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pippistrellodaqua, Optometrist
Category: Eye
Satisfied Customers: 134
Experience:  Specialty in contact lenses, medical eye management, LASIK
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I have astigmatism and diplopia. I am 33 years old.

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I have astigmatism and diplopia. I am 33 years old. Corrective eye surgery was performed 5 years ago on my right eye (muscle reattachment) to help the diplopia. It helped quit a bit actually (no longer splitting when I'm tired, no longer can force the vertical eye split on purpose). It still happens on occasion when things are close, when looking far to right or left, or when looking through binoculars.
Last week I went in for an eye exam (haven't been in 4 years). Long story, but my wife has chronic illnesses and I've been so focused on taking care of her that I've not given my own issues the priority they need. Anyway, I finally went to the doctor (primary care) and then referred to Optomology. I asked if I should go to Opthamology due to my previous surgery/condition and they said no. Went to Optomology (eye doctor) and came out the other side with a prescription to help both Astigmatism and Diplopia. They prescribed prisms.
I received my glasses today and was thrilled about seeing better, after getting them though I was less than satisfied.
Symptoms That Drove Me To Recent Appointment
- floaters, strong flaring or halos from lights (especially taillights at night driving), ghosting (monocular double vision), blurriness, etc.
Reason For Concern Post Receiving Glasses
Although the glasses appear to help with astigmatism problems (text is clearer, crisper)...
- Prism glasses are making my right eye move up while left eye stays straight on, evident when looking in mirror (was not like that prior to getting prism glasses)
- Feels like I'm looking through fishbowl, nausous feeling
- headache
- glasses are rectangular and narrow, can see a lot below glasses and isn't right
- when i take the glasses off I see double, which was NOT occurring before glasses
- straight lines are skewed, images are skewed, looks like super artificial 3D tunnel vision
Why did they prescribe prisms? When they were treating for astigmatism the lens equipment was like binoculars to me and made my brain split the image and go double (eyes moving). This does NOT happen without things in front of my face. I think they felt the need to address.
I wish I had went to an opthamologist who understood my past surgery and to talk through a better plan first, going on over pros and cons. I'm worried that I'm going to do more harm and potentially negate the surgery I had.
I don't want people to see my eyes misaligned, which I'm having with the glasses on (hurts my self esteem).
Should I get a second opinion? Should I see an opthamologist? Should/can I get my money back for the glasses? I want to be able to take my glasses off and wrestle with my kids without seeing double again and having adjustment problems. I just want to see clearer!
pippistrellodaqua :

I am happy to assist you with your question tonight.

pippistrellodaqua :

I often see patients who have diplopia and who have had eye realignment surgeries to correct this double vision.

pippistrellodaqua :

There are several factors we need to consider here. The diplopia can be corrected by 3 possible solutions. 1 surgery, 2 prism, and 3 eye training exercises.

pippistrellodaqua :

The best approach will vary based on each individual case and sometimes it will require several of these solutions to get the best effect.

pippistrellodaqua :

As an primary care doctor, your optometrist focuses on prism spectacles and possibly eye training exercises, while the ophthalmologist will focus on surgery.

pippistrellodaqua :

Prism is rather tricky and not always the best approach. Prism will move the image you're looking at so that it (hopefully) matches up better with your deviated eye.

pippistrellodaqua :

Surgery is also rather tricky in that the deviated eye is moved to (hopefully) match up better with the image.

pippistrellodaqua :

Because prism moves images and not the eye it will definitely appear that your right eye has moved. Again, this is just an appearance as prism does not move the eye, but it does move the image of your eye when you look in a mirror.

pippistrellodaqua :

The real trouble with prism glasses is the adaptation to the new quality of vision you experience. Your brain has been used to looking at the work one way. You now have two differences in the quality of the images your eye captures and your brain interprets. These differences areise from the astigmatism correction and the prismatic effect. The astigmatism correction is likely responsible for the skewed appearance and fishbowl effect. The presence of prism can compound these concerns.

pippistrellodaqua :

The fact that you notice these problems, however, is not necessarily a bad thing. An ample adaptation period may be required for the brain to get used to the new quality of vision. I know this may sound like a cop out answer, but it is very well documented. Often times within a few weeks the brain interprets the new quality as normal. The distortions you mentioned will likely disappear and hopefully the diplopia will have been eliminated.

pippistrellodaqua :

I'm making assumptions that the prism and astigmatism were measured correctly for this adaptation period to occur successfully.

pippistrellodaqua :

That being said, prism is not always the best approach and despite our best efforts there is a percentage of patients who will not be able to adapt to prism. You should know in a few weeks if you belong to this category. If non-adaptation is an issue then yes you should address this with your optometrist who will refer you to a ophthalmologist for a surgical consult, or possibly to a vision therapist to help you strengthen the muscles of your eyes.

pippistrellodaqua :

You will not do harm to your eyes by trying to adapt to these glasses. I strongly recommend you give them a go. Though it may seem goofy and even cause discomfort or headaches for a while this adaptation will occur much quicker if the spectacles are worn full time. After 14 days or so if you still note concerns then it is time to try the next approach.

pippistrellodaqua :

Seeing clearly is a goal that is more than reasonable. It is to be expected. I wish you the best in your adaptation. I will be available to answer any follow-up questions you may have.

pippistrellodaqua :

Please consider leaving a positive rating based on this answer. After you give the positive rating I will still be available to continue the follow-up dialogue. Thanks for the opportunity to help.

pippistrellodaqua :

I will be available to answer any follow-up questions you may have.

Please don't forget to offer a positive rating once your question has been answered fully.

Also, please note that the information here does not replace an examination and should be used as educational purposes only.

Customer: replied 5 years ago.

Thank you for responding. What I don't want to happen is harm to the positive effects of my original eye surgery. When I say that I mean, the surgery has given me single binocular vision without glasses. I still have monocular double vision in both eyes, but that's from the astigmatism. The problem is, after wearing these glasses, when I take them off I am seeing double again. What I don't want to happen is ending up with double vision every time I take off these glasses (swimming, playing, etc.). I don't have that problem now. I only have double vision when they were putting things in front of my eyes at the optomotrist.

They didn't mention anything about the narrow rectangular glasses, which were provided at the same place. I'm worried they may be too narrow as I see both the old world (below glasses) and new world through lenses.

Finally, with the glasses on, my right eye has moved up. It is not the appearance of it moving up. It actually is pointing up more with them as opposed to without them. I don't want that... if I can avoid it.

Perhaps I need a second opinion and perhaps I need to get back into the original doctor and address my concerns. I felt rushed through the process and didn't have time to think about all this while I was there. My eyes were diolated from the full eye exam and my vision was cloudy and disrupted from that, making it more difficult to see how the prism testing was affecting me.

You bring up a valid concern. You are likely experiencing something called "suppression" because you do not report double vision prior to using your spectacles. Suppression is a process by which the brain ignores the input from one of the eyes so that instead of seeing double you see a single (not always clear) image instead of two images. Suppression is a great adaptation the brain makes to keep things simple. Suppression should not be broken down by prism or surgery unless it gives true binocular vision and what we call stereopsis (true depth perception.) By breaking down suppression we may or may not ever get it back. If stereopsis is obtained it may be worth it to break it down by wearing the spectacles, but this would cause a full time need for glasses. I do recommend that you see your optometrist who fit you with the prism and make sure his goals are clear. If suppression is broken to obtain stereopsis then it is likely worthwhile, but you should be aware of the full-time need for spectacles.

Regarding the appearance of the eye moving it is truly an appearance. Prism cannot move the eye but it moves the image. Prism will always make the eye appear to be more deviated than it really is, but again this is an appearance of the image.

I will always say that second opinions are fair. The eye dilation should have occurred after the check for prescription and prism. Don't feel that you're being picky, it's your eyes and it is the responsibility of your doctor to get things right for you. I'd start with the optometrist who prescribed the prism. He should check you again at no charge. If there are still questions or concerns I'd perhaps try to find an optometrist who focuses in binocular vision. Some of the best binocular vision doctors can be found at the major medical schools. Hopefully there is one close by.

Please don't hesitate to contact me again for further follow-up.
Please consider leaving a positive rating. This is the only way we are compensated for our time on this site. Thanks again.
Do you have any additional questions? I am more than happy to assist you further. Please consider leaving a positive rating once your question has been answered in full. Thanks.
Customer: replied 5 years ago.

I don't believe I have suppression. Although my 3D vision may have decreased slightly I can still see out of both eyes with and without glasses. I do also see that my right eye does point up more than my left with the glasses on. It is not a perception thing. My eyes are not stationary on the diplopia, they move. My brain adjusts and the eyes move. When I take the glasses off, I see double for a minute or so and then I adjust and see a single vision again (with both eyes). When I put the glasses back on, I see double again and then a single image after a few seconds. I can force the double vision by closing my eyes and relaxing them and then opening them without focusing.

I have setup an appointment with an opthamologist, but unfortunately I cannot get in for 3 months (they are booked). I am also trying to consult back with the eye doctor that prescribed the glasses.

It's a complicated case and I'm not ready to where these glasses until I know they are the best thing for me.

It is very very good that you are able to overcome the double vision when putting on AND taking off the glasses. Again, if the prism amount was measured correctly these spectacles should help keep your vision clear and single without as much effort. You may be very correct in your assessment of not suppressing the image (this will be determined at your eye exam.) I still recommend wearing the spectacles as much as possible for a couple of weeks to allow the best opportunity for your brain to adapt. Mistakes can be made, but when a doctor prescribes prism (s)he should be confident in the assessment. Unless there is a strong suspicion of a mistake then these spectacles should help in theory. It will not hurt to wear them (unless suppression is broken down, which should have been checked for prior to the rx of prism.) Please let me know if you still have further concerns. I appreciate the opportunity to assist you. Again, I hope you will find this information useful and rate your experience appropriately. Thanks again.
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