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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7750
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Im 55, have SLE. Ive been ealing with double vision that has

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Im 55, have SLE. Ive been ealing with double vision that has worsened over the past nine months. I saw an opthamologist who found "tracking" problems, early cataracts from prednisone use, and suspected cranial nerve involvement which sh expected to resolve. At first they thought it was due to the new diagnosis of type II Diabetes; again a consequence of long term steroid usage. They expected the blurring and double vision to resolve as the diabetes got under control. I am 5'8 and weigh 155 now; more than my usual 132 but its due to weight gained since I was unable to ride my bike and exercise as usual because of arthritis in the low spine. Now my A1C is in the normal range and I have adjusted my diet and am doing well. But the double stacked vision did not resolve. It became worse. At first some days were okay and other days it was very very bad. Now all days are bad. Im scheduled to have one lens replace just to see if it helps the blurry vision; although she says it may or may not. The ouble vision is NOT due to retinopathy, optic neuritis (of which ive had several times), is in both eyes which is so different from any Ive had before as it was always just one eye before.
Now, i have a new symptom for which I see the doc in two weeks; takes a long time to get in?

I noticed that when Id try to read (difficult at best), id blink and the page and print would be right but would fade to a slight darker over two seconds, then id blink, the vision would be bright but would fade to darker in two seconds, blink... repeat.

Then yesterday I had a few episodes where id be viewing the TV and noticed that everything in my visual field just faded to black, like the aperature of a camera closing. This happened in two to three seconds in a gentle fade to black then would go the opposite direction and fade back to the normal bright. this happene several times that day.

Tonite it happened more dramatically, and faded fast to black, just like before, similar to the aperature of a camera being stopped down to closed. Then it faded back to my normal. Id also been experiencing over the past week seeing black dark areas in my visual field "swipe by me" and were gone. Im still having the problem where when I open my eyes things are bright but then fade to a darker field. I then blink, it appears bright and then immediately fades to dark. over and over. Im quite alarmed by this. Im a photographer and a legal videographer and have had to stop doing my work as I never know how bad my vision will be one day to the next. My doc did say she felt the reason some days were worse, as far as the stacked double vision, because the muscles in my eyes were being affected , maybe by the Lupus... and when I was tired or not feeling well, this muscle problem was even more affected due to fatigue. She didn't know what for sure is the cause of the tracking problem, the blurred vision, and the double stacked vision in both eyes yet. She said she has a planned approach to begin ruling out and doing posssible surgeries and then referring me out to a specialist beyond her. But I don't see her for two weeks and this new "fade to black" problem has me scared. She found no clots in the vascular supply.... but did suspect I may be having small strokes. But then, she said it still doesn't explain why at first, id have a day where there wa no double vision and then days of it.. Now i never have a day without it. so it seems I have a number of problems going on with my yes at the same time. Hard to "tease" out. I am finally on the schedule to have the left lens replaced in three weeks.... had to wait till I stopped flaring so often. Im now taking the Lovenox injections once a day like I had to do for ten years at one point. I had anti phospholipid syndrome. But ten years later I stopped making the antibody so we discontinued the Lovenox. However, just to cover our bases, my rheumatologist put me back on them and sure enough, my tests turned out I do have that again. so to prevent another PE, I make sure I administer the injection daily. I also take 150 mg Imuran in three divided dosages per day along with having been able to finally lower my prednisone dosage now to15 mg a day. I do still ave flares atleast a bad one every month to where I need to go up another ten mg for a week and then taper slowly back down to the 15 over a two week period. I can't go lower then 15 or I get bad bad flare that swells my leg joints to cantalopes for knees and red hot along with fatigue to where I can't keep my eyes open and sleep for two days solid. then I get better. So it goes. Can you tell me what problems Might be responsible for this dampening of my vision to black, and then the problem where it is bright but thn the page becomes darker and I blink, its regular bright but again fades to darker until I blink again? The complete closing of the aperature to where it faded to complete black really got me scared/
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Rick replied 2 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

You discussed a number of issues in your post but I would like to address the most serious issue: The issue where you vision fades to black like a camera aperture closing.

Dr. Rick :

It sounds like what you are suffering from is something called Amaurosis fugax (AF).

Dr. Rick :

Amaurosis fugax is the transient loss of vision in one eye. It has many causes and, in the early 1990's, a study called the Amaurosis Fugax Study Group defined and grouped them to help with diagnosis and treatment of this problem.


 

Dr. Rick :

What can cause AF? It can be due to an embolism, problems with the blood, problems with the eye itself or, sometimes due to no cause we can figure out (idiopathic). I would be happy to go through all the different diagnostic possibilities in each of these categories but I don't think that is the best use of your time.....you need to know what to do.


 


AF is a symptom that something serious is wrong. It can be a warning that you are heading toward a dangerous vascular event such as a TIA, stroke or even death. It is important for you to see your ophthalmologist and possibly your internal medicine physician ASAP. What will they do? A complete history and physical, a complete eye examination, maybe a fluorescein angiogram of your retina, laboratory tests, possibly ultrasound of your carotid arteries or an CT/MRI of your head.


 


Treatment depends on what is found on the above workup.

Dr. Rick :

I can not stress enough the need for you to be seen for a complete exam as soon as possible.


 

Dr. Rick :

Does this make sense to you?

Dr. Rick :

Please remember the top 3 ratings are positives [Excellent service is my goal] and this is how we are compensated. Rate my answer when you are satisfied. If you feel the need to rate low, please stop and reply to me via the REPLY TO EXPERT button with the issue you have. I will be happy to continue further and do everything I can to provide you with the service you seek.


Otherwise, a high positive rating is very much appreciated, bonuses are great, and find me anytime for follow up.


 


Let me know if you have further questions.

Dr. Rick :

I see that you are offline. I'll switch over to the Q&A system. This system works a lot like 'text messaging' but an email is sent to each of us anytime something is posted to this thread. We can continue to work on your question there..... :)

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7750
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 2 years ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

What happens now?

If you haven’t already done so, please rate your answer above. Or, you can reply to me using the box below.
Expert:  Dr. Rick replied 2 years ago.
Have a good day.
Expert:  Dr. Rick replied 2 years ago.
Hi,

I was just thinking about you and wondering if anything was found on workup for your loss of vision. I hope everything is OK.
Customer: replied 1 year ago.
Dr. Rick,
I want to thank you for your help and response to my vision problem. I was seen by the Opthamologist caring for my eyes. You were correct And my problem had escalated. She verified I did still have the cataract problem related to the steroids, but also the tracking problem had worsened and additional findings were found upon more testing. I was having tiny strokes in the back of the eye and she felt AF was a real possibility because if my history with the "anti phospholipid and anti cardio lipid " auto antibody production in the past. Turns out I was making both once again. I'm now taking the Lovenox injections again and she referred me to another eye specialist for the problems with the eye muscles which aren't working correctly. I'm scheduled to have the eye muscle surgery next month and then we will see uf I later also need prisms in eye glasses as well. I'm now under the care if a hematologist to manage the blood clotting medication need and am seeing a cardiologist to care for the advanced atherosclerosis that I also was found to have (no surprise there due to long term sterod use. I had been a long distance athlete and continued cycling even with the SLE but had not been able to ride for past twi years due to the spine involvement. But they just opened a salt water lap pool in the new huge "wellness center" our hospital and medical community opened. So I've just been cleared to start lap swimming and am excited about this. ). Your advice put me in the right course to finding several underlying problems that were quite serious and were seemingly silent killers waiting to pounce. I sure appreciate your help and time you spent to respond to my inquiry. I've recommended this service to many if my friends and associates. I may never get complete normal vision back (but I'm remaining hopeful we can but open to the possibility it's permanent) but even if I don't; I'll not be a steoke victim waiting to happen. You have saved my life I feel. And thee is nothing I can do to reward you for doing such but to tell you how much you have had a vital part in keeping a tragedy from happening. I may have had comicated SLE for 22 years and seem to have as many bad days as "relative" good days but that's enough for me to still enjoy being alive and still desiring to be a meaningful member if my community and to contributing where I'm still able. That , for me, is so very important. We have been created with a fierce internal "will to live" and it's from this that I get my determination to overcome the all to frequent obstacles placed in front of me. So your service is greatly appreciated and valued! Thank you so much! Susan
Expert:  Dr. Rick replied 1 year ago.
Susan,

Thanks for the update. I am glad to hear that you are in good hands and, hopefully, with the correct treatment things will go well.

Let me know if there is anything else I can do to help.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7750
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 1 year ago.
Hi Susan,

For some reason I found myself wondering how you were doing. I hope things are going well.

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