina is larger, and one image appearing larger from the + prescription in the glasses. (Another option would be to make the eye with the larger image nearsighted, and then wear glasses with a - prescription which would make the image smaller.) If they do cataract surgery and they give you plano in both eyes, then glasses would not help your issue. If they intentionally make the normal eye farsighted or the eye with the larger image nearsighted, a normal pair of glasses should then resolve the double vision, but if you have the surgery without checking to see if this can help you first, you won't be able to fix it as easily later.
I advise you to go see a more competent optometrist, and see if he is willing to give you a lets say a +2.00 contact for the eye with the larger image, and then correct you back to plano with glasses over it to see if that helps your problem at all. Depending on just how different the image size is you could try  different prescriptions. (Like wearing a +6.00 contact, and then glasses with a -6.00 in that eye) it depends on how different the sizes are, most people can tolerate up to 5%, but more than 5% will cause double vision. Glasses will also make images appear larger or smaller, 2 diopters of correction with glasses will also cause a 5% difference in image size. Depeding on how different the images are, using a contact to make the eye that far off from plano and then wearing glasses to bring it back to plano could solve your double vision problem. If this works, when you have cataract surgery you want them to aim for the prescription in the contact lens instead of plano, so you dont need to wear the contact anymore afterwards.
1 Comments
Thanks. I will keep this in mind and will ask primary care doctor who to go through. My OS prescription has gone from -0.5 -0.5 x090 an OD was -0.5 -1.00 x085 is -0.25 -0.75 x90   hasn't changed nearly as much . I have no idea when doctors will recomment cataract surgery. I think the hight of a distant object in my left eye is about 75% the apparent height in my right eye.  The left eye has over lapping images. I see triple overlapping street lights with just my left eye. How do I find an optometrist familiar with this? I have done searches and the closest specialists appear to be in MN and OH.
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Avatar universal
I too have image disparity, especially at distance.  Mine is caused by by Dragged Fovea Diplopia Syndrome. My central vision does not fuse, but my peripheral vision does.  A small piece of Scotch Satin tape applied to the inside glassses lens of the affected eye, just in front of my pupil, blurs the central vision and causes me to use peripheral vision.   Perhaps these two sources will be of interest to you.  Best wishes.

http://www.opticaldiagnostics.com/info/ri_aniseikonia.pdf

http://ce4optometry.com/web/mediconcept/CRO_24.6_Gorner.pdf
1 Comments
Thanks I have already read the first link. Second is new but describes adifferent problem. Left image overall is just larger than right image.
Avatar universal
Did you have a scleral buckle?
Avatar universal
No membrane peel in both eyes gas bubble and face down  positioning  in left for a week.
Avatar universal
Since you didn't have a buckle, the shape of your eye was not changed.  Do you currently wear glasses?  Is there a large difference in lens strength?  
3 Comments
The visual receptor distribution is changed after peeling the epiretinal membrane so the eye shape isnt changed but the ditribution of the receptors is.An ERM is associated with an enlarged image and a macular hole is assoted with a reduction of apparent image.
Yes, I understand.  I have an ERM that has redistributed my reciptors as well,
I followed several paths before I discovered the info on Dragged Foveal Diplopia.  I tried a prism which didn't work. I contacted Shaw Lens http://shawlens.com/ and they said that their product would not help.  I contacted Dr. Toole who runs the anisiekonia service at Ohio State University and he explained that no glasses or contacts could correct retinally induced anisikonis.  So...tape it is, and happily it is an acceptable solution.
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Avatar universal
Did you ever try the contact lens and glasses combination mentioned in the first post? I have seen that solution more than any other.The problem that I notice the most is the size difference.Last week I recieved a new prescription with a significantly stronger - lens in the left eye which has the smaller image to start. I'm glad that I found out about low cost glasses on line. I will probably order this weekend. I have single vision glasses for distance only.
3 Comments
No, I never tried that.  Since my anisiekonia is field dependent, I don't think it would help.  My right eye is damaged and the images are 13 % smaller.  (I was able to measure this because
Dr deWit sent me a free version of his Basic Anisiekonia Test.). Try the tape, it is a three dollar investment which may or may not work.  It was a godsend for me.  I was able to ignore the central blur after a few days.
Forgive all the reposts and other weirdness.  Medhelp displays are very inconsistent lately.
Avatar universal
Who tested you? What type of specialist? How were you referred. Did you just call around to Shaw  lens and the specialists in Ohio?
2 Comments
I live near New York City and I have been under the care of two world class surgeons (Richard Mackool Sr for cataracts and Stanley Chang at Columbia University for retina.  It was through my own research that I arrived at the information about Dragged Fovea Diplopia Syndrome.  Former Medhelp poster jodieJ got me started on this topic and I am forever grateful to her.
I contacted Shaw folks directly and they referred me to a local diagnostic opthamologist who examined me and had a subsequent phone consult with Shaw.  Together they determined that it would not be a solution for me.  They do offer a money back guarantee if you want to investigate this path.  I emailed Dr. Tool eat Ohio State with a query about whether it would be worth coming for an assessment.  By that time, I had discovered that the tape helped and he said that tape Was the ideal solution for my condition
Avatar universal
Thanks.  I just emailed Dr de Wiit's company. I have followed JodyJ's post. This seems to be the only forum that addresses this topic. Anomolychick made an excellent point. It seems that I have to be my own advocate. Thanks
4 Comments
Yes.  I just sent you a message via Medhelp.  It includes my phone number, in the event you want to call me this weekend.
The deWit test requires red green glasses.  The place I bought it from no longer sells to the public.  Here is an additional source that may be of interest. http://www.guldenophthalmics.com/products/index.php/red-green-wraparound-adult-glasses.html
I think my primary care doctor will help me pursue this after appointment with surgeon in January. Thanks for your advice.
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Avatar universal
Best wishes.  Let us know how things turn out.
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