Ghost images for 7 years

[doc130576]

35 years old male. C/O Ghosting after prolonged near work since 7 years(complaints started in 2004 & gradually worsened). Initially, diagnosed & treated for 'Convergence weakness' for 3 years. In 2007, he found that diplopia was MONOCULAR (worse in Right eye). And then, Corneal topography & Aberrometery were done, which showed superficial corneal ulcerations. Schirmer's test (I & II) results were very low. Treatment was started accordingly, but problem kept on worsening even on tear substitutes, autologus serum, topical steroids & cyclosporin. Possibility of any systemic disorder (like Sjogren's) were ruled out by Rheumatologist. .                                                            Few points explaining the symptoms - 1) It is the ghost image of original image that appears first superiorly, and later on, another ghost comes inferiorly too............. 2) It worsens on prolonged work of 'starring' and not necessarily the 'near work' i.e. on reading, on watching TV, or even on watching movie in theater ..!! Tolerance time sometimes decreases to few minutes only........... 3) Once developed, ghosting goes by prolong rest only {no significant effect by even tear substitutes}. .............4) Problem is MONOCULAR . Appears earlier and is more sever in Right eye............ 5) Vision improves on watching through a Pin hole ............6) Similarly, on opening the eyes widely, superior ghost disappears but inferior one remains ......7)Presently, he is on bifocal glasses but problem is not related whether he uses spectacles or not......8) Seasonal variation is noticed {worse in summer time} but never felt complete freedom......... 9) Psychiatric etiology has been ruled out.....[These characteristic symptoms could be explained neither by "Xerophthalmia" nor by "Convergence weakness" even by multiple Ophthalmologists so far. Patient can in short say that his vision becomes something like what you see after putting a drop of oily liquid in your both eyes. Besides, all necessary investigations done so far are normal e.g. MRI Brain, Thyroid FT,ENA, ANA,RA Factor. Problem is troubling him now in his routine activities too. Please help him & his treating Ophthalmologists]

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

Well from what you've told me everything in the eye is normal except for the corneal surface (epithelium) of the symptomatic eye. That cretes irregular asstigmatism which causes the monocular ghosting.

Multiple therapies have been tried to heal the superficial corneal "ulcerations" without success.

Ways of trying to eliminate the ghosting would be:
1. try a "wave front" pair of glasses, example Zeiss iScription series. These new type of glasses correct higher order optic abberations that regular glasses down.
2. Fit the symptomatic eye with a soft contact lens. That would take the irregular astigmatism caused by the outer layer of the cornea to a regular spherical surface on the contact. That is a standard approach that is used on treating irregular corneal astigmatism.
3. I would see the best corneal external disease specialist you have access to for another opinion.
4. Complely removing and resurfacing the cornea with an Eximer laser and bandage soft lens is another frequently used treatement for superficial corneal dystrophies.

JCH MD

[AlexMR22]

Where could I find I.scription wavefront  lenses and how much average that kind of glasses? They can fix ghosting and starbursts??thank you a lot

[JohnHaganMD]

Many commercial optical companies sell wave front glasses. IScript is by Zeus’s. They require special equipment to fix. They do not correct all causes of ghosting and starbursts.   Very very expensive.

[AlexMR22]

Oh thanks do you think wavefront aberrometer could give me some answer?

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

You mean the instrument Zeiss uses to make the glasses calculation ? If so no.   As time has passed and more experienced wave front glasses don't seem to work well for abnormal corneas with irregular astigmatism.  Definitely need cornea topography test.