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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7757
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I am female, in my early 60s, nearsighted, have cataracts

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I am female, in my early 60's, nearsighted, have cataracts on the edge of the lens of the eyes. Other medical conditions are as follows: I have hypertension that is being treated along with Hishaimoto Thyroidisis. Recent blood work showed a slight elevation on the ANA test, which is under further evaluation at this time.

Three years ago I started to have afterimage problems. I can look at anything and I immediately see the ghost of it and it quickly disappears. I consulted a top neuro-opthamologis, who conducted various tests and he told me everything was fine. In April 2013, I went on my own and I spent an afternoon being evaluated at Hopkins Wilmer Nueuro-Ophtomology clinic. They conducted a battery of eye tests and a neurological exam and everything was fine. No further testing was recommended.

Recently, I started to have some balance issues so I consulted with an ENT doctor. At my request, in July 2013, he sent me for an MRI. The MRI with contrast showed a 4mm rounded focus of increased signal intensity within the posterior aspect of the right corona radiata with subtle enhancement. I am waiting for a follow-up MRI in September 2013, and then it will be determined if this was a sub-acute infarction, active inflammation/dmyelination, or a vascular lesion. The neurologist that I consulted with informed me that the MRI finding does not match my symptoms of the afterimage issue or my balance problem. He seems to think I had a mild stroke because my blood pressure has been elevated.

In the process, the ENT doctor also sent me for an ENG test last week (August 2013). The results were that that I have central vestibular pathology due to abnormal tracking and optokinetic and directional changing nystagmus seen during caloric testing. All the other occulomotor tests were normal. The ENT could not give me an explanation for this finding and he sent me along to see the neurologist. I have an appointment this week with the neurologist. From doing research, as best I can, it seems to me that the ENG test picked-up that my eyes go back and forth when looking at objects. I have a long standing problem that when I talk to folks I look all over the place and I cannot focus on their faces.

I don't know how to interpret the ENG findings in view of the fact that I do not have any eye diseases except for the conditions that I noted. The MRI results to me do not seem to support the findings on the ENG of pathology in the parts of the brain that affect the central nervous system such as the cerebellum. Any information that you can give me about interpreting the ENG results will be greatly appreciated.

Thank you.

Sally
Submitted: 11 months ago.
Category: Eye
Expert:  Dr. Rick replied 11 months ago.
Sally,

Hi. I'm Dr. Rick and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.

Do you have any problems with your vision, other than the cataracts?

When you were a child, did you have any eye muscle surgery, need to wear an eye patch or any other issues with your eyes.


This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. I look forward to helping you.
Customer: replied 11 months ago.

>Hi Dr. Rick,



The only problem that I have other then being nearsighted and the cataracts, is that I have the afterimage issue which I explained in my original question to you. As a child I did not have any eye muscle surgery or wore an eye patch. I was diagnosed as being nearsighted when I was about ten years old. This was corrected by wearing eyeglasses until I got hard contact lenses when I was 18 years old. I over wore the lenses in my early 20's and I temporarily had double vision and cornea abrasions for about a month. After my vision returned to normal, I wore soft contact lenses until I reached my early 60's. Contact lenses no longer work for me and I wear bifocals now. Although my close-up vision is excellent without glasses regardless of my age.



In 2002 I had eye surgery to remove extra skin from the top of the lids and bags under the eyes due to age.



>In 2012 I had pitosis surgery on the left eyelid to repair the muscle. This was an ongoing condition since 2005 that got progressively worse. I was told that it was a muscle issue related to age or to perhaps the wearing contact lenses.



Otherwise, all my eye exams have been normal throughout my life.

Expert:  Dr. Rick replied 11 months ago.
Thank you for that extra information.

MRI would be expected to supply any new data to your ENG test battery.

Also, from what you have posted, I think this abnormal test result is going to be a red herring....if you do enough tests -- and you have done almost all of them -- you will eventually get some abnormal results. I can not see how this has anything to do with your after image issues.

You have had an extensive workup by one of the best Neuro-ophthalmology departments in the USA and, possibly, the World. If they couldn't find a reason for your symptoms I do not believe that they are going to be found.

I would be very surprised if your upcoming neurology consult bears fruit. :(

So. What to do? You may have to just resign yourself to these after image problems for the foreseeable future.

I realize that this was not the answer you were hoping to hear but it would be unfair to you and unprofessional of me were I provide you with anything less than truthful and honest information.
Surely, you prefer that I tell the truth rather than what you wish to hear. Because it reflects very poorly on me unless you press one of the top three feedback choices, keep this in mind when rating my answer and please do not punish me for being honest. I understand that this may not be easy to hear, and I empathize.
Even though my answer was not quite what you were hoping for, please understand that my priority was to provide you with the most honest information. With that in consideration, I hope that you found my answer useful. Please click the excellent feedback button so that I can receive credit for my efforts.

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7757
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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