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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3177
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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Why have I never had double vision, even with strong prisms?

Resolved Question:

I was diagnosed with exophoria and prescribed prism prescription for my eyeglasses. My symptom is headache, and so whenever I get headaches again (usually 7-10 days after using a new prism strength) I increase my prism strength and get relief from my headaches. My question is... why have I *never* had double vision??? Before using prisms, I never had double vision. Now I am up to 10 diopters in each lens (20 total diopters!) and I *still* don't see double. I can take off my glasses and put them back on again and never see double. I have tried to research eyes and understand this condition, but I just cannot understand why I have never had double vision. Can you explain it to me?
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Dan B. replied 2 years ago.

Doctor DanB : Hello and thanks for your question. Are you available to chat?
Doctor DanB : Presumably, you had a symptom or complaint that brought you to your eye doctor's office where you were prescribed these prisms. Can you tell me about it (them)?
JACUSTOMER-gp5k8qkg- :

Hi! yes, I'm here and can chat

JACUSTOMER-gp5k8qkg- :

My whole problem is explained in this document: https://docs.google.com/document/pub?id=10nCd6ovQfYiZNBtfIuE0nNrUmGnG9D3Tr6WHcDHi7l8

JACUSTOMER-gp5k8qkg- :

To summarize, I have a headache *every*single*day* that when not treated properly with prism eyeglasses also comes with nausea, brain fog and occasional electrical shocks

Doctor DanB : Yet, youare needing an ever increasing strength of prism to keep your headaches at bay?
JACUSTOMER-gp5k8qkg- :

I am having difficulty getting a prescription more than 20 diopters... right now I am using eyeglasses with 8 diopters built into each lens, and a 4 diopter fresnel prism over the right lens. It appears to have lessened my symptoms for the moment, but they've been "expiring" much more quickly lately

JACUSTOMER-gp5k8qkg- :

yes, it feels like a never ending search for a stronger prescription of prism eyeglasses

JACUSTOMER-gp5k8qkg- :

No one I've spoken with understands why I never see double vision

Doctor DanB : What that tells me is that you are having a problem that may just be being covered up by the prisms. Did you see an optometrist or ophthalmologist?
JACUSTOMER-gp5k8qkg- :

I have seen one optometrist and three ophthalmologists

Doctor DanB : Do you do a lot of computer work and/or reading?
JACUSTOMER-gp5k8qkg- :

I am a software programmer, so yes, I use the computer often. However, the problem is not isolated to my computer. I also have problems taking a shower (because I can't wear my eyeglasses) and talking to people.

JACUSTOMER-gp5k8qkg- :

Oh... and a SEVERE problem with any sort of transportation vehicle.

Doctor DanB : What sort of problem?
JACUSTOMER-gp5k8qkg- :

Riding in any sort of vehicle will often knock me out for half a day

JACUSTOMER-gp5k8qkg- :

Severe motion sickness that also induces headache

JACUSTOMER-gp5k8qkg- :

If I keep my eyes closed I can often minimize or eliminate the chance of symptoms occurring. But lately, as I've gotten worse, keeping my eyes closed will only kinda make things better. I still get very very ill.

JACUSTOMER-gp5k8qkg- :

Showering effects me the same way. I try to not open my eyes while in the shower, but for some reason I still get very very ill.

Doctor DanB : Has anyone talked to you about surgery to correct this problem? Most people can't function in the amount of prism you're wearing.
JACUSTOMER-gp5k8qkg- :

If I don't use prism eyeglasses, motion sickness knocks me out big time. With eyeglasses, I just have to deal with the headaches. But now that I've reached up to 20 diopters, the motion sickness is taking its toll on me again.

JACUSTOMER-gp5k8qkg- :

I'm have a *massive* problem getting anyone to even treat me as a patient let alone offer treatment options :(

JACUSTOMER-gp5k8qkg- :

Two ophthalmologists said they couldn't do anything for me

Doctor DanB : Were thy both general ophthalmologists or subspecialists?
JACUSTOMER-gp5k8qkg- :

The other who diagnosed me with exophoria doesn't have time to treat me. He can't fit me in his schedule. I presume I am just not a priority because I don't risk vision loss.

JACUSTOMER-gp5k8qkg- :

He referred me to another ophthalmologist but she won't see adults except for once a month and she's booked for months

Doctor DanB : It sounds like you were referred to a pediatric ophthalmologist. Can you be referred to another pediatric ophthalmologist?
JACUSTOMER-gp5k8qkg- :

I can't find any :(

Doctor DanB : Where do you live?
JACUSTOMER-gp5k8qkg- :

I tried to see a neuro-ophthalmologist who has been doing research in eye muscle disorders, but she wouldn't see me, either

Doctor DanB : Whatbwas her excuse?
JACUSTOMER-gp5k8qkg- :

She referred me to the standford headache clinic but I haven't heard anything since

JACUSTOMER-gp5k8qkg- :

She didn't say... just had her assistant call me and tell me that she thought the headache clinic would be better

JACUSTOMER-gp5k8qkg- :

I do have an appointment with a neurologist, but it isn't until August 3rd

Doctor DanB : Where do you live?
JACUSTOMER-gp5k8qkg- :

I'm trying to get someone at the standford headache clinic to answer the phone... and the UCSF headache clinic to answer the phone and return my messages, but neither will

JACUSTOMER-gp5k8qkg- :

I'm in San Francisco

JACUSTOMER-gp5k8qkg- :

I have another referral out to another neurologist but I can't get through to get an appointment. The last they said was that they'd call me back in an hour or two to schedule an appointment but never called back

JACUSTOMER-gp5k8qkg- :

but balancing my pain and trying to earn money, it's been so hard to find time between 9-5 (and not lunchtime!) to call everyone

Doctor DanB : If you'll give me a moment, and the names of the pediatric ophthalmologist you were referred to and the neuro-ophthalmologist who won't see you, I'll see if I can find someone else appropriate for you to see.
JACUSTOMER-gp5k8qkg- :

sure

JACUSTOMER-gp5k8qkg- :

The neuro-ophthalmologist who referred me to the Standford Headache Clinic was the Directory for neuro-ophthalmology at Standford, Y. XXXXX XXXXXao

JACUSTOMER-gp5k8qkg- :

The ophthalmologist who diagnosed me with exophoria was Dr. Creig Hoyt of the Beckman Vision Clinic at UCSF

JACUSTOMER-gp5k8qkg- :

Dr. Hoyt referred me to Dr. Alejandra De Alba also of the Beckman Vision Clinic at UCSF... she only sees adults once a month

Doctor DanB : Jonathan C Horton MD PhD  Member Type: Fellow  Primary Office: Department of OphthalmologyXXXXXStreet K301 San Francisco, CANNN-NN-NNNNPh:(NNN) NNN-NNNNe is a neuro-ophthalmologist and pediatric (strabismus) ophthalmologist. He is likely the perfect blend of specialist for you to see. I would try to be as persistent as humanly possible about trying to get into see him, without being overbearing.
JACUSTOMER-gp5k8qkg- :

Yeah, I tried to see Dr. Horton, but for some reason I saw Dr. Hoyt instead. I don't know why that happened.

Doctor DanB : Well, it might be the better part of valor to ask for Dr. Horton again.
JACUSTOMER-gp5k8qkg- :

Ok, I can try again

Doctor DanB : Also, if you go to this link, you can search for all of the pediatric and/or neuro-ophthalmologists in your area. http://www.geteyesmart.org/eyesmart/find/index.cfm
JACUSTOMER-gp5k8qkg- :

I don't know why it happened. I had explicitly asked for Dr. Horton but saw Dr. Hoyt instead for some reason.

Doctor DanB : Maybe it was just the day or the time that didn't sync with Dr. Horton's schedule, so it might be worth it to try again.
JACUSTOMER-gp5k8qkg- :

Ok, I can try

JACUSTOMER-gp5k8qkg- :

So, do you have any idea why I would never see double vision?

Doctor DanB : Dont give up. In my experience sometimes it takes seeing exactly the right person with the specific experience to figure these puzzles out. I suspect that you've had some degree of xenophobia all your life and nmay have never developed complete and good stereoscopic (binocular) vision and therefore you don't get double vision because your brain never had the stereoscopic vision to get confused about. Just my suspicion (after all, I can't examine you :) )
Doctor DanB : That should say exotropia, not xenophobia (darn auto-correct)
JACUSTOMER-gp5k8qkg- :

<nods> So weird. So very weird. It'll be nice if I can someday understand what is going on with me.

Doctor DanB : I hope you can. Keep beating down the doors, though. There are doctors that are willing to see you and helping figure out your problems, even if they aren't the ones you've tried yet.
JACUSTOMER-gp5k8qkg- :

Thanks :)

Doctor DanB : My pleasure. Good luck to you. Your feedback is important to me and will help me improve my encounter with future customers.  If at anytime you feel this process has been helpful, please press the ACCEPT button, if you see it.  This does not end our conversation, however-we can continue to discuss any of your concerns without further charges until you are satisfied.  Any positive feedback and/or bonus you may feel prompted to provide would be welcomed and is appreciated.  Thanks for your inquiry!  My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor.
JACUSTOMER-gp5k8qkg- :

I'll let you go then. Have a good night.

Doctor DanB : You as well.
Customer:



Any ideas of what could cause eye-triggered headache, nausea and brain fog? I have a full write up of my condition that I have been providing to doctors. I have made it public on Google Docs here: https://docs.google.com/document/pub?id=10nCd6ovQfYiZNBtfIuE0nNrUmGnG9D3Tr6WHcDHi7l8 The only diagnoses I have received is exophoria, a type of strabismus. Treating my exophoria does reduce my symptoms, but does not eliminate them -- and, my ailment is starting to become more severe than the treatment of exophoria can handle. Other doctors are doubtful that my decompensated exophoria is the cause for all my symptoms and believe instead that another underlying condition is exasperating my exophoria. The link I provided above goes into detail the symptoms I have been suffering. To summarize, I have severe headaches, motion sickness, brain fog, fatigue and even occasional electric shocks. This came on abruptly on January 21st, 2012, and has persisted every single day since then. The symptoms appear to be triggered by the usage of my eyes, and treatments directed at my eyes have helped to reduce the severity of my symptoms. However, I am getting worse, and no one has any idea how to help me. I am very debilitated at this time, unable to work even part-time, and I am, well, quite miserable. The only doctors I have "on my side" right now are a nurse practitioner and my psychiatrist. Other specialists have not been helpful. Two ophthalmologists have told me they cannot help me at all, and another ophthalmologist does not have time to continue seeing me because I am not a priority. One neurologist has told me "to stop using the computer", and I am having trouble securing appointments with other neurologists. I am looking for direction that my nurse practitioner or psychiatrist can use to help find me a proper diagnosis and/or treatment for my problem. I live in the San Francisco Bay Area, so even pointing out specific doctors who could help me would be tremendously helpful.


 


Optional Information:
Person's Gender: Female
Person's Age: 30

Already Tried:
6, 8, 10, 12, 14, 16, 18, 20 diopter prism eyeglass prescriptions. MRI Clean Vicodin helps headache pain if taken as soon as pain is felt. Fioricet does not work. Lorazepram helps to minimize and occasionally eliminate nausea. Can use odancetron if needed for nausea. Closing my eyes almost always works to stop pain. But lately I have been waking with pain.




Doctor DanB : K
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3177
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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