Double vision at near, big change in prescription

[yogibear42]

Hi,
I am a 21 year old female and have been having problems with my near vision for about 3 years. My current prescription is:
right eye: +4.25/ -0.75 at 105
left eye: +0.75
both eyes have a 2 diopter prism base out, and a 2 diopter add for near (they are progressive/varifocal). I've had this prescription since june, and it felt great at first, but now I experience double vision at near (images are side by side).
I've had glasses since the age of 3, my Rx then being +5 in the RE and +4 in the left (both with a minus one cyl at 90). When I was about 13 I stopped wearing my glasses alltogether, and was fine untill I started college and got my own laptop. I got headaches and photophobia after using the computer, and saw an optician. Since then I have not been able to get used to wearing glasses again, and have had my prescription changed at least 3 times. I still get eyestrain and photophobia even with the +2 add, and no one seems to think that it's weird that I went from a +4 to a +0.75 in my left eye in five years! My distance vision in my left eye is often blurry with my glasses after doing near work.
I'm really fed up of all this and just want something that works, I feel bad about complaining about my prescription, but no one seems to be able to get it right. Any advice would be greatly appreciated. Thanks,
Yogi
PS I'm studying to become a dispensing optician

[yogibear42]

Hi again! Hope you had a Merry Christmas and a Happy New Year! (or a Happy Holidays)

I know this took a while, but I couldn't get an appointment untill today. The drops that were used were Cyclopentolate 0.5% (one drop in each eye) Afterwards I was refracted, and my left eye was LESS hypermetropic than my prescription (it was +0.50) and my right eye was slightly more (+4.50). My vision was going double almost the whole time they were refracting, but they didn't seem too concerned.

I'm not sure the drops were very effective though, because they said it could take up to eight hours for the effects to wear off, but I could read small print without my glasses already an hour after the exam. My pupils are still enlarged though, but not photosensitive like they were the last time I was cyclopleged.

They didn't beleive me when I said that I used to have a higher Rx in my left eye, that it was impossible for it to have changed that much. They told me my dominant eye must have been overcorrected on purpose, but why would I have had bifocals for both eyes then?

Nothing seems to make any sense, and I feel very dissappointed at how the whole thing went. Before the drops went in, they did a measurement and it turns out I only have 6 diopters of accommodation in each eye (which is low for my age). But I got no answers about why I'm getting eyestrain and double vision at near, they said it was probably just my eyes getting tired after reading for long periods of time. But I start experiencing symptoms almost right away when I start reading, and I'm very frustrated because I've always loved to read, but only managed to read one book last year.

I'm supposed to come back in two weeks time and be given some excercises that are supposed to help me accommodate more effectively. I really hope these excercises work, I'm starting to feel that there's no hope of ever fixing this. I just wanted to thank you for giving me advice and taking the time to read my rediculously long posts, thanks so much!
Sincerely,
Yogi

[John C Hagan III, MD, FACS, FAAO]

Hello Yogi     You might print off the page and take it it. you can tell the ophthalmologist that this is from the Official American Academy of Ophthalmology MedHelp.org website.

Your professor is wrong. There are several tests to diagnose dry eyes: Schirmer tear strip test, tear break up time (TBUT), measuring tear osmality (dry eye is hypertonic), Rose Bengal stain is often helpful and of course the medical history.

JCH III MD  FACS   FAOO

[yogibear42]

Thank you JCH,
I will try to get an appointment with a pediatric ophthalmologist or orthoptist  asap, and mention what you wrote. I think I will try to use contact lenses if my dry eyes can cope with it. Thanks again for your advice, I really appreciate it. I will come back and post the results of my eye test when I've had it.
Sincerely,
Yogi
PS one of my proffesors said that there wasn't really a  test to dignose dry eye, is that true?

[John C Hagan]

First I strongly believe that your left eye is still about +4.00 diopters. You make know this but the eye can correct for hyperopia by focusing. To see clear your left eye has to focus +3.25 diopters all the time then if you read even with a +2.00 diopter add an additional 1 to 1.50 diopters.

Many people that are farsighted cannot wear their full correction because the focus muscle will not relax and let the glasses do the work. In kids we often put them on homatropine drops to prevent them from focusing and let them 'accept extra plus'.

You need to see a Eye MD ophthalmologist-physician that specializes in strabismus. Often these Eye MDs are called "pediatric ophthalmologists" because most strabismus occurs in kids but almost all of them do adult strabismus.

The eye MD needs to see you and measure your eye muscle balance before any drops are put in your eye. then you need a manifest refraction using a fogging technique and the technician should be instructed to "push plus" on your.

then your eyes need dilated with a relatively strong cycloplegic like 1% cyclogel and 1% mydryacyl. After 15 minutes or so you need a post cycloplegic refraction to determine how far-sighted each eye is. I believe you will find your left eye is much more farsighted than your correction.

You would need to discuss with the strabismus ophthalmologist your options. One will be stronger glasses that will blur your vision when you get them and probably take at least a week to get use to. other options include contact lens.  A final option would be to have bilateral refractive surgery (hyperopic lasik, or conductive keratoplasty) to correct all or most of the farsightedness in both eyes.

If you get rid of the high hyperopia many of your problems will go away and your glasses won't be so thick and make your eyes look so big.

JCH III MD