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Dr. PG
Dr. PG, Ophthalmologist
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Experience:  MBBS, MD (Ophthalomology)
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Unexplainable Vision Disturbances - HELP Neuro/Opthamologist

Customer Question

Please review my post carefully as it is lengthy. If you are a Dr. please reply with your professional thoughts and ideas. This has been quite an enigma with no clear cut answers.<br /><br />1. 1 Retinal Specialist said he just didn't think I had Solar Retinopathy - the other said I didn't have it<br />2. The Neuro-opthamologist I am seeing said I do not have Solar Retinopathy and that I didn't have an eye problem at all but rather a brain problem. The only brain issue that has come up to date has been that of a pineal cyst that has changed slightly from 3 months ago way before this event. Size of cyst on original MRI 10mm x 9 mm x 7 mm new size is 9mm x 9 mm x 8 mm. The person's initial thoughts were that this may be the issue but has to still review the films.<br />3. Several doctors including a retinal specialist and Neuro-Opthamologist both believe the sun incident is a red herring for what is really at work here including a Corneal Specialist who said my cornea's looked great.<br />4. I have seen a Neurologist who doesn't know what to make of my symptoms and doesn't believe the cyst is the issue, since it has relatively no change in size and no other changes were evident on the MRI. <br /><br />I am seeing a psychiatrist and am on Zoloft 100 MG and Ativan 3x a day .5 mg to keep my anxiety and stress and depression under control - I'm afraid I will never see the same again and that is very very scary.<br /><br />Based on all the details below what are your thoughts and or suggestions. I'M REALLY OPEN TO ANYTHING AT THIS POINT. While everyone has said that this is a transient thing 2 straight months of little to no changes in any symptoms has me wondering what's really going on. I have never had anything close like this happen to me medically.<br /><br />The Neuro seems very committed but other than a low vitamin D level of 17 which I am now on a 50,000 IU pill once a week for 8 weeks and a small corneal abrasian that was in my right eye and was healed via the eye drops 6 days later we have nothing. Advanced bloodwork for things like Lyme Disease is still pending and I will know answers to that next week when I have my follow up appointment.<br /><br />____________________________________________________________________________________<br />Drugs taken - Present / Past:<br /><br />Past:<br />Humira - for 11 months 1 time every 2 weeks | Stopped 3/12/2010<br />Enbrel - for 5 years on and off | Stopped April 2009<br />Chinese herbs 3 times a week about 3/4 of a cup per serving (only consumed 4 batches of herbs total throughout treatment | Stopped 6/5/2010<br />Medicinal Marijuana | Stopped 6/15/2010<br />Vitamin D - 1,000 Mg a day | Stopped 7/1/2010<br />Sambazon Acai Berry Capsules | 2 or 4 a Day, serving size = 2 capsules 1,000 MG | Stopped 7/22/10<br />Milk Thistle - 400 Mg.  | Stopped 7/1/2010<br />Ambien | took 2 nights only | Stopped  - 10 MG Dose<br />Lexapro | 5 MG | Stopped after 2 days – blurred vision side effect and increased anxiety<br />SolaRay - Valerian Root Extract| 1 pill = 230 MG Valerian Root – 50 MG Extract | Stopped after 1 day – blurred vision and increased anxiety; took 3 pills in 24 hour period.<br />Present:<br />Multi Vitamin - Mega Men<br />Zoloft - 75 MG – Have been on for 6 days<br />Used to combat Stress, Anxiety and Depression associated with current traumatic vision issues<br /><br />Ativan - .5 MG As needed but have taken up to 3 a day ok by Psychiatrist <br />Used to combat Stress, Anxiety and Depression associated with current traumatic vision issues<br />_____________________________________________________________________________________<br />Incident Details:<br /> <br />Eye Wear: iC Berlin Corrective Lenses (wrap style w/ UV coding)<br /> <br />Tuesday June 1, 2010 I was out walking. Near the end of my walk I looked at the sun in the following manner. It consisted of quick 1-2 second glances – 2 at a time. Glance, glance then walked a few feet. I did this 3 times. Then walked a while further did it again and then walked almost to the building of my work and did it once more. So a total of 10 stares each stare 1-2 seconds tops probably closer to (1, 1000 of a second) time wise and then time in between. Most glances were a quick head nod up down and only a couple where there was a good direct lock on the sun but even these were for no more than a second to second or 2 at most. There was at least a couple of seconds in between each glance. After coming inside and looking at my computer the word “Google” was flying around in the center of the screen (it was like spin-art) and was doing so in strange colors in a strobe like fashion. <br /><br /><br />Only symptoms:  Blurriness most notable in right eye and especially at reading levels of distance and eyes were burning.  <br /> <br />As a result I left work early and bought Visine for my eyes. 1 time was right before bed.<br />o    I used this about 2 times this day. A couple of drops in each eye.<br />o    I used this the following day about the same number of times in the morning – a couple of drops in each eye. <br /><br />Visiting my optometrist 4 days after the incident on June 1, 2010 which was  June 5, 2010 they noted (and this has been the only finding to date on any exam or test) a mild / minor corneal abrasion in my right eye. When I saw the Ophthalmologist 2 days later  – June 7, 2010 the abrasion had healed as he didn’t note any. The Retinal Specialist also concurred with this opinion when he saw me 2 days after that June 9, 2010<br /><br />Wednesday June 2, 2010:<br /> <br />·      Woke up in the middle of the night my eyes were burning maybe 2 AM blurriness was more visible in the right eye – used Visine again which helped briefly and then I worked on an email to my Optometrist. By the time I got an email back was mid-morning. He said stop Visine and switched me to Systane Ultra and Systane Nighttime. Which I Systane Ultra was used 4-6 times daily 2 drops per eye and Systane Nighttime was used right before bed for about 2 weeks. I then continued with Systane Ultra off and on sometimes using it up to 1x per hour as directed by my Optometrist to control dry eye and the irritation.<br /> <br />6-2-10 NEW Symptoms:  Around 3 or 4 PM in the afternoon suddenly my vision felt off in that there was an odd distortion like things were slanted. I went and got the Systane medication after this occurred and left work early. A credit card looked closer to a parallelogram especially on the left side and still to some degree has this effect today. The same could be said about an 8 ½ by 11 sheet of paper. All this is with my glasses off and was never noticeable before. That evening these other symptoms became present:<br /><br />Incredible Light Sensitivity<br />Odd Line Distortion – Squares and Rectangles don’t feel perfectly square<br />o    It seems street lights and signs have a slight tilt to them like nobody planted everything straight in the ground. Left right angles seem worse than right side right angles.<br />o    I sometimes feel squares or rectangles to this slight bowing of top or botXXXXX XXXXXnes or side lines like at the very top or very bottom of one of the sides. Most noticeable when walking on a sidewalk. It seems like while the lines are straight they angle more than they ever used to (slant more).<br />o    Putting something at an angle seems to help in visual perception of shapes. Like moving the laptop screen closer to be closed seems to make it a perfect square whereas pushing it out seems to make it look like an upside down or right side up trapezoid. Lying on my side appears to help somewhat with shape dissemination<br />o    Turning my head all the way right makes text and objects clearer and sharper than any other angle.<br />o    Sometimes a square inside a square looks more square than the square outside the square like a picture frame effect. Ex#1 – Looking at Yahoo IM on my flat 22 inch monitor at work now looks like the left right angle of that IM window either slants or curves down. The right side right angle doesn’t appear to do this.<br />o    Sometimes covering up the right or left eye will make the right or left side of something look straighter like a credit card<br />o    A web page will look bowed too when its content is centered or especially on a full screen on a widescreen monitor it will look like the edges are concaving in. Especially with my glasses on.<br />o    Looking at something while lying on my side to then moving into an upright position made certain things clear and other things less clear<br />After Images – Will look at many light sources and have an after image. <br />o    Example: I will look at a clock and then moving my eyes causes me to see an after of the clock almost move around the clock depending on where I look. <br />o    Example 2: I will look at the word Google on the home page and looking left or right produces a similar after image just not as intense as the first day.<br />o    Example 3:  I will look at a light coming through vertical blinds the light and then avert my eyes to a mirror or TV and I can see those lines still and it take several blinks or seconds for them to go away. First they fade to black shadow lines and then they completely disappear this can take up to 20 seconds sometimes. <br />o    Example 4: If a light hits a surface like the side of my TV and then I move my eye to the black screen I will almost see a faint circle that will quickly fade out – it’s like the James bond circle but much fainter. <br />o    Example 5: A 3 hole punched piece of paper – if I look at the holes and advert my eyes I will get an after image of the 3 holes.<br />o    Example 6: I will look at a door frame and dart my eyes and then a black (faint) vertical line will come across my vision – this is a transient but annoying effect.<br />o    Example 7: I will look at the top of my mirror and then look down while lying in bed and I get the same effect as in example 6 but horizontal. <br />Seeing little pixel sized light flashes when my eyes are open or closed - these are appearing sometimes out of my peripheral vision but sometimes happened straight ahead.  <br />When I look at solid colored walls it appears that they have a bit of shimmer or that they fade in places maybe they shouldn’t or like they have extra fainter shadows. <br />Look at my computer monitor in low light especially causes me to see lots of mini flashing pixels - well they appear to be flashing and moving fast. Most noticeable on a white background although this effect seems to have subsided somewhat.<br />Night vision seems to be worse and a lot grainier than I ever remember it being<br />Shapes don't seem quite right - squares and rectangles seems to have a trapezoidal effect <br />Changing the angle of plane of an object or shifting the object to the far right of my FOV can correct angles not being perceived correctly. Ex#1 – Moving a piece of paper to the right of me fixes the left side of that paper not appearing straight – going to the left however doesn’t fix the problem. <br />Generally things feel distorted / tilted / crooked. <br />Moving my head causes the environment to apparently “shift” position as well. Ex. 1:  Lying in bed and then sitting up-right it feels like the room moves upright instead of just me. Ex: 2 Turning a corner at work results in the environment seeming to shift after I have turned. Ex#3 – Moving my head side to side when watching TV changes the shape of the TV into more of a parallelogram one way or the other. The same effect happens when I look at my computer monitor.<br />With my glasses on there seems to an effect now that wasn't there before like it what I am seeing is like  a computer monitor (best example) feels like it has a curve like an old tube TV instead of a flat look like it used to have. Additionally the sides of the monitor seem to come inward like an upside down trapezoid.<br />Differences in color intensity (i.e. in my left eye "red" seemed a little lighter and in on my right side red seemed a little darker. I am red green color blind but it appears that this may have been intensified or worsened by this experience. Colors overall seem duller than they did before. Especially in the yellow, green, red, orange and blue hues. White doesn’t seem as intense either there sometimes (usually with text) appears to be a little faint yellowish ness behind that but  that might just be blur.<br />I saw in my right eye something that looked like a white strip down in my field of vision maybe a couple of white stripes down the middle. This happens in different ways when looking at the computer monitor. I can illustrate this better than I can type it.<br />When looking at pattern - such as on a carpet pattern one color or part of the pattern seem to stick out more to me than the other part of the pattern when i switch eyes like a black and white checkered pattern - white prevalence in one eye - black prevalence in the other<br />I seem to have more floaters now than I can ever remember having one black one in my right eye and then several clear ones in both eyes. There are a lot of clear ones including a couple of dots and a lot of odd spider web looking ones. They seem to come and go and are annoying.<br /><br />6-9-10 NEW Symptoms:  After going to a Retinal Specialist and having a Fluorescein Angiogram completed I started noticing that evening the following symptoms:<br /><br />Light Sensitivity<br />Starburts around many light sources – that get bigger as I move away<br />Headaches and Stomach Aches – almost constant for 6 weeks every day to some degree. Headaches would usually be worse later in the day with wearing glasses of some kind whether they be prescription or not. Stomach aches usually happened in the morning<br />Difficulty sleeping- for the first 6 weeks I was averaging about 3-5 hours per night waking up to urinate and then going back to bed<br />Dehydration – I have felt dehydrated often since the event<br />Lack of appetite (although recently it has gotten better) <br />Weight Loss (weighed 177 before the event got as low as 152 – I’m back up to now about 162)<br />High Glare Sensitivity – It’s as if every light source provides a sheet or light feedback in the form of streaks or full on sheet <br />o    Blinking and looking at a light background when in a Movie theater or on a TV.<br />o    Blinking and looking at a sun spot hitting the car (which is already bright causes light to streak back at me or off the spot <br /><br />Light Streaking that occurred most when I would blink. This happens more noticeably at night but started happening during the day. <br />Depth perception feels off – the entire environment and objects in it just don’t seem right  <br /><br />7-14-10 – 7/25/10 NEW Symptoms:  After going to a Retinal Specialist and having a Peripheral Retinal Exam completed which came back normal the following started occurring:<br /><br />More Starburts around almost all light sources indoor and outdoor, day and night – that get bigger as I move away and smaller as I move closer. They look like firecrackers in doors but headlights looks wild angry stars flaring in all different directions.<br />Double Vision & Ghost Images especially without my glasses and especially when watching movies. During the day time it is most noticeable with signs and traffic lights. <br />Blurrier Vision – Despite reading at 20/20 with my corrective lenses on 7/14/2010 I find text and other things a little blurrier than before (i.e. looking at my cell phone). Right eye still seems to struggle more than my left. <br />Fonts – Parts of letters will appear missing mostly when watching TV – that is until I get closer to the screen. Looking at the number 2 on my answering machine made me see ghost 2’s all the way around<br />Reading Difficulty – Has happened more when driving – it is harder to read signs with sunglasses on whereas before it was easier. It looks like a lot of words / letters of words are doubling over. Reading up close has also become more difficult.<br />Night Driving and Night vision – appear to have gotten worse as well primarily due to the starbursts and streaking but there seems to be some shimmering and increased “noise” at night.<br />The Moon – Appears to have many moons – like a ven-diagram of moons<br />Even Higher Glare Sensitivity – It’s as if every light source provides a sheet or light feedback in the form of streaks or full on sheet <br />o    Blinking and looking at a light background when in a Movie theater or on a TV.<br />o    Blinking and looking at a sun spot hitting the car (which is already bright causes light to streak back at me or off the spot <br />Increased Light Sensitivity<br />Saw a white circle when I blinked – this was around for a couple of days and was transient (it would come and go). First it happened only with rapid blinking then it happened with some regular blinking depending on my condition. After Tuesday 7/20/2010’s 2nd retinal exam this seemed to go away. I hope it stays gone but is a reason I want to do a thorough blind spot test<br />Field of View seems narrower at all distances – it feels like I have to step back further to see more of what I could see before. Ex#1  more people in a circle of people Ex#2 more of the computer screen from a certain distance – it almost feels like everything besides what I am focused on is out of focus – but this could be normal and I could be hyper-sensitive. Again I would like as much blind spot and focus testing as possible to examine this.<br />Focus – Seems to go in and out sometimes I feel like I control this sometimes I don’t. <br />My nose – It seems like when I look right with both eyes left with both eyes or straight ahead with both eyes that I am seeing my nose more than I ever remember seeing it. Whether it be the tip of it or the side. <br /><br />QUESTIONS:<br />Can we conclude if these visual disturbances are as a result of permanent damage?<br />IS THERE A DIAGNOSIS FOR WHAT’S CAUSING ALL THIS / OR AT LEAST MOST OF IT?<br />Are these changes in vision transient? <br />Are these changes in vision in your professional opinion a result of looking at the sun or of something else entirely? <br />Was the sun a possible trigger for these new visual disturbances? <br />A Retinal Specialist and many others contend that that sun was a “red herring” for all this – would you agree?<br />Is there anything that will fix my visual disturbances (some or all)<br />Will I ever feel like I did again prior to this incident?
Submitted: 4 years ago.
Category: Eye
Expert:  Dr. PG replied 4 years ago.

Hi,

I have gone through your question and would like some more information in chronological order -

- you experienced first symptoms on June 1, 2010. Did the symptoms persist through out or did they occur periodically?

- are there any associated headaches with the visual symptoms?

- how long did the visual symptoms last - minutes, hours?

- how did they get relieved - by rest, eye drops, pain killers?

- presently what medicines are you taking?

- when you consulted an Ophthalmologist did you get any tests for the retina done like - OCT, FFA (angiography of the eye).

- do you have family history of migraine headaches?

- any other symptoms besides visual symptoms?

- since when are you on medicines for depression?

Regards

Customer: replied 4 years ago.

- you experienced first symptoms on June 1, 2010. Did the symptoms persist through out or did they occur periodically?

 

A: Not only have they persisted out - per my detailed response new symptoms have come about. No symptoms that have occurred or resolved only new symptoms.

 

- are there any associated headaches with the visual symptoms?

 

A: I usually will wake up with a headache and often times have mild to moderate headahces throughout the day. Before this I got headaches only once in a while that went away using over the counter meds. But the visual symptoms persist even without the headache.

 

- how long did the visual symptoms last - minutes, hours?

 

Once I have gotten each visual symptom it has been persistent since the day I got it. I.e. glare feedback and streaks since June 9 the day I had my Florescin Angiogram. This happens when I blink most noticably and depending on my head angle occassionally when I don't.

 

- how did they get relieved - by rest, eye drops, pain killers?

 

Rest only helps the fact that I'm tired - eye drops only mildly helped the dry eye nothing else and painkillers haven't solved any problems.

 

- presently what medicines are you taking?

 

Mega Men Multi Vitamin

Vitamin D 50,000 I.U 1 per week b/c my vitamin d number came back 17. Before the incident it was 23 then before that 29.

 

- when you consulted an Ophthalmologist did you get any tests for the retina done like - OCT, FFA (angiography of the eye).

 

I had a FFA - normal - except I started getting starbursts (firecracker effect) around many light sources and light streaking (when blinking) after this test. I get this glare feedback even when blinking and using things like a television or cell phone. It's simply awful. It seemed to get worse after July 15 appointment where i had a Peripheral Retinal test (results came back normal) 10 pics each eye. Now I see starbursts around more light sources and even on ones there shouldn't be like a belt buckle in direct sunlight I will see a little starburst. None of this has improved yet. 6 weeks since the FFA and 2 weeks since Perif ret. I can't image how or why either of these tests would make things worse that just doen't compute for me.

 

Can Florescin stay in the blood or the eye and cause problems - can it be detected or removed?

 

OCT was done several times with no abnormalities found

Glocoma test was normal

Amsler Grid testeing has always been normal

Slit Lamp Normal

Corneal topogreaphy and additional corneal tests all normal

Peripheral acuity test (test for blind spots - done several times all normal)

My vision acuity with the galsses I wores teh same day as tehe event hasn't changed it has either been 20/20 or 20/15 in each eye.

Basically every test covdered conventionally in a opthamologist or retinal specialist eye exam has been done multipel times except the ffa which was only done wonce. I am scared to ever have that again because of what ha happened with that and the other birght camer test I have had done on the peripheral retina.

 

HELP ME ?????

 

Fundus exam was normal

 

the only eye issue found by any doctor was that I was read /greeen color blind which have been since I was little.

- do you have family history of migraine headaches?

 

No.

 

- any other symptoms besides visual symptoms?

 

Yes ears have hurt occassionally but more of a dull ache. It's mainly the right ear but sometimes the left. Occassional nausia in mornings.Somtimes I have felt weak in the mornings as well.

 

- since when are you on medicines for depression?

 

Almost 2 weeks. I had a breakdown and just couldn't hanlde living. No answers to my symptoms every doctor basically has no explanation and I feel like this was never going to go away. As such I wento a pscyh for help. because i felt like i wanted to end it - the visual disturbances have been that much of a change and that hard for me to handle. This sucks plain and simple and I just want my life back of 2 1/2 months ago. I can't image what I did would cause so much shit to happen. The symptoms all have persisted (see detailed list in previous response). The meds have helped my mood but not my eye symps.

Expert:  Dr. PG replied 4 years ago.

Thank you for the information.

The symptoms you are experiencing can be due to problem in the eye or at the Neurological level.

Since all your detailed eye examination and repeated investigations are normal, it rules out an eye involvement.

The most probable case seems to be Neurological. Though you have been reviewed by a Neurologist and a neuro-ophthalmologist, your symptoms indicate that you are most probably having ocular migraine. This is a variant of normal migraine headache. It usually presents with visual symptoms like yours - haloes, distortion, glare etc. These symptoms might or might not be accompanied by a headache. Usually the symptoms of the ocular or ophthalmic migraine resolve after sometime. They occur in attacks. Rarely, in some cases they might be persistent. The diagnosis of ophthalmic or ocular migraine is usually reached by ruling out other problems like a lesion in the brain, any inflammatory neurological process etc (which has been done in your case). There are medicines to abort the acute attack and to prevent further attacks to a large extent. Medicines like propranolol have shown good results in treatment of ocular migraine. To abort an acute attack anti-inflammatories in combination with caffeine and ergotamine in them usually helps. Patients who are sensitive to ergotamines, respond to to sumatriptan.

I would recommend you to discuss the possibility of ocular migraine with your doctor and to start you on treatment for the same.

Hope this information helps.

Regards

Customer: replied 4 years ago.
Dr. PG,

Thank you for your detailed answers it offers up some "hope" which is great in light of just how downright bad I have been feeling.

A couple of follow up questions for you please - I want to pay you all 115 for sure I just will have some additional questions for you that have yet to be answered by my doctors. Thank you again for your time I appreciate it SO MUCH.

1. Vitroues and Non Vitrous Floaters - Do they go away - can stress and anxiety cause them as well as depression - can any medications I'm on cause them? I have a lot of clear ones some are little bubbles I have read these may come from fluid behind the macula and may not be vitreous the other are opaque but more like different mini web patterns.
2. Eye vitamins like Eyesight RX do you recommend these at all to someone in my case? Are there any eye things I should take to help symptoms and better sight i.e antioxidants, fish oil etc...Basically does GNC carry stuff I should look into...
3. Do you believe the sun incident has caused any damage at all - i.e. a retinography would that be hlepful in measuring retinal ganglian cells and rod and cone photoreceptors? Do you think based on what I did I damaged any of these and do any of these play a role in my symptoms?
4. What capacity does the eye have to heal itself? Can it replenish regnerate retinal cells i.e. photo receptors etc.
5. Do you feel I have Solar Retinopathy or would you be able to rule that out - furthermore is it even possible for someone in your or your colleagues practice to have such a condition and to then to have no damage but have an onslaught of symptoms?
6. My tear film and punctum - how should those be checked is something being missed?
7. Is there any advantage of doing a Wavefront test on my eyes at this point?
8. What are your thoughts on the Pineal Cyst situation - can these go from being suddenly asymptomatic to symptomatic? Do my symptoms fit? Have you had any cases where this is removed and all goes back to "the good old days"
9. Could my eyelids themselves and or eyelashes be playing any role in the glare feedbcack are there questions I should ask my doctor / tests I should take?
10. Do you feel that an EEG would be helpful in my situation?
11. Do you think any off the wall blood work or additinonal tests should be ordered in my case?
12. Palinopsia - what is your experience with this - could my current drugs worsen this, is this a temporary condition - does it come with Ocular Migraine as previously suggested? Do anxiety, stress and depression play a role in its occurance? Could the sun or FFA or Peripheral Retinal test caused or enchanced this phenonmen?
13. Do you believe the sun has played any role in the this or can i finally put this behind me as a causative factor - or do you think it stimulated the Pineal Gland which is my thought and because there is a cyst there complications have arrisen?
14. The FFA test seemed to cause some streaking and starbursting around lights - this got worse with glare and starbursts got even more apparent with the use of the Peripheral Retinal test - now I understand that every test has risks but it is my understanding that these tests are to be non invasive and shouldn't cause any harm or symptoms visually - the only side effect of the FFA that I had was slight upset stomach but that passed. It wasn't until hours later when driving home at dark that I noticed everything.
15. The seeing multiple moons and looking at an answering machine with a message number indicator on it or looking at a traffic light and night and seeing multiple circles, multiple moons or multiple numbers in the answering machines case - again occular migraine stuff? Did the test do something to cause this?

16. BIG QUESTION: Do you seem my eye symptoms and problems as being a transient / temporary occurance or permanent. If temporary how long do you foresee before any of these symptoms start alleviating.

This has been an unbareable 2 months for me and I just want my life back - anyone probably would. I have been beating myself over my sun thing but have been told by others that A. I didn't do anything B. It's a red herring C. You didn't cause any damage D. It was a tipping point.

I know there are no certainties in life and I have a follow up with my Neuro-Opthamologist which I am looking forward to next week. I just hope I can get my life back.

Thank you again sir for your time and dedication and reading through all my questions. I f anyone ever needs an interview on what HELL is like - I'd be happy to volunteer my time.

-Jeff
Expert:  Dr. PG replied 4 years ago.

I am glad to be of help.

1. Vitreous floaters can be seen in cases of detachment of vitreous from the retina (seen normally in old age, high myopes etc), in cases of uveitis (inflammation of the eye). What you are describing are not vitreous floaters. They are visual haloes etc.

2. Ocular supplements and other supplements like fish oil etc help in degenerative conditions of the eye to some extent like age related macular degeneration etc.

3. the damage to the retina or macula caused by sun is usually seen in eclipse or just before full sunrise etc. This is because when the sun is bright during day, a person is not able to look at the sun sufficiently for any damage. The bright sun rays make it impossible for the eye to concentrate on the sun for damage to occur. In any case, the damage usually caused is in the macula and is picked up by FFA and OCT.

4. We have a retinal pigment epithelium layer which regenerates dead cells in the retina normally in all individuals

5. I do not believe you have solar retinopathy. I have seen patients of solar retinopathy. They do not have symptoms like yours and as I said they are easily diagnosed on a retinal examination and further by FFA or OT.

6. A tear film examination is done on slit lamp by putting a fluorescein dye strip and checking the tear break up time and doing a schirmer's test. Patency of punctum can be checked by doing syringing. If you do not have constant tearing in your eyes and if you get a taste in throat when intilling eye drops in your eye, then your punctum is patent.

7. A wavefront test can wait at present

8. If your pineal cyst is small and not increased in size, then no need to worry. The symptoms are mostly neurological - hydrocephalus etc. The visual symptoms that can occur are usually paralysis in a particular gaze. Your symptoms seem not to be related to pineal cyst

9. Eyelids and eyelashes do not cause glare and symptoms like yours

10. You do not seem to have symptoms like an epilepsy, so EEG can wait.

11. At present I feel all blood work should be put on hold and a trial for ocular migraine treatment should be tried.

12. Palinopsia has been seen in some patients of ocular migraine. FFA or any retinal tests do not cause Palinopsia. Stress, anxiety etc can cause ocular migraine.

13. Sun and pineal gland do not seem to have caused your symptoms. It is merely a coincidence.

14. FFA as you have read does not cause any lasting effects. SO your symptoms worsening are not caused by FFA. The stomach upset might have been in reaction to the dye injected during FFA, which can occur in some patients.

15. Let me assure you, all the tests done on you do not cause any of the symptoms that you are experiencing.

16. If your diagnosis is ocular migraine then you should respond to the treatment well and be relieved of the symptoms. Ocular migraine responds well to treatment.

Dear XXXXX, I sincerely XXXXX XXXXX to recover fast and hope that a correct diagnosis is reached and treatment initiated as soon as possible.

All the best.

Regards

Customer: replied 4 years ago.
Dr. PG,

You have been so informative. I have some additional questions but my money is good so I hope you can continue to answer them as detailed as you have before until I am clear out which I believe will be soon.

1. Metamorphopsia - is there any surefire way to test if I have this? Are there different forms of it? What are the effects - how would it affect me?
2. Occular Tilt is a word that has been used to describe how I feel more things than I remember previously are now tilted and that my computer monitor or TV seem to have the sides come in or out at an angle. Is this a migraine symptom? Is there any way to calibrate a person sort of like using a level of a shelf to make sure its straight? Is there a test that can test for something like this. Turning my head seems to make some things better and then rotating my head and looking at a picture the picture seems to slowly turn kind of like going through a flip book really slowly....same analogy applies when going around a corner - I go around the corner and then the room feels like it adjusts to me. As mentioned before it seems like street lights aren't at right angles and that some signs are crocked and it feels like a big frat party came through and pushed things to the side or forward or back - kind of feels like I'm livinging in an alternate 1985 (Back to the Future Reference)

3. I am wondering if my gaze has changed. I feel that my FOV feels narrow but maybe this is me overanalyzing. Like when I am typing this I can only see the start menu button and task bar at the bottom of my screen but they aren't in focus. They aren't out of focus but it feels like i am using peripheral vision a lot. Has this always been this way? I feel like I open a webpage and I can see everythign but my focus is where my eyes are centered and I don't feel like I am amble to take it all in - at least as I remember it
4. When wearing glasses now and looking at the computer the sides converge in and the screen appears to have a fishbowl (old tube tv) kind of effect to it and never did before. Before I put on my glasses and it just sharpened things up..
5. Can Drusen cause any of the issues I have mentioned - one opt. found 3 in my left eye away from the fovia and 1 in my right eye away from my fovia. A retinal specialist thought this was an overcharacterization and my corneal specialist viewed them as merely calcium deposits.
6. To clarify further - the RPE helps regenerate lost rods and cones? Do you know how long it takes for new ones to appear?
7.Can Occular Migrains appear without a specific aura or scintilating scotoma in my case and no headache (mines seems to come and go)
8. So if this is an occular migraine light sensitivity and when I blink at a bright light would not cause streaks or when I am watching tv lines woudn't come back at me....(glare coming back at me kind of like a sheet of glare)
9. If I read what you are saying correctly it is possible that these clear floaters and the spider web like ones can be part of a visual aura / occular migraine and aren't really there?
10. How do you explain the starbursting effect i've mentioned in detail previously- also Migraine. Before all this I never had this. Now this is most noticalbe with glasses off but with glasses on its not a sharp (cirlce for example)
11. Sometimes things come out of focus (or I can make them out of focus) again a occular migraine thing?
12. Sometimes I see double vision - most noticable at night examples given were the moon and even teh power button on my DVD player it looks like ghosting of a circle of power buttons around that power button - same thing happens on an answering machine - occular migraine - something else etc. (this is with glasses off) but still i never saw this poorly or any of the visual disturbances with them on
13. More night time noise when all the lights are out - and night vision seems worse - possible explanation here?
14. Did I already mention bright light sensativity out doors especially driving at like 7 PM when sun is setting or going into deparment stores and I take my sunglasses off things feel too bright and I get the line streaks back at me with lights and even if I am not looking at lights. If lights hit a glass surface for example and I blink I will get slighter streaks coming back at me then. It seems like this streaking affect is just everywhere.
If this is an occular thing (it is the eyes themselves) - and someone has missed something on exam (highly unlikely) what additional tests would you have done? Would an Electroretinography be helpful for me regardless of what's going on?

Your answers have been very detailed and I greatly appreciate them - I'm not sure if you are a neuro-opthamologist or just a general one but you have a great deal of knowledge.

I would be most obligize if you are able to consult either some experts on this form or eye gurus in your circle to see if there are any other theories. I am just looking to obtain as much information as possible and any thoughts or theories based on my long emails would help me greatly. I just want my life back as mentioned before and this has been a helacious couple of months.

If you would like or would be willing to talk via phone I can provide my cell. If there is another eye expert (guru) who would be willing to offer phone time as well I would be very happy. Anything people can say as reassurance in the medical community as far as my eyes go is great. If all should return to as it was then I would be greatly appreciated.

I.E. if not occular migraine then what? Although your theory seems to be the best I have heard thus far and seems to fit. Any other out of the box ideas - I'd hate to end up as another statistic on the internet of one of those guys who nobody knows what's gonig on but that doesn't appear to be the case.

-Jeff

P.S. On the off chance they say "yes it's teh Pineal Gland" would these kind of symptoms come from this?

P.S.S. What other reasons can people get feedback when blinking when looking at bright lights or headlights, streetlights or other light source as I do. It's crazy annoying and almost crazier to believe I could be experiencing an occular migrain for 2 months straight.

Finally just to reconfirm - from you answers you feel like what I am going through is tranistory / temporary and no permanent damage or condition is in effect here - aka the world should right itself back to how I remember it?
Expert:  Dr. PG replied 4 years ago.

Dear XXXXX,

What I can gather is that you are very upset with your symptoms (understandably so). The questions that you are asking are more or less similar to the previous ones. Still let me explain.

Metamorphopsia etc will be easily picked by by tests like Amsler grid. You do not seem to have any problem in the eye, which has been verified by the various tests done on your eye. As far as rods and cones are concerned, any defect in them would not present with various symptoms like yours. So there is no role of electroretinogram or electrooculogram at present in your case. The visual symptoms of ocular migraine can vary a lot from patient to patient - floaters, different colors, after images, distorted images, central loss of vision, star burst phenomenon, diplopia or double vision, light sensitivity etc. There is no hard and fast rule that each patient of ocular migraine will have same set of symptoms.

As I wrote before your problem seems to be Neurological in origin. I have encountered and treated cases of ocular migraine who have presented with totally different symptoms than seen in normal patients of ocular migraine. The good news is that most of the patients respond well to treatment.

Since you have an appointment with the Neuro-ophthalmologist next week, I would recommend you not to worry and discuss this possibility with your doctor. Worrying will only worsen your symptoms. You seem already have a lot of information overload after extensive reading. I sincerely XXXXX XXXXX not to get confused further and just try to relax as far as possible. I know it is tough, but I guess that is the option for you.

Regards



Edited by Dr. PG on 8/6/2010 at 5:59 AM EST
Dr. PG, Ophthalmologist
Category: Eye
Satisfied Customers: 2337
Experience: MBBS, MD (Ophthalomology)
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Customer: replied 4 years ago.
Thank you so much for all your help and reading all the details of my case. I hope the compensation was appropriate. They say knowledge is power and its something I am willing to pay for in a situation where up and until now I have felt as if there were no answers. I feel like there is hope and if you thoughts prove to be true well then sir well I may end up getting my life back - and that doesn't have a price tag I can put into words.

I hope we are able to stay in touch via this forum Dr. PG or email if need be.
- my email isXXX@XXXXXX.XXX.

-Jeff
Expert:  Dr. PG replied 4 years ago.

I am glad to be of help.

I hope you recover fast and fully.

All the best.

I am more than happy to help you.

Regards

Customer: replied 4 years ago.
I appreciate all your time and your timely responses. I will be posting on this forum next week after I meet with my Neuro-Opthamologist. I will bring our discussion.

If you have any thoughts on my updated posting please feel free to share them. Thank you for taking an active interest in helping me getting to the bottom of this troublesome and debilitating situation.

-Jeff
Expert:  Dr. PG replied 4 years ago.

I a more than happy to help you.

Regards

Customer: replied 4 years ago.
Quick side question - I'm taking .5 mg of Ativan 3x daily until the 100 MG of Zoloft I am taking can kick in - I was taking 75 MG previously. I've been on both since 7/20/2010 and the 100 MG Zoloft since 8/2/2010. This has been perscribed by my Psychiatrist and from a mood standpoint seems to be helping.

In your experience can either of these drugs / in these doses either separetly or mixed together induce or enhance (worsen) Paliponisa or any of the other symptoms I am displaying?

It seems unlikely just because these drugs are so widely prescribed and such moderate doses and from what I understand they have a low side effect profile. My dad takes 100 MG of Zoloft too which is one of the reasons the Psychiatrist chose the drug (the genetic factor).

Thank you for your thoughts in advance. Outside of this question I won't have any additional questions or feedback until next Wednesday after I meet with my Neuro-Opthamologist.

Greatly appreciate all your time and insight. It's the best kind of comfort food so to speak to have people who really care and are looking after your best interests and well being in the medical community - especially during such a trying and frustrating circumstance.

Kindest Regards,

-Jeff
Expert:  Dr. PG replied 4 years ago.

Hi,

Thanks for the kind words,

There is direct connection between ativan/ zoloft use and palinopsia,

warm regards

Customer: replied 4 years ago.
Does that mean that I would need to discontinue 1 or both of the medications for the effect to be reduced or eliminated or is this now a permanent side effect I am going to have to deal with indefinitly...(I sure hope not).

Would there be any other medications in these classes of medications that won't cause these effects or are these side effects of all Benzodiazapines and SSRI's.

Again thank you for your answers.

The idea in my whole situation is to subtract not add or enchance symptoms.

What questions would you suggest regarding these 2 drugs (and this particular symptom that I ask my Psychiatrist and/ or Neurophthamologist?

-Jeff
Customer: replied 4 years ago.
Dr. PG,

Not sure if you had a chance to review my last post - just wanted to see if you had any thoughts on the drug interactions mentioned previously. I have appointments with my Neuro-Opthamologist Wednesday and Psychiatrist Thursday. Any suggestions or questions you can give on the above would be helpful. I will throw in some extra money but I just need to see if this is something you are able to answer beyond the answer given. I understand this might be etching outside of your field of expertise.

Thank you again and I will be sure to follow up with you after I go to my appointments. The information you have provided to date at the very least has been incredibly informative and has given me a shred of hope with this entire situation.

-Jeff
Customer: replied 4 years ago.
Relist: The answer is very satisfactory; if not incredible. I am just looking to have a couple of additional doctors either back up or weigh in on their thoughts. I have seen a lot of specialists - paid a ton of money. While this answer has provided me with the only ray of hope I have thus far (and I paid handsomely for it) I want to have my case re-opened for other experts to view. I really need as much information and as many opinions as possible because whatever I have / am experiencing is "rare" and "unusual" and doesn't seem to "fit" any of the standard eye/brain things that happen to people which is a daunting and scary thought. I am hoping when I visit the Jules Stein Eye Institute next week that they will either be able to concur with the experts on here or have additional ideas. Either way my quality of life has been impacted greatly by this. I believe truly that while looking at the sun is far from the smartest thing to do - everyone I have seen has pretty much stated it as a "red herring" event and that I have a "brain/neurological" and not an "eye" problem and that I didn't cause this to happen but rather my body / vision is undergoing something currently unexplainable.

I certainly hope this lengthy explanation helps. I am only trying to recover from and find treatment for this. We live in a modern world 2010 - last I checked - and for absolutely nothing to be found / possible treatable just seems a little hard to believe.

Thank you.

-Jeff.
The answer is very satisfactory; if not incredible. I am just looking to have a couple of additional doctors either back up or weigh in on their thoughts. I have seen a lot of specialists - paid a ton of money. While this answer has provided me with the only ray of hope I have thus far (and I paid handsomely for it) I want to have my case re-opened for other experts to view. I really need as much information and as many opinions as possible because whatever I have / am experiencing is "rare" and "unusual" and doesn't seem to "fit" any of the standard eye/brain things that happen to people which is a daunting and scary thought. I am hoping when I visit the Jules Stein Eye Institute next week that they will either be able to concur with the experts on here or have additional ideas. Either way my quality of life has been impacted greatly by this. I believe truly that while looking at the sun is far from the smartest thing to do - everyone I have seen has pretty much stated it as a "red herring" event and that I have a "brain/neurological" and not an "eye" problem and that I didn't cause this to happen but rather my body / vision is undergoing something currently unexplainable.

I certainly hope this lengthy explanation helps. I am only trying to recover from and find treatment for this. We live in a modern world 2010 - last I checked - and for absolutely nothing to be found / possible treatable just seems a little hard to believe.

Thank you.

-Jeff
Customer: replied 4 years ago.
Relist: JUST TRYING TO RE-POST THIS TO SEE IF ANYONE ELSE HAS ANY ADDITIONAL THOUGHTS OR IDEAS - ANY HELP WOULD BE GREATLY APPRECIATED. I WILL ABSOLUTELY PURSUE THE ADVICE GIVEN. DR. PG HAS BEEN PHENOMENAL. JUST SEEING IF ANYONE ELSE HAS ADDITIONAL THOUGHTS / IDEAS / TESTS THAT SHOULD BE DONE - THIS HAS BEEN TO SAY THE LEAST A TROUBLING EXPERIENCE. I JUST NEED ALL THE LEADS / THOUGHTS / IDEAS I CAN GET - NOBODY I HAVE SEEN TO DATE CAN PUT THEIR FINGER ON THIS....
Customer: replied 3 years ago.
Anybody else have additional ideas?

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