Double vision after macular pucker vitrectomy

[tictactoe68]

I am a 43-year-old woman. I had a vitrectomy on January 18 to remove a macular pucker from my retina and for floaters left by a vitreous detachment. As my vision began to clear after surgery, I began seeing double.  I'm seeing separate images from each eye, but they are not "meshing" together when using both eyes. I do not have double vision when I cover either eye, it's only when I try to use my eyes together. Before surgery, my vision was distorted due to the macular pucker and I had an extremely large floater, but I was not seeing double.

My retina looks fine post-surgery and the retina specialist doesn't know why I have double vision. He sent me back to the optometrist who, after seeing me, said he believes my double vision is a processing problem. The optometrist said my vision was so compromised before the surgery that my brain can't put the images from each eye together. He prescribed prisms which I should be getting this week.

I'm trying to educate myself on what's happening and am finding little to none on "processing problems" such as mine. I'm also concerned there could be more at play here since I have Lyme disease and have a first degree relative with Grave's disease.

I'm not sure what to think. I'm trying learn more and figure out how I want to proceed. Any input is appreciated. Thank you.

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

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[JodieJ]

Your eye is still healing--hopefully your vision will improve.  You might want to consult another retinal surgeon to see whether a second surgery might improve your situation.

In my own case, partially correcting the image size difference between my eyes with a +3.5 contact lens worn under a -3.5 glasses lens eliminated my double vision.  Possibly this type of solution would work for you.

I accidently discovered another option that might work in your case.  I use an Acuvue 1-day moist contact, which is so comfortable that I've occasionally forgotten to remove it at night.  More than once, I've inserted a second +3.5 contact lens and gone the entire day wearing 2 contacts in the same eye!  Amazingly, this seemed to make little (no?) difference in my vision, although I was using only my "good" eye to see.  This suggests that wearing the wrong prescription in your operated eye (using either a contact lens or glasses) might eliminate your double vision and give you comfortable binocular vision.

Dr. de Wit's paper (Retinally Induced Aniseikonia) has some other suggestions that have been helpful to others--it's not clear what would work for you.  Feel free to contact me through a personal message if you have more questions.  Unfortunately, it's been my experience that the eye care professionals in my area had little to offer me--maybe you'll have better luck in New Zealand.

[Ruth1246]

Thankyou Jodie for your reply as I said I have an appt with a specialist optometrist at the Auckland university on tues and will take you suggestions along with me also Dr De Wits paper on aniseikonia I wil post a comment and let u know how I get on . Many thanks Ruth Do u buy the Acvue I day moist contact on line I only had glasses for reading prior to my surgery

[JodieJ]

You're so fortunate to have a specialist optometrist available to help you.  You might want to print out the information about the Aniseikonia Inspector test from Dr. de Wit's website.  I believe that your optometrist could get a free trial of this software (and perhaps a consultation about using the test results to get a prescription for minimizing the image size difference between your eyes.)

I'm sure that your optometrist will know all about ordering contact lenses in your area, and s/he will probably have samples of the major brands in stock.  There are several good 1-day contacts available now.  My eyes are somewhat dry, and I cannot wear some brands of contacts comfortably for more than a couple of hours.  However, I can wear two 1-day Acuvue moist lenses in the same eye all day (not recommended).  It would probably also be possible to give you comfortable vision with glasses alone.  Keep us posted!

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

JodieJ: Thanks again for sharing your experience and research. JHaganMD

[Ruth1246]

hi Jodie Yes I intend taking the information an the aniseikonia inspector with me on tues. and I am lucky to have someone in Nz he is about 3 hours from me at the university of Auckland .Whenthis first happened I managed to stumble over your site and got on to Dr De Wits stuff from there it hen did a nz search for retinally induced aniseikonia specialists  in nz and his  was the only name popped up .the Auckland university school of optometry and vision science runs  teaching clinics at the university and so I ph and got an appt with him.Ken Robertson is Canadian he apparently developed the Robertson technique of measuring dynamic aniseikonia and designed iseikonic lesses you can google him  I feel incredibly lucky as I suspect he is probably the only one in nz. Will let you know how I go