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 are incredibly lucky!  I live in a large metropolitan area (Chicago), and I have yet to encounter an optometrist who is knowledgeable about retinally-induced aniseikonia.  A couple of optometrists actually became hostile when I attempted to explain the concept of field dependency.  I did see a very enlightened local neuro-ophthalmologist who used correction techniques similar to those of Dr. de Wit.  However, the ophthalmologists I contacted who specialized in binocular vision actually refused to see me when they learned that my problems were retinally induced.

NZ is apparently more advanced in this area than we are in the US.   It sounds like you are in good hands.  

[Ruth1246]

Hi I went to see the eye specialist  who was very apologetic said he only ever come across this once in his professional life and didn't know what to advise me .he had written and phoned Ken Robertson in Auckland also he took copies of Gerard De Wits paper on retinal induced aniseikona and the info on the aniseikonia inspector . I attended the appt with Ken Robertson who was helpful he also was aware of Gerard De Wit  Ken is trying to make me some lenses at this stage for driving did say that it would be atrial and error exercise but was happy to hang in there . My major problem at the moment is constant headaches despite taking panadol 2  every 4 hours do u have any suggestions I am trying to work and finding this a real struggle with the headaches  any suggestion will be appreciated . Ruth Solly

[JodieJ]

Yes, getting the right correction will involve a trial and error process.

Do you have glasses now?  I'd suggest trying to wear a foil on the inside of the lens for your affected eye that would blur your vision so that you'd be relying on your good eye.  This is a much better solution cosmetically than wearing an eye patch.  Your optometrist should have foils available in a range of powers.

I don't know the extent to which my own experience would generalize to others, but wearing the wrong prescription in my bad eye provided comfortable vision.  Through some type of neuroadaptive process, my brain automatically screened out the distorted image in my bad eye.  It seemed like I was seeing out of both eyes, and I wasn't aware of the loss of depth perception.  (Apparently, there are many visual cues for judging depth.)  This wouldn't work for viewing 3-D movies, but my vision seemed to be fine for driving.  (In the 3rd edition of "The Fine Art of Prescribing Glasses Without Making a Spectacle of Yourself" by Milder & Rubin, the authors prescribe glasses with the wrong script in one eye for a physician who suffered a badly botched LASIK procedure in one eye--and it worked just fine.)

[Ruth1246]

Hi Jodie I i made my self up a lense a week or so ago out of some clear   baroque glass i do stained glass as a hobbie which does work  blurres the image but i can still see out of that eye and it allows me to drive I have it stuck in with sticky tape certainly worked better than the ones the local optometrist made up for me. Ithink some of my headache problem is that I have been trying to go without glasses in an attempt to get the brain to suppress the distorted image in my r eye headache is much better today as I had my glasses on all day this may be a helpful suggestion for others while they are waiting to get to see a specialist optometrist thank you so much for all your help and suggestions  Ruth Solly

[Ruth1246]

Hi Jodie thank you so much for all your help and advice will let u know how my driving glasses turn  out once they arrive ,again many thanks for all your help cheers Ruth Solly

[JodieJ]

This type of correction often involves some tweaking, but I really believe that you can come up with something that works for you.  I'm always available if you have questions.