monocular diplopia

[RBtx]

Madams/Sirs:  I have monocular diplopia in my left eye.  Here's the background:
- 57-year-old male
- lens replacement in both eyes for cataracts in my early 50s (courtesy of a youth spent fishing in south Florida?)
- subsequent retinal tears in the right eye, and a scleral buckle.
- subsequent retinal tears, laser tack-down, then vitrectomy and retinal membrane peel in the left eye.
- subsequent retinal detachment, and scleral buckle, in the left eye.  All of this about 4 years ago.

About a month ago I developed a blurriness in my left eye.  I now see that the blurriness is a diplopia, a ghost image about one degree to the right in my visual field -- when I look at a stop light, the ghost image about covers the space of the light next to it.  Pinhole fixes it.  Close up vision is no problem.

I cannot tell if there was some rapid onset or if there is a gradual worsening and it just exceeded the threshold of my perception.  I think it was the former.  There was no precipitating event that I remember.

I've been to two eye doctors for whom I have tremendous respect.  My retinal surgeon says my retina is flat and smooth.  The ophthalmologist who replaced my lens says it is clear and centered.  They both say to come back in a few months.  The one apparent problem is the sac that holds my left lens is a little loose, somehow.  You can see my lens kinda wobble into place when I make an eye movement.  But this has been true for a long time (since the lens replacement?).

My current hypothesis is that while my lens IS centered over my pupil, it has become tilted somehow.  Does that sound likely?   If it is true, is there some (easy?) surgical fix?  I would welcome any thoughts on the matter.  Thank you in advance for your help.
  

[RBtx]

Thank you, sir.

[Ray T Oyakawa, MD]

Good info.  If the pinhole fixes it there is most likely astigmatism in the cornea or from from the  lens (which you state your lens is loose, it may have moved).   Your ophthalmologist should be easily able to determine the cause.  The loose lens can be sutured or replace it this is the cause and can not be fixed with glasses.