Double vision after macular pucker vitrectomy

[tictactoe68]

I am a 43-year-old woman. I had a vitrectomy on January 18 to remove a macular pucker from my retina and for floaters left by a vitreous detachment. As my vision began to clear after surgery, I began seeing double.  I'm seeing separate images from each eye, but they are not "meshing" together when using both eyes. I do not have double vision when I cover either eye, it's only when I try to use my eyes together. Before surgery, my vision was distorted due to the macular pucker and I had an extremely large floater, but I was not seeing double.

My retina looks fine post-surgery and the retina specialist doesn't know why I have double vision. He sent me back to the optometrist who, after seeing me, said he believes my double vision is a processing problem. The optometrist said my vision was so compromised before the surgery that my brain can't put the images from each eye together. He prescribed prisms which I should be getting this week.

I'm trying to educate myself on what's happening and am finding little to none on "processing problems" such as mine. I'm also concerned there could be more at play here since I have Lyme disease and have a first degree relative with Grave's disease.

I'm not sure what to think. I'm trying learn more and figure out how I want to proceed. Any input is appreciated. Thank you.

[JodieJ]

An ERM can produce traction on the macula.  Usually, the pull is inward to the fovea.  This can change the photoreceptor distribution, which can alter the image size in the affected eye.  Some people with an ERM experience double vision before surgery.  According to the medical literature on this topic (which tends to be 10+ years old), most of these people continue to experience double vision after ERM surgery.

It's reportedly less common to initially experience double vision after ERM surgery.  One theory (expressed in the literature) is that acuity in the affected eye was too poor for double vision to occur (since double vision requires reasonably good acuity in both eyes).  Luvtoski, your theory makes sense to me.  I also believe that ERM remaining in the eye post-surgery can be a factor.  

[Ruth1246]

Hi to both you and Jodie I really appreciate all your information and support .yes luvtoski I can relate to your experience the image in my right eye also seems funny that's without the distortion and smaller image it's blurry and feels like the image is inthe wrong place .Hope I don't have to wait 18mthe to get some improvement. My eye surgeon didn't have much to offer seemed very surprised this had happened .I am still waiting for my driving glasses to arrive just hope they improve the situation . Again thanks to you both cheers Ruth

[Luvtoski]

Ruth, I have "distance"/driving glasses now too as my good eye is not seeing distance as good as it used to either. (57 years old)
The distance glasses help bring the diopters of the two eyes closer together, which seems to help my perception of the images.

What I found is that when I take my thoughts off of my sight and just "go with the flow" I tend to forget about the discrepencies enough that I think my brain merges the images better.  Not sure if this makes any sense, but with time and taking my mind off of my sight (as much as possible) I am happier and believe better.

Again, good luck to you as I totally know what you are going thru !

[Ruth1246]

Thankyou for your support I feel at the moment that my eye problems have taken over my life hopefully things will improve when my glasses turn up . Cheers Ruth  

[Ruth1246]

Hi Jodie some advice please my driving glasses arrived they do improve the double vision somewhat but not enough to drive safely there was still some doubling of cars and the road ahead was distorted with grass and trees superimposed on it a lot of the time. I contacted Ken Robinson  the opyometrist in auckland this morning he felt I should persevere so that my good eye would take over and the brain would ignore the image from my right eye which he said was my dominant eye .I now not sure that he is on the right track I have another appt with him on the 11th of sept. I did fix the problem my self in the mean time by putting two small pieces of cling wrap in the centre of thel lens I am now a bit confused if I should leave the cling wrap on or follow his advice at least around the house. I would appreciate your advice. Thanks Ruth

[JodieJ]

I'm really not knowledgeable enough about neuroadaptation to advise you.  I can only relate my own experience.  My ERM was also in my right (dominant) eye.  As the ERM was slowly and progressively distorting my vision in my right eye, my brain did "neuroadapt" by automatically screening out the distortion when I used both eyes.

I believe that double vision is a different issue.  I think that I read someplace that young children can neuroadapt by suppressing a second image, but older children and adults cannot do this and the double vision will persist.  (You could try asking one of the ophthalmologists on this forum about this issue by starting a new thread.)

Are your driving glasses made to (partially) correct the image size difference between your eyes?  If so, it sounds like the degree of correction may be insufficient.  This type of correction worked immediately for me with glasses and a contact lens.  (If your optometrist is willing, he could probably get a free trial of Dr. de Wit's Aniseikonia Inspector software.  Your test results could be used to fine tune your prescription.

The bottom line:  you've already found something that works (the cling wrap).  In your place, I'd stick with what works.