"ghosting" effect in vision.

[Mspringett]

Hi there :)

So I have a current problem with "ghosting" in my vision - an extra ghostly image of various objects that gets worse the further away I am from the object (and the more contrast there is between the object and the background). I have this in both eyes - it is helped by glasses, but not cured. Here is an image that shows what it looks like: http://i.imgur.com/IHWBflS.png

I've had this effect for 2 years - it started suddenly along with floaters in both eyes. I recently got some new glasses that I thought might get rid of the ghosting effect - but it doesn't. It improves it more than the previous pair of glasses I had, but it's not gone. I am getting the lenses adjusted for some mild astigmatism, and I'm hoping that will help, but to be honest the doctor wasn't that helpful, and I'm worried that if these lenses don't work for me, he won't make any more effort to solve this problem. I will of course wait to see if these new lenses help, but if they don't, does anyone have a suggestion of what step to take next? Perhaps I should seek out a particular kind of eye doctor for this issue?

Thank you in advance!

-Miriam

[JohnHaganMD]

Best of luck. I doubt that explanation. If pupil size were the problem you would be assymptomatic in daylight and only symptomatic in the dark when pupil large.

[Mspringett]

Hi again Dr. Hagan,

Since the last time I commented here - I have seen another ophthalmologist (not one specializing in corneal diseases though) and was referred to a eye-nerve specialist, and had an corneal topography done. The ophthalmologist and my regular optometrist both seem to think I have "a bit" of irregular astigmatism mainly in my left eye. My optometrist was convinced of this once she read the results of the corneal topography she ordered, and the ophthalmologist did the pin-hole eye test which seemed to lead her to the same conclusion.

My optometrist thought that hard contact lenses might help, since it corrects the shape of the cornea. She ordered 1 lens, as a test for me, and I am having it fitted for me soon. I really hope it helps.

I know you mentioned seeing a ophthalmologist that specializes in corneal diseases, however when I mention this to my regular GP she tries to explain to me that astigmatism is normal and isn't convinced I need to see a specialist. My optometrist (who referred me to the ophthalmologist and nerve specialist) also seems reluctant to send me to yet someone else, and concludes that I am simply a very "observant" patient. Since I have had the topography done, and am having a lens fitting soon, is it still worth trying to find a ophthalmologist who specializes in corneal diseases? Should I wait to see if the hard contact lens helps the issue?

Viewing screens and going to the movies is becoming more unpleasant because of the glare/ghost image, and my eyes are often quite sore and strained/stinging after trying to work on my artwork. Overall, this has been quite bad for my state of mind. I'm mentioning this because I want to emphasize how important solving this issue is in terms of my overall health.


Thanks so much for reading - and any suggestions on how to move forward in solving this problem would be appreciated :)

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

Of course "regular" astigmatism is normal and is corrected with glasses and no ghosting. "Irregular" astigmatism that causes ghosting not corrected with glasses is abnormal.  There is a very good chance the rigid contact lens will take care of the problem.  If it does all the cornea needs is to be checked regular to be sure CTL fits and repeat topography to be sure the irregular astig doesn't get worse and that you don't have keratoconus. If the doubling persists and you find it troublesome then I would see a Eye MD cornea/refractive disease specialist.

[Mspringett]

Hi again Dr. Hagan.

Thanks again for your previous response.

So since last writing I have tried the rigid contact lenses briefly - but they were very hard to tolerate . I may try them again if nothing else works (though the pair I tried were a sample, and did not improve my vision anyway). In the meantime - my optometrist ordered some softer contacts for me (and also mentioned in my last exam that I had some more "uncorrected" astigmatism that she changed on my file and prescription). I got a couple of trial contact batches made for astigmatism and my prescription. They do seem to change the ghosting effect - improving it from further away, but from middle distance to close up is seems to make it worse/harder to focus. While it was interesting to note the change in the ghosting - at this point I am finding it hard to believe that I don't have some eye disease or another problem besides astigmatism/irregular or not. Since neither glasses nor contacts seem to correct the problem completely. The corneal topography seemed to suggest to my doctor that I do not have keretaconus, and only mild irregular astigmatism - so why is this seemingly impossible to correct? You mention seeing a cornea specialist - and I would like to do that, but because my optometrist and family doctor seem to think that I don't have any need to see one, I'm not sure how to get a referral or an appointment. Would searching for one and simply calling their office be an option if my doctor doesn't agree to help me with this?

Thanks for your continued help, it is very reassuring.

[Mspringett]

Hi Dr Hagan,

I thought I'd update you again and ask for more advice. So since posting here last, I have tried a few contact lenses and a new glasses script via my optometrist - and it's been a bit frustrating because they seem to make the ghosting both worse and better. With contacts the vision seems pretty clear far away but then as time goes on the ghosting/blurring seems worse and I can't read text very well. I have to blink and squeeze my eyes a great deal to try and correct this (this is probably dry eye). I tried rigid contact lenses in my optometrists office, and they were very hard to tolerate and didn't seem to help my vision. It was very blurry and my eyes watered like crazy.

To expand a bit on the contacts lenses: they seem to give me less ghosting in general and sharp vision in normal lighting (like in my apartment or outside during the day - though I usually wear sunglasses),  but in those situations where the ghosting is the most obvious - it's still pretty bad. Bright stores with white on black signs everywhere - text on subway signs - movie theatre screen - tv screens - computer screens. It's still pretty obvious in those circumstances, and I *need* to be able to be in this situations in order to enjoy my life. It's notable that while the ghosting is still bad, it seems "softer" than just with glasses - less clearly an sharp extra image around the main object - more hazy. The close up vision with the contacts is not wonderful, and seems to also get blurry pretty easily. I reported back to my optometrist and she didn't change the script, just thought a different type of lens might work. So I am waiting on that, I hope it will work a bit better.

So my optometrist thinks my eyes are "sensitive" and I have mild irregular astigmatism (according to the corneal topography), mild dry eye and perhaps a slight muscle imbalance between eyes . She thinks this explains my symptoms - but when I brought up the corneal specialist again,  she didn't think it was a good idea because they wouldn't be able to do anything further for me. Who should I go and see? How will I move forward with some sort of successful treatment if my optometrist thinks I don't need further help? Do you have any tips on what specialist I should seek out and how to get a referral if not from my optometrist?

I really appreciate your answers, any more tips or guidance would be fantastic. :) Thanks so much!

-Miriam

[JohnHaganMD]

Alright I have reviewed all your postings. You have seen a 'regular' Eye MD ophthalmologist and a 'nerve' ophthalmoloigst. I presume that is a 'neuro'ophthalmologist. The working DX is 'mild irregular' astigmatism. Your optometrist has tried glasses, soft and hard contact lens without success. Your optom wants you to 'live with it'.  You seem reluctant to do that.  If you want move to the next level you need to see an Eye MD ophtthalmologist that specializes in cornea/refractive eye surgery.  You need to get all your records together from your optom and the two consults you have seen.   You might want to do your own research about who is the outstanding cornea/refractive surgeon you can easily drive to see on a regular basis.  The cornea doctor your optom recommends may not be the best. Most optoms have working relationships with Eye MDs. Often these involve financial considerations. That is many optoms refer only to cataract surgeons that 'co-manage'  that means the optoms gets part of the surgical fee.  That used to be called fee splitting and was both illegal and unethical but medicare law has been changed.  As a minimum the patient should be told of this fee-splitting but that is not required by law and most don't.  Some eye surgeons will not fee-split/co-manage. Optoms don't normally refer to these conscientious surgeons.    The other thing is that the 'co-managers' will often bend over backwards not to make the optom look bad if they disagree with the diagnosis.  An independent Eye MD is more likely to give you a completely forward opinion if he/she is not worried about losing referrals from the optom.  So I would start doing some research. If you have a medical center with a school of medicine the department of ophthalmology will almost always have a cornea/refractive expert.

[dori76]

I found an article about a case of dry eye that caused an irregular topography result (and ghosting was one of the symptoms). https://www.ophthalmologymanagement.com/issues/2017/may/when-dry-eye-deceives

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

Nothing new there

[dori76]

It might be new to people who don't know about it, if not to you.

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

=

[HamzaRanjha]

Such a piece of information!
So Doc, we can reverse irregular astigmatism from dry eyes, right? Thus, lowering ghosting?
Are Artificial tears like Systane enough to cure dry eyes? Or something else too? Plus how many times a day should you use the ATs?

[JohnHaganMD]

Go to my home page and read the article on treatment of dry eye. It is complex and different for every person.

[JohnHaganMD]

Best of luck.

[Mspringett]

Thank you Dr Hagan, I will try to see an opthalmologist that specializes in that area. That gives me a direction to go in if this problem doesn't go away, so I appreciate your answer.

Just an update: I got my newly corrected glasses, and it does get rid of most of the ghosting, but not all of it. The doctor I saw most recently, said that it might be because I have very large pupils and they can cause ghosting sometimes. I will try and be satisfied with this explanation for now, but if the ghosting never goes away or gets worse, I will seek out a ophthalmologist that specializes in corneal diseases. Thanks so much for your time!

Miriam