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Ghosting in the eye - Astigmatism or dry eye ? Will sclerals help?

Hello Doctors and fellow community members . This will be a long post so kindly stay patient while I highlight my case. So I have been highly myopic since childhood but stable vision . Since 2000 , I have mostly worn contact lenses my contact lense power was stable for last 15 years at -7.5 (R) and -9.5  (L toric lens with . 75 astigmatism). This was until 2020 when suddenly things started to change. At 42 in Sep 2020 , I had.a PVD in my left eye and got a large Weiss ring floater , obviously it was hard to adjust but I eventually decided not to do anything as my retinal doctor told me to not do anything. I also have lattice degeneration so the risks are higher for any FOV and YAG laser. During the PVD I developed two small tears that were fixed by laser . This was 2020 December. I felt I finally got over the worst but things started to get worse for my other eye (right) in Apr 2021. The right eye has always been my stronger eye and I stared to see ghosting and blurred images specially during day time. Coincidentally the worsening of ghosting coincided with my covid vaccine but I don't know if it's any way related.My opto asked me to take omega tablets and OTC drops to help with the dry eyes she observed however ever since the ghosting continues to get worse. My contact lens prescription also changed for the right eye to -8.0 from  -7.5 which had stayed stable all this while. Also, as per the prescription I also have developed -0.5 astigmatism in that eye that is too small as per my opto to correc using contacts. Result is I see multiple images of green traffic light when I drive , sign boards are blurred and quality of life continues to drop. I play tennis at a high level and see 3 images of the tennis ball. Now the left eye prescription also changed after the pvd and my astigmatism reduced but the spehwrical power went to -11. It also has small uncorrected astigmatism as toric lenses don't come greater than -10.0. In summary I wear spherical contacts with no correction for small astigmatism. However that small astigmatism is causing havoc in my life or maybe it's dry eyes. I don't get irritatwd or red eyes due to dryness but it could be the year film evaporating quickly. Either way the ghosting is severe and persistent. At night I see the sign boards clearer but have halos from lights and traffic light still have triangular images. So basically 1 green light appears as 3 lights in traingular shape.

I am going to see a scleral lens specialist as out of box rpg lenses have not helped and were painful to adjust. My 1 year old glasses have severe ghosting too even though I am not sure the prescription on them are outdated. With my prescription and my intense tennis I never got used to wearing glasses . I do wear them to avoid contact lens overuse and plan to get a new pair.  

I would love to get thoughts from the great doctora on this forum and any pointers that may help. Thank you for staying and reading my post . God bless you all .
2 Responses
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233488 tn?1310693103
MEDICAL PROFESSIONAL
First read this:  https://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You--2019-2020-Update      If you have 'early onset cataracts' you don't need surgeery.   As the article says surgery is only indicated if your best corrected vision is a big problem and you are ready for surgery understanding your increased risks.  Once you deteremine it is a BIG problem and BAD ENOUGH to undergo surgery understand you will need both eyes operated on. I would not do both at the same time as is done in some places.  If you opt for surgery i would see the retina surgeon for clearance for cataract surgery and again several weeks after surgery to check the retina.  Your risk come from high myopia not lattice. Lattice is found in 6-8% of eyes depending on how diligent it is looked for. I have lattice in both eyes but am a simple (-2.25) myope. Cataract surgery, even modern no stitch surgery increases the risk of RD in everyone but much more so in the high myope. The extra steps of seeing a retina surgeon before and after surgery is what I do with my patients.
Helpful - 0
233488 tn?1310693103
MEDICAL PROFESSIONAL
You need to see an Eye MD ophthalmologist not an optometrist.  I would first see an Eye MD ophthalmologist that specializes in  retina. You need a dilated exam, special exam of your peripheral retina, macular OCT. You need to see if you are deveoping a cataract.  If that is okay I would see and Eye MD ophthalologist that specializes in cornea and refractive surgery. Go in without wearing your contact lens. You need a cornea topography to be sure you don't have keratoconus, need to be sure you don't have cataract.  At your age and with that degree of myopia you need reading glasses or multifocal glasses. You can also talk to the cornea/refractive surgeon about LASIK or PRK surgery. You may also have irregular astigmatism from your contact lens.
Helpful - 0
18 Comments
Thank you for the comment doctor.   . I have a regular retina opthomologist that I see every 6 months due to my pvd . Retina looks good . I also saw cornea optho last September and he ruled out keratoconus. They also didn't see cataracts even though my optometrist suspected an early onset. Also given I have lattice my retinal opthomologist has suggested against any corneal surgery or lens replacement in abundance of caution. I am seeing scleral lens specialist who is also an optho this week in Georgia Atlanta .
Glasses and scleral lens are for distance vision (20 ft or further) at you age you need to use reading glasses.  Ask the optometrist for a reading glasses perscription.
I am using a reading glass for reading and computer work . My ghosting is for distant objects . I have no ghosting reading etc
Does the ghosting at distance go away when you shut one eye? Is it present in each eye?
It's present in each eye when I shut one at a time. There is no ghosting while reading books or computer work
Since you have ghosting at distance but not at near that suggests it is corneal and related to pupil size. When you read or do near work your pupil gets smaller, at distance it is larger. Sometimes post LASIK patients have this problem. There are two things you might discuss with your ophthalmologist. One is a trial of Alphagan-P this keeps the pupil from dilating especially in twilight or night. It has helped some patients.  The other is brand new and you would  have to ask your retina doctor about it. They are marketing pilocarping which constricts the pupil as a treatment for presbyopia or the need for reading glasses in people in their 40's However pilocarpine can increase the risk of a retinal deatachment and it is entirely possible you retina specialist would not want you to try this.  
Thank you these are good ideas. The pupil size makes sense as I sometimes (once in 10 days) use a low dose atropine . 01% and my ghosting reduces. One more thing is that my ghosting increases in bright sunny days when more light enters the cornea . Could this be a corneal issue that can be addressed with custom sclerals ?
If you don't have a cataract, and your macula has been checked with Macular OCT test then it's almost certainly a cornea problem.
So I finally saw the eye specialist and he took various scans of my eye . He found higher order abberrations on the scan and thinks my options are very limited. Lens exchange or scleral lenses that are hard to fit and only supported by couple of manufacturers . Given my lattice issues my retinal doctor may not support lens exchange but love to get the thoughts from the Dr John.
Also the scans for the cornea came clean and the HOA is interior/Lens level . Hence the option for lens exchange surgery or special sclerals
I wish you the best of luck, don't know what else I can add. You seem to do research well.  A 'clear lens exchange' in a highly myopic patients pretty dramatically increases the risk of an RD.  Even in people that do not have risk factors for RD where the risk of RD before cataract/IOL surgery is 1 in 8-10,000   increases to about 1 in 4 - 6,000 after an uncomplicated cataract removal/IOL insertion.
Thank you doctor , I presume with your comment that going with highly customizable scleral lens to remove or minimize HOA is my best bet ?
It is the safest, least expensive and certainly should be tried before intraocular surgery.
Well the Scleral specialist said it's $7000 so quite expensive but your point is very valid Dr John . Thank you so much
That seems outlandish to me.  Research average costs or get a second opinion. That is many times more expensive than LASIK or clear lens exchange.
Yes that was my first reaction but he says since my issue is internal and not corneal it is only supported by only 2 manufacturers and will take multiple sittings .
Okay, your money and your eye and your choice
Dr John , I saw another optho today and he said I have early onset of cataracts in both eyes . Given my lattice issue is cataracts surgery still viable for me ? I will see a cataract surgeon in a month too but wanted some thoughts . I am trying to balance risk vs quality of life

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