Possible cause of monocular diplopia? Complicated case :)

[HerrEye]

I’m a 33 years old, one-eyed person and I’ve got a serious problem with monocular diplopia. It started almost two years ago and slowly developed. Due to the retinopathy of prematurity my visual acuity was never good (VOS = 0,1) but now my sight is even worse than it was through my whole life.

Initially my doctor suspected astigmatism because the ghost image I see is always placed on the same axis, but toric lenses which he prescribed didn’t help.

Then I noticed additional symptoms like unnatural colors and halos around the light sources and I was diagnosed with cataract. I undergone surgery but it also didn’t change anything. (I had monofocal lens implanted without any complications, it isn’t off-centered etc.) – actually my diplopia is even more severe.

Now some doctors claims that it’s caused by the PCO, but other says that my capsule is only slightly blurred and wrinkled only on the edges so it shouldn’t affect my vision. They say that there can be some irregularities of the fovea spotted on the OCT… but others argue it’s not so important nor significant… or that everything is fine.

Because of my nystagmus it’s almost impossible to obtain a reproducible keratometry result but I’ve got also AS-OCT before my surgery and doctors assure that only some irregular astigmatism is present. They deny that I can have a keratoconus.

And probably I also have some level of eccentric fixation (that can be responsible for my low VA) – but once again – it never caused seeing ghost image during my whole life.

If I push my cornea slightly, I’m able to reduce image blurriness or move doubled images a bit closer. Generally ghost image moves away from the real one with the increase of distance to the object… Unfortunately, as I’ve said, toric lenses don’t help me, only my old -3,5D glasses make distant objects a bit sharper (they also “move” ghost image closer to the real image of the object) - but my vision still remains bad.

Now I can’t read text on my TV from about 50-60 cm, games and movies watched from 30-40 cm are blurry, bright straight lines on the screen get doubled…

I still suspect that it can be some problem only with my cornea. It’s hard to believe that some age-related retina (another explanation) strains could totally ruin my sight in less than a year…

WHAT CAN I DO KNOW?

Perhaps some of you have another theory, another possible explanation? Please help me because I don’t know what to do. (and yes, I was diagnosed by – theoretically – very good doctors in my area, two PhD’s and one professor)

[JohnHaganMD]

You have several conditions that alone on together can cause monocular ghosting/diplopia that is not cotrrectibable with glasses or contact lens:  nystagmus and eccentric fixation. Moreover retinopathy of prematurity (ROP) is usually associated with major peripheral retina scarring and produces folds and distortion of the retina/macula.   It is most likely that your problem comes from the retina/macula and cannot be helped. It is not likely due to regular or irregular astigmatism.  If you have not had it done you might have a cornea ophthalmologist or optometrist contact lens specialist try fitting you with trial rigid contact lens for diagnostic purposes. If that does not eliminate the problem it is not corneal and is coming from the retina/macula.

[HerrEye]

I know that all these problems together add up to a difficult situation, but I don't understand why diplopia appeared just now even though - as I suppose - negative consequences of the retinopathy must have been present through my whole life. Initially all my doctors were fully convinced that double vision is caused by cataract and didn't mention any other explanations. Now I have a impression that they don't know what to do and list all existing problems which were previously irrelevant. I know that something could have change during that one critical year, perhaps even because of the cataract which had grown and became mature really fast, but...

Well, I thought about rigid contact lenses too and it seems that it may be the only solution left for me. Actually one of many doctors I've visited mentioned them (while others remained skeptical).

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

A trial of rigid lens is the only way to absolutely rule out irregular astigmatism especially since you can't get good cornea topography readings.   And "Why me? and Why now"  are two of the most commonly asked questions and often no good answerer.

[HerrEye]

Does it mean anything if I've realized that I actually see two ghost images, one "below" and one "upon" the real object (In fact thy are placed on 15 deg. axis)?
In everyday conditions it's hard to observe as if one of them is less visible than the other, but when I look for example on the white outline of square on black background I clearly see two "additional" squares.
I ask because usually DIplopia is illustrated only as SECOND visible  image (and astigmatism is illustrated as an image blurred in one axis). :)

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

No it adds no insight