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.

[JodieJ]

You could get the same effect of tilting your glasses by wearing a toric contact lens.  You would need to wear a glasses lens over the contact to maintain your best acuity.  I think that this type of correction might resolve your problems in a manner that would be cosmetically acceptable to you.  Your glasses could be single vision or progressive, and they would look like regular glasses.

You would need to find a cooperative optometrist to work with you.  I believe that the optometrist could get a free trial of Dr. de Wit's Aniseikonia Inspector software.  S/he would need to consult with Dr. de Wit (by email) in order to translate your test results into a prescription for the contact lens and glasses.  Any consultation fees would be worth the money.  (Your optometrist could probably publish the results in a professional journal.)

[tictactoe68]

I'm now thinking the doctor at Johns Hopkins was wrong.

I simulated the "lights on-off" test he used to diagnose the dragged fovea syndrome as the cause of my double vision. Albeit not "scientific", I think it still it points to me NOT having a dragged fovea.

Last night, I got a white letter on a black background on my smartphone. I wrapped the rest of the phone in electrical tape to block out any other light coming from it. I went into a pitch dark room and put the phone up on a shelf and stepped about 6-7 feet back.

I saw one letter, as I did at Johns Hopkins. BUT, after looking at it for more than 5 seconds, the letter went double and the second image floated up and to the right.

I also had a black letter on a white piece of paper. With the lights on, I still saw double, but it actually wasn't as bad as when the lights were off and I was looking at the white letter. The second image stayed closer to the actual image and didn't float away.

When I was at Johns Hopkins, the doctor asked me how many letters I saw as soon as the lights were out and then flipped the lights back on right after I answered. I don't think he gave me enough time. It takes between 5 and 10 seconds for the image to go double.

This, in addition to being able to eliminate the double vision when I tilt my glasses (which induces prism) makes me think the doctor at JH is wrong. So, looks like a second opinion is in order for me. I just have to figure out where.

[JodieJ]

Prisms don't work in most cases of retinally-induced distortion because the degree of distortion is not uniform across the visual field.  An ERM usually pulls the photoreceptors inward toward the fovea, so the degree of distortion is most severe in the foveal area and less severe at the macular periphery.  Peripheral vision is unaffected.  (Dr. de Wit explains this much better than I have in his paper, "Retinally Induced Aniseikonia", which can be downloaded from his website.)  On the other hand, the correction induced by prisms is uniform across the visual field.  Therefore, prism that aligns the images of each eye at the fovea will induce misalignment at the periphery.

Retinal inflammation adversely affects acuity.  It can sometimes produce a smaller image size in the affected eye.

Luvtoski, the dragged fovea syndrome paper answers the questions you raised.  I'd be happy to send it to you if you give me your email address in a private message.

I felt very much alone when I was struggling to find a way to correct my double vision.  The local eye care providers all told me that my condition was "untreatable."  I wish there was a place where we could share information about what worked for us.

[TrapperV]

Tilting the glasses is a phenomena I also have experienced. I'm not positive, but in my case I believe some of that is due to the tilt changing the focal point (or progression point) in my progressive lenses, thus shifting the image slightly. Because of my tilt demonstration (all of this was prior to my cataract surgery) the optometrist started trying prisms. He would put in a prism, and I'd try it out, and in the office, it would help (but using a fixed lens arrangement). But once I got the new progressive lens in, the tilt problem was back. We tried several prisms, but we could never overcome it. That was what got me thinking about the progression factor.

An interesting thing is happening to me. I've been on a topical NSAID for several months for some retinal swelling post cataract surgery, and I've noticed two things. The amount of correction needed in that eye has changed. Several weeks after the cataract surgery, I had a refraction done, and the results were that +1x diopter was needed for correction in the eye. I never got the glasses, as I was waiting on the ERM surgery which has gotten postponed several times. I finally decided I need something to equalize the eyes and do close work, so I got retested about a month ago. My Rx in that eye now requires a +2 correction. Once I got my glasses last week, I immediately improved my acuity in the ERM eye to about 20/25. The most amazing thing I;m also seeing, is that a lot of the gross distortion from the ERM has obviously changed. Not to say it's gone, but it's almost livable now, compared to what it was about 6 months ago. The reverse italics are still there, and some obvious size distortion, but the funhouse effect has greatly diminished.

The only thing I can attribute both the acuity change and the ERM distortion thing to is the NSAID reducing the retinal swelling. I have a call into the physicians office now to run it by him.

Perhaps the swelling existed before the cataract surgery, and it through off the measurements they used in calculating the IOL power. I was worried they had put in an incorrect IOL, but as it's changing, now I don't know what to think.

[Luvtoski]

Was wondering if JH explained how they came up with the dragged fovea syndrome diagnosis.  Was it thru looking at your OCT test result ?  Did they show you your fovea on that OCT test result and exlplain why it was swollen or distorted?  
Just part of the information gathering...I believe that I also have it but wasn't formally told that.

Thank you for sharing !

[JodieJ]

Yes, yes, yes--wearing a contact with the wrong prescription might work well for you.  I discovered this by accident.  See my posts (above) dated 7/27/12 and 8/1/12.  Your headaches may be the result of your brain's attempts to fuse 2 dissimilar objects.

Coincidentally, I just sent the paper about correcting dragged fovea syndrome with satin tape to Ruth.  (Send me your email address if you'd like a copy.)  This paper was written by doctors at John Hopkins.  When I tried this type of correction, it made things worse for me.

I suspect that some type of correction using a toric contact lens and glasses would work for you, since you can eliminate your double vision by tilting your head.  Test results from the Aniseikonia Inspector would be needed.  (See Dr. de Wit's website.)  You would need an optometrist to request a free trial of the Aniseikonia Inspector and to consult with Dr. de Wit about the test results.  

Your best bet is to become as knowledgeable as you can about your condition and the possibilities for correcting it.  Like it or not, it's probably going to be up to you to direct your own treatment.  I'm always available to help to the extent that I can.