Bad vision at night

[NightWolf149]

Hi,im 22 years old and im proffesional driver,and first im sorry if i make any language mistakes because my english is not very good. I have bad problem with my eyes,i already been to 5 different doctors and they dont know what is the problem. My problem is ghosting at night,i can see perfect at day or in well lit areas but when im in dark and when my pupils dialate problems begin. When im driving at night i can see realy long lines under tail lights,i can see lines around headlight like they have eyelashes and they are really long,i can also see transparent images under and over street signs and not just one i usually see 3 images under and one over. I can see normal in areas with street lights and in daylight,also i have perfect vision at distance and near only this is a problem,i dont wear any glasses because they dont help because my vision is really good at all distances. Does anyone have same problem and maybe know what this could be?

[NightWolf149]

Also i would like to add that problem is with everything which gives or reflect light,also if i cover bottom part of my pupil when its dialeted it helps,its imposible for me to watch movies in dark room because white letters have ghosting on dark background so bad that i can see triple but only original text is clear other two are blurry and unreadable. This last over a year already and its getting worse over time.

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

What kind of 'doctors' have you seen? Optometrists? Ophthalmologists?  What type of subspecialists Eye MD cornea specialist?  Have you had corneal topography?  Have you been given glasses RX? Have you had macular OCT?   Have you actually bought and worn glasses? Has a diagnostic contact lens been fitted?

[NightWolf149]

I have seen ophthalmologist and i had corneal topography. I haven't been given glasses RX because no glasses can help because i can see all those letters at test just fine. I didn't have macular oct and i dont think that exist in my country. I didnt worn glasses,i tried but with glasses i see blurry. They didnt tried or offer me any kind of contact lenses.

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

Your problem is common and there are many previous discussions on this.  If you have seen 5 ophthalmologists and none prescribed glasses  and none found anything serious its not likely anything that threatens your vision.  Since you are young it's not likely an incipient cataract.   I suspect you have irregular cornea astigmatism.  This should have shown up with the cornea topography but there are all kinds of instruments to measure this some much more accurate than others and obviously the skill of interpreting the cornea topography varies from physician to physician.

This is what I would suggest. This problem is relatively common after lasik and surface refractive surgery.  Generally occurs at night when the pupil gets larger and the vision is passing through a larger area of the cornea that when the pupil is small (daylight).  There is a drop we use for this. It's normally used as a glaucoma drop. It's called Alphagan-P  available as a generic brimonidine. When instilled in the evening it keeps the pupil from dilating in the dark and has been remarkably successful. It is okay for daily use. The Alphagan-P is more expensive but more gentle on the eye.  the generic is more likely to cause redness and irritation. There is a new over the counter eye whitener made from brimondine called Lumify but the concentration of the medicine is too low to prevent the pupil from dilating at night. I think that is your best bet. you can print this out and discuss it with the ophthalmologist you have the most confidence in.

[NightWolf149]

Ok,thank you,....one of doctors said that it would be bad for my eyes to use eye drops every day for the rest of my life,i was hoping maybe there is some kind of contact lenses that could help me,maybe ones with small pupil hole if that even exists?

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

That makes no sense at all.  As ophthalmologists we prescribe a variety of eye drops that many people take for decades and decades to maintain eye health.  You can certainly try a small pupil contact and see if that helps. Know that wearing contacts involves risk of infection, allergy, scarring and damage to cornea.     OR you could ask for a prescription for Alphagan-P/Brimonidine  and try it for a week or see to see how much it helps.  If it doesn't help cross it off your list. If it does help the risk of long term use is minimal. The most common side effect is redness of the eyes and irritation of the eyelids. that occurs in about  15% of generic meds and 8% of Alphagan-P patients.  But glaucoma patients take usually twice a day. you should be able to get by with one drop at night when you start to notice the symptoms so the chance of allergy is much lower.

[NightWolf149]

I will try to find alphagan-p but i dont think its possible here in my country,.....i have one more question,why my symptoms keep getting worse over time? Is there somsthing i could do to stop it?

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

If you smoke or use nicotine products stop immediately as nicotine damages the rods of the retina that provide night vision. Smokers have worse vision than non smokers (also e-vapor, snuff or chew).    Also certain illegal drugs (at least in USA) like meth/speed/crank  dilate the pupil and can cause those problems.  Some studies have shown that chronic cannabis use can damage retina cells.  Live a healthy life.

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

Also with a RX from your eye physician you might be able to order Alphagan-P on the internet from an international pharmacy. The company may have some cash discount coupons on their website.

[NightWolf149]

Well,i dont drink alchohol,dont smoke and i dont do any kind of drugs....only thing i like to do and really enjoy doing it is driving at night,doing night shifts on my job and i like to play video games on my pc in free time few hours a day but i think this two things are really bad for my eyes what do you think?? Also i checked in local pharmacy there is alphagan but without P is that one any good?

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

Yes.  Alphagan was the first product.  With that formulation and using the drops 2 or 3 times/day for glaucoma about 20% developed red, irritated eye. The company then reformulated it as Alphagan-P which has a patented preservative which reduced the incidence of red/irritated eye to about 8%   It is more expensive because of the special preservative. Since you would only use once/day prior to evening driving it would be less likely to cause a problem so Alphagan should work fine for your purposes. Let us know if you find this helpful.  There is another drop to make pupil small called pilocarpine but for a variety of reasons it's not a good drop to use.

[NightWolf149]

Ok,thank you very much for your help.

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

come back and let us know how it worked

[NightWolf149]

I will but i will be thankful if you answer me on my question from previous post which you skipped about doing night shifts and playing video games in free time is it going to make my condition worse?

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

Not generally but prolonged video games is associated with eye fatigues, dry eyes and increased incidence of myopia

[NightWolf149]

Ok,heres a little update of this situation,...i visited my doctor again and she did corneal topography again,after that she said that my cornea is slightly curved but its so little that she think it can not be the cause of my problem,she belives that problem might be in my pupils which are over 8mm wide in dark. I didnt tried alphagan because i read that for some people it made some new symptoms which they didnt had before and also they say that you get used to it after few months so after that it doesnt work. My condition has got worse again and its continue to progress,its really hard for me to drive at night now and im getting really depressed,few nights ago i got so depressed that i liteareally abonden my job in the middle of my shift,also i stopped using my computer completely,i dont go out anymore and i noticed that my blood sugar has started to go up its almost over the border of being normal,i had high sugar last year about month later after my vision problem started it was from stress and anxiety and it is happening again....I dont know what to do im suppose to start driving big trucks accross Europe very soon which i was waiting whole my life but until i fix this problem i guess that wont happen. I still dont understand why i wasnt offered any contact lenses i read that scleral lenses are really helpfull for this problem but i never tried them. Also i was trying to find what could be the cause of this and i figure out that i my problem started after buying new monitor,i was using small 17"monitor for years and never had problems but i did had a lot of eye strain,fatigue and dry eyes from it and 2 years ago i bought 22"led monitor which eliminated eye strain and dry eyes but after a year of using it i got this problems,i changed that monitor for brand new 24"led monitor but my problem is still getting worse so i decided to stop using computer completely. I dont know if this could really be the cause but i know for sure that until i bought LED monitor i didnt had problems so maybe its all new LED stuff which is killing our eyes and health.

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

8 mm pupil in the dark is monstrously large. That is bigger than many people pupils are after we use 2 to 3 types of eye drops to dilate they for retina exam. My suggestion would be for your ophthalmologist to refer you to a 'neuro-ophthalmologist" to see 1. why your pupils are so dilated. There is a condition called 'Adie's Pupil" in which the pupils are abnormally large and con't contract. It sometimes take the special skills of a neuro-ophthalmologist to diagnose. You could also ask the neuro-ophthalmologist about 1: Aphagan-P  (we have used with much success)   2. Contact lens with iris/small pupil on it.  3. dilute pilocarpine.  I would move forward with this as it often takes time to get in to see a neuroophthalmologist.

[NightWolf149]

So you also think that my pupils could be the cause? But why is then my condition getting worse? Does that mean that my pupils are growing even more? Is it normal for pupil to cover almost whole iris in mild and dark conditions, because mine does? I will try to find lenses with iris and small pupil and i will find and see neuro ophtalmologist if there is one around here. What do you think about scleral lenses can it help? I will also talk with neuro ophtalmologist about alphagan but there is no way i can get alphagan-p only standard one......I will keep this thread updated as soon as i find out something new so it can alsi help someone else and thank you a lot for helping me.

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

You said your ophthalmologist felt that was the problem. I said 8 mm pupil in the dark is a problem, will cause symptoms and needs investigated by neuroophthalologist.       If you have a big pupil that doesn't react well , and you don't want to try Alphagan-P (of course if you read about it it will list side effects, all medicines have side effects,  many thousands of people bleed to death each year from aspirin.  Alphagan-P is very well tolerated and i probably have 300 patients on it for glaucoma.  Alphagan is okay also.   I'm not talking about a scleral lens, I'm talking about a soft lens with iris on it and opening for pupil   something like this  https://www.miamicontactlens.com/our-lenses/cosmetic-lenses/prosthetic-and-soft-colored-contact-lenses/

[NightWolf149]

Ok than i will see a neuro ophthalmologist but there is another problem which i didnt even mention to my ophthalmologist and its that i very often pain behing my eyes,i also often feel like something is in my eye sometimes it feels like its inside eyeball like a sand and in last few months i have very high light sensitivity which makes impossible for me to drive in the daytime without sunglasses even when its cloudy,could this be something bad or just eye strain and dry eyes?

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

It is not possible to give you a definite answer and it would just be speculation. If it is dry eyes when your eye feels that way and you use a high quality artificial tears it should make it feel much better for several hours.

[NightWolf149]

Update on my problem. I visited doctor again,they gone through all the tests again and found nothing. Only thing they found is slightly curved cornea for which they say can not be the cause of the problem. But what it is then? Also i noticed that using computer makes my condition worse. I have been sick for a week and only thing i was doing for a week was playing games and watching movies whole day long. After those few days of starring at computer whole day i got severe dry eyes,my eyes were red and burning but that is not a problem. Problem is that when i got out at night after that my vision was much worse,every ghosting and starbursting was double of its size than it was before that week. I got scared and used hylo comod eye drops and after 10 minutes my vision was slightly better. Since that day which was almost a month ago i didnt use my pc at all and my dry eye symptopms were gone just after 2 days but my night vision never returned to what it was before i got sick and used pc for a full week. I will see a doctor again in about month,it will be the same doctor who was the first to do corneal topography on my eyes last year and we will compare results from now and last year and see if anything changed.

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

With your dry eyes and symptoms you should ask your doctors about going on Restasis or Xiidra or the newly out Cequa.  These medications take 4-6 months to start to work so if you need them the sooner the better. If several ophthalmologists have not been able to diagnosis your problem for certain no way I can do from a computer. However it sounds like severe dry eyes is a part of your problem and those 3 eye drops are the top of therapy for that problem. I have said this many times here, I have bad dry eyes and my wife also. Both of us have been on restasis (multidrop vial) for over 5 years with excellent results.

[NightWolf149]

Can i somehow send you corneal topography result? Are there some values? Maybe this SimK value can tell you is there something wrong. I am asking this because i heard you are  not suppose to have red color on result picture anywhere on the eye but i have,in the bottom part of the cornea there is red on both eyes and there is orange in the middle. Im talking about corneal topography result.

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

The rules of MEDHELP.org do not allow me to receive tests, correspondence, personal email or calls because legal conceerns.

[NightWolf149]

Oh,i didn't know that.....
I will keep this post updated until i find a solution and hoppefully i will find it and i hope this thread will help someone else with the same problem.

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

Okay, good luck

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

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[NightWolf149]

Today i noticed one interesting thing while sitting in the dark room. I closed my eyes and moved them up,down,left right and in circles for a minute or two. After that i opened my eyes and ghosting and starbursting was reduced a lot,almost completely gone but after 20-30 seconds it started to return and after a minute it returned back to normal. What this could mean?

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

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[Danielelston]

If you have suffered after a long time for dilated pupils or your pupils react slower than normal to changing light conditions, you will be more sensitive to sunlight. Consider purchasing eyeglasses with photochromic lenses that darken automatically outdoors in daylight for greater comfort. Or purchase sunglasses with polarized lenses for optimum comfort and glare reduction in bright sunlight.

If you notice dilated pupils after you've started taking one of the medications noted above, call the prescribing physician for advice.

In cases other than those described above, call your eye doctor immediately for advice if you notice your pupils are dilated — especially if the onset is sudden. If you don’t currently have an eye doctor near you, you can find one here.

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

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[NightWolf149]

Actually i think my pupils are normal. They are  over 8mm wide in dark but in the daytime they constrict a lot and react to light. Also i noticed they react slower and i have sensitivity to light when my eyes are dry.

[Gtk2018]

Probably as suggested by Dr hagan,  have an appointment with neuro-opthalmologist or go to emergency.

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

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[NightWolf149]

Hello,here's another update after a very long time,i returned because i thought that things i found out might help someone. So,what i found out is that i have severe dry eye syndrome,and doctors said that my dry eyes are the cause of my bad vision. We don't have Restasis or something similar in here so my only option are artificial tears which barely help at all. I wanted to point to another thing,someone might judge me but i'm 100% sure that LED monitors,phones,....are causing dry eyes. How do i know? Simple. I've been using LED monitors and my eyes were becoming worse all the time,but few months ago i bought CCFL monitor and since than my eyes are stable. Also i noticed that when i'm using my phone a lot my eyes become irritated and very dry but i can sit whole day in front off CCFL monitor without problem. I have another proof,my sister started using my LED monitor because she didn't believe me and after just one week off usage she developed same night vision problems which i have,and after she stopped to use LED monitor her eyes returned to normal. So my point is some people are obviously sensitive to LED light,not all, but some are,my father also used that LED monitor for few months and he got zero problems,he even said that it's better than CCFL for him. I tried multiple LED monitors and all have same effect for me.
I hope that this might help someone,if anyone reading this and having hard time with LED lights than stop using them before it's too late,for me it is. I will update you again when i found out something new.

[JohnHaganMD]

It is well established that many activities make dry eyes worse: reading, using any type of video screen, watching TV and going to movies.   LINK:  https://www.health.harvard.edu/diseases-and-conditions/electronic-screen-alert-avoid-this-vision-risk