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cataracts and diplopia
cataracts and diplopia
I have monocular double vision in both eyes. It comes and goes fairly
quickly. It lasts between a few hours and a couple days. It occurs
in both eyes at the same time, but not to the same degree. Sometimes
I see two images quite clearly focused, other times it can be multiple
images. The double vision goes away completely if I look through a
pin hole. I went to an MD ophthalmologist who recommended new
glasses. I tried them and it makes little difference. I went to an
OD who thinks it is probably cataracts and referred me to a cataract
surgeon. I have an appointment at the end of the month.
From my reading double vision can be a symptom of cataracts. I don't
think I have other symptoms. With cataracts does the double vision
come and go quickly? Any ideas of what else it might be that I
should have checked?
I have monocular double vision in both eyes. It comes and goes fairly
quickly. It lasts between a few hours and a couple days. It occurs
in both eyes at the same time, but not to the same degree. Sometimes
I see two images quite clearly focused, other times it can be multiple
images. The double vision goes away completely if I look through a
pin hole. I went to an MD ophthalmologist who recommended new
glasses. I tried them and it makes little difference. I went to an
OD who thinks it is probably cataracts and referred me to a cataract
surgeon. I have an appointment at the end of the month.
From my reading double vision can be a symptom of cataracts. I don't
think I have other symptoms. With cataracts does the double vision
come and go quickly? Any ideas of what else it might be that I
should have checked?
Re: cataracts and diplopia
Monocular dioplopia would come-and-go very readily with changes in the size
of your pupil and the qualities of the scene.
High-contrast, bright targets against dark backgrounds are classically best
for eliciting monocular diplopia.
Large pupils make it much more noticeable.
Holding a pinhole close to your cornea would eliminate double images
immediately.
The only other reasonable cause for monocular diplopia would be corneal
irregularities. These would vanish with pinholes too, but they are MUCH less
likely to develop suddenly, if you're over 50 with no history of corneal
trauma, surgery or degeneration.
Have the surgery on one eye first, the eye with more noticeable diplopia.
Surgical implants have their own phenomena, like flare and reflections. To
some degree you're trading one for the other.
-MT, OD
"ray" <spammers@do.not.reply . com > wrote in message
news:cif704tt58rjg3gesrqrgldb457h18kgn3@4ax . com ...
>I have monocular double vision in both eyes. It comes and goes fairly
> quickly. It lasts between a few hours and a couple days. It occurs
> in both eyes at the same time, but not to the same degree. Sometimes
> I see two images quite clearly focused, other times it can be multiple
> images. The double vision goes away completely if I look through a
> pin hole. I went to an MD ophthalmologist who recommended new
> glasses. I tried them and it makes little difference. I went to an
> OD who thinks it is probably cataracts and referred me to a cataract
> surgeon. I have an appointment at the end of the month.
>
> From my reading double vision can be a symptom of cataracts. I don't
> think I have other symptoms. With cataracts does the double vision
> come and go quickly? Any ideas of what else it might be that I
> should have checked?
Monocular dioplopia would come-and-go very readily with changes in the size
of your pupil and the qualities of the scene.
High-contrast, bright targets against dark backgrounds are classically best
for eliciting monocular diplopia.
Large pupils make it much more noticeable.
Holding a pinhole close to your cornea would eliminate double images
immediately.
The only other reasonable cause for monocular diplopia would be corneal
irregularities. These would vanish with pinholes too, but they are MUCH less
likely to develop suddenly, if you're over 50 with no history of corneal
trauma, surgery or degeneration.
Have the surgery on one eye first, the eye with more noticeable diplopia.
Surgical implants have their own phenomena, like flare and reflections. To
some degree you're trading one for the other.
-MT, OD
"ray" <spammers@do.not.reply . com > wrote in message
news:cif704tt58rjg3gesrqrgldb457h18kgn3@4ax . com ...
>I have monocular double vision in both eyes. It comes and goes fairly
> quickly. It lasts between a few hours and a couple days. It occurs
> in both eyes at the same time, but not to the same degree. Sometimes
> I see two images quite clearly focused, other times it can be multiple
> images. The double vision goes away completely if I look through a
> pin hole. I went to an MD ophthalmologist who recommended new
> glasses. I tried them and it makes little difference. I went to an
> OD who thinks it is probably cataracts and referred me to a cataract
> surgeon. I have an appointment at the end of the month.
>
> From my reading double vision can be a symptom of cataracts. I don't
> think I have other symptoms. With cataracts does the double vision
> come and go quickly? Any ideas of what else it might be that I
> should have checked?
Re: cataracts and diplopia
Thank you, both Mike and Jan for the good explanation. I recently
moved north by 30 degrees (from Hawaii to Washington state). The
dimmer light in Washington would tend to dialate my eyes and make the
double vision more evident. I will look to see if pupil size and
diplopia track. The condition is most evident on red traffic lights
and point sources such as small LEDs. With the LEDs I can sometimes
see 6 clearly focused images. It can be very obvious on high contrast
items such as black on yellow traffic signs, computer monitors, and
text in books. When at it's worst everything is double.
The condition seems to get worse after reading. My eyes focus at a
comfortable distance for reading, so I read without glasses. Maybe I
should get brighter lights for reading?
I can live with the condition at present, so I am not in a big hurry
to get surgery. Medicare will pay when the corrected vision is 20/40.
I assume this is a progressive condition. If so how fast does it
normally progress?
On Mon, 14 Apr 2008 15:52:31 -0500, "Mike Tyner"
<mtyner@mindspring . com > wrote:
>Monocular dioplopia would come-and-go very readily with changes in the size
>of your pupil and the qualities of the scene.
>
>High-contrast, bright targets against dark backgrounds are classically best
>for eliciting monocular diplopia.
>
>Large pupils make it much more noticeable.
>
>Holding a pinhole close to your cornea would eliminate double images
>immediately.
>
>The only other reasonable cause for monocular diplopia would be corneal
>irregularities. These would vanish with pinholes too, but they are MUCH less
>likely to develop suddenly, if you're over 50 with no history of corneal
>trauma, surgery or degeneration.
>
>Have the surgery on one eye first, the eye with more noticeable diplopia.
>
>Surgical implants have their own phenomena, like flare and reflections. To
>some degree you're trading one for the other.
>
>-MT, OD
>
>
>
>"ray" <spammers@do.not.reply . com > wrote in message
>news:cif704tt58rjg3gesrqrgldb457h18kgn3@4ax . com ...
>>I have monocular double vision in both eyes. It comes and goes fairly
>> quickly. It lasts between a few hours and a couple days. It occurs
>> in both eyes at the same time, but not to the same degree. Sometimes
>> I see two images quite clearly focused, other times it can be multiple
>> images. The double vision goes away completely if I look through a
>> pin hole. I went to an MD ophthalmologist who recommended new
>> glasses. I tried them and it makes little difference. I went to an
>> OD who thinks it is probably cataracts and referred me to a cataract
>> surgeon. I have an appointment at the end of the month.
>>
>> From my reading double vision can be a symptom of cataracts. I don't
>> think I have other symptoms. With cataracts does the double vision
>> come and go quickly? Any ideas of what else it might be that I
>> should have checked?
>
Thank you, both Mike and Jan for the good explanation. I recently
moved north by 30 degrees (from Hawaii to Washington state). The
dimmer light in Washington would tend to dialate my eyes and make the
double vision more evident. I will look to see if pupil size and
diplopia track. The condition is most evident on red traffic lights
and point sources such as small LEDs. With the LEDs I can sometimes
see 6 clearly focused images. It can be very obvious on high contrast
items such as black on yellow traffic signs, computer monitors, and
text in books. When at it's worst everything is double.
The condition seems to get worse after reading. My eyes focus at a
comfortable distance for reading, so I read without glasses. Maybe I
should get brighter lights for reading?
I can live with the condition at present, so I am not in a big hurry
to get surgery. Medicare will pay when the corrected vision is 20/40.
I assume this is a progressive condition. If so how fast does it
normally progress?
On Mon, 14 Apr 2008 15:52:31 -0500, "Mike Tyner"
<mtyner@mindspring . com > wrote:
>Monocular dioplopia would come-and-go very readily with changes in the size
>of your pupil and the qualities of the scene.
>
>High-contrast, bright targets against dark backgrounds are classically best
>for eliciting monocular diplopia.
>
>Large pupils make it much more noticeable.
>
>Holding a pinhole close to your cornea would eliminate double images
>immediately.
>
>The only other reasonable cause for monocular diplopia would be corneal
>irregularities. These would vanish with pinholes too, but they are MUCH less
>likely to develop suddenly, if you're over 50 with no history of corneal
>trauma, surgery or degeneration.
>
>Have the surgery on one eye first, the eye with more noticeable diplopia.
>
>Surgical implants have their own phenomena, like flare and reflections. To
>some degree you're trading one for the other.
>
>-MT, OD
>
>
>
>"ray" <spammers@do.not.reply . com > wrote in message
>news:cif704tt58rjg3gesrqrgldb457h18kgn3@4ax . com ...
>>I have monocular double vision in both eyes. It comes and goes fairly
>> quickly. It lasts between a few hours and a couple days. It occurs
>> in both eyes at the same time, but not to the same degree. Sometimes
>> I see two images quite clearly focused, other times it can be multiple
>> images. The double vision goes away completely if I look through a
>> pin hole. I went to an MD ophthalmologist who recommended new
>> glasses. I tried them and it makes little difference. I went to an
>> OD who thinks it is probably cataracts and referred me to a cataract
>> surgeon. I have an appointment at the end of the month.
>>
>> From my reading double vision can be a symptom of cataracts. I don't
>> think I have other symptoms. With cataracts does the double vision
>> come and go quickly? Any ideas of what else it might be that I
>> should have checked?
>
Re: cataracts and diplopia
"ray" <spammers@do.not.reply . com > wrote in message
> The condition seems to get worse after reading. My eyes focus at a
> comfortable distance for reading, so I read without glasses. Maybe I
> should get brighter lights for reading?
By all means, if it helps.
> I assume this is a progressive condition. If so how fast does it
> normally progress?
It's too variable. Sometimes it remains stable for years then changes
suddenly.
The Medicare justification may vary with state carrier, and with how
cooperative a surgeon you find. Seems to me that diplopia and large or
frequent changes in refraction are also justifications.
-MT
"ray" <spammers@do.not.reply . com > wrote in message
> The condition seems to get worse after reading. My eyes focus at a
> comfortable distance for reading, so I read without glasses. Maybe I
> should get brighter lights for reading?
By all means, if it helps.
> I assume this is a progressive condition. If so how fast does it
> normally progress?
It's too variable. Sometimes it remains stable for years then changes
suddenly.
The Medicare justification may vary with state carrier, and with how
cooperative a surgeon you find. Seems to me that diplopia and large or
frequent changes in refraction are also justifications.
-MT
Re: cataracts and diplopia
On Mon, 14 Apr 2008 15:52:31 -0500, "Mike Tyner"
<mtyner@mindspring . com > wrote:
I went to the eye surgeon. He said my cataracts were very small and
not the cause of my problem. He said that I had Fuch's Endothelial
Corneal dystrophy. This was based on see divots in the cornea and
measuring the cornea thickness with some device that contacted my eye.
On looking the condition up I don't see diplopia as being one of the
symptoms. I don't seem to have the symptoms attributed to the
condition. Any insight would be appreciated.
Below is a description of the condition.
Fuch's endothelial dystrophy is a disorder of corneal degeneration in
which edema (swelling) and gradual vision decrease are characteristic.
This condition usually presents between 50 and 70 years of age, more
commonly in women. Most cases are of dominant inheritance, which
implies that both eyes are affected and the disorder may affect blood
relatives. The underlying defect is an abnormal deep layer of the
cornea, known as the endothelium. This layer of cells, situated on the
"back" side of the cornea, must be of sufficient number in order to
maintain a relatively dehydrated and clear cornea (with consequent
good vision). In Fuch's' endothelial dystrophy, this layer of cells is
more rapidly lost by attrition than normal, and the consequence is
swelling of the cornea and gradual vision loss. As the disorder
progresses, swelling of the cornea causes "blisters" on the front of
the cornea known as epithelial bullae. This latter condition is known
as bullous keratopathy.
>Monocular dioplopia would come-and-go very readily with changes in the size
>of your pupil and the qualities of the scene.
>
>High-contrast, bright targets against dark backgrounds are classically best
>for eliciting monocular diplopia.
>
>Large pupils make it much more noticeable.
>
>Holding a pinhole close to your cornea would eliminate double images
>immediately.
>
>The only other reasonable cause for monocular diplopia would be corneal
>irregularities. These would vanish with pinholes too, but they are MUCH less
>likely to develop suddenly, if you're over 50 with no history of corneal
>trauma, surgery or degeneration.
>
>Have the surgery on one eye first, the eye with more noticeable diplopia.
>
>Surgical implants have their own phenomena, like flare and reflections. To
>some degree you're trading one for the other.
>
>-MT, OD
>
>
>
>"ray" <spammers@do.not.reply . com > wrote in message
>news:cif704tt58rjg3gesrqrgldb457h18kgn3@4ax . com ...
>>I have monocular double vision in both eyes. It comes and goes fairly
>> quickly. It lasts between a few hours and a couple days. It occurs
>> in both eyes at the same time, but not to the same degree. Sometimes
>> I see two images quite clearly focused, other times it can be multiple
>> images. The double vision goes away completely if I look through a
>> pin hole. I went to an MD ophthalmologist who recommended new
>> glasses. I tried them and it makes little difference. I went to an
>> OD who thinks it is probably cataracts and referred me to a cataract
>> surgeon. I have an appointment at the end of the month.
>>
>> From my reading double vision can be a symptom of cataracts. I don't
>> think I have other symptoms. With cataracts does the double vision
>> come and go quickly? Any ideas of what else it might be that I
>> should have checked?
>
On Mon, 14 Apr 2008 15:52:31 -0500, "Mike Tyner"
<mtyner@mindspring . com > wrote:
I went to the eye surgeon. He said my cataracts were very small and
not the cause of my problem. He said that I had Fuch's Endothelial
Corneal dystrophy. This was based on see divots in the cornea and
measuring the cornea thickness with some device that contacted my eye.
On looking the condition up I don't see diplopia as being one of the
symptoms. I don't seem to have the symptoms attributed to the
condition. Any insight would be appreciated.
Below is a description of the condition.
Fuch's endothelial dystrophy is a disorder of corneal degeneration in
which edema (swelling) and gradual vision decrease are characteristic.
This condition usually presents between 50 and 70 years of age, more
commonly in women. Most cases are of dominant inheritance, which
implies that both eyes are affected and the disorder may affect blood
relatives. The underlying defect is an abnormal deep layer of the
cornea, known as the endothelium. This layer of cells, situated on the
"back" side of the cornea, must be of sufficient number in order to
maintain a relatively dehydrated and clear cornea (with consequent
good vision). In Fuch's' endothelial dystrophy, this layer of cells is
more rapidly lost by attrition than normal, and the consequence is
swelling of the cornea and gradual vision loss. As the disorder
progresses, swelling of the cornea causes "blisters" on the front of
the cornea known as epithelial bullae. This latter condition is known
as bullous keratopathy.
>Monocular dioplopia would come-and-go very readily with changes in the size
>of your pupil and the qualities of the scene.
>
>High-contrast, bright targets against dark backgrounds are classically best
>for eliciting monocular diplopia.
>
>Large pupils make it much more noticeable.
>
>Holding a pinhole close to your cornea would eliminate double images
>immediately.
>
>The only other reasonable cause for monocular diplopia would be corneal
>irregularities. These would vanish with pinholes too, but they are MUCH less
>likely to develop suddenly, if you're over 50 with no history of corneal
>trauma, surgery or degeneration.
>
>Have the surgery on one eye first, the eye with more noticeable diplopia.
>
>Surgical implants have their own phenomena, like flare and reflections. To
>some degree you're trading one for the other.
>
>-MT, OD
>
>
>
>"ray" <spammers@do.not.reply . com > wrote in message
>news:cif704tt58rjg3gesrqrgldb457h18kgn3@4ax . com ...
>>I have monocular double vision in both eyes. It comes and goes fairly
>> quickly. It lasts between a few hours and a couple days. It occurs
>> in both eyes at the same time, but not to the same degree. Sometimes
>> I see two images quite clearly focused, other times it can be multiple
>> images. The double vision goes away completely if I look through a
>> pin hole. I went to an MD ophthalmologist who recommended new
>> glasses. I tried them and it makes little difference. I went to an
>> OD who thinks it is probably cataracts and referred me to a cataract
>> surgeon. I have an appointment at the end of the month.
>>
>> From my reading double vision can be a symptom of cataracts. I don't
>> think I have other symptoms. With cataracts does the double vision
>> come and go quickly? Any ideas of what else it might be that I
>> should have checked?
>
Re: cataracts and diplopia
"ray" <spammers@do.not.reply . com > wrote
>
> I went to the eye surgeon. He said my cataracts were very small and
> not the cause of my problem.
It's the "small" or "early" cataracts that cause monocular diplopia.
> He said that I had Fuch's Endothelial
> Corneal dystrophy. This was based on see divots in the cornea and
I'm very familiar with Fuch's and it's very common. The optical effects are
negligible in early Fuch's.
You haven't described essential Fuch's symptoms - morning erosions, diurnal
haze - so presumably you're "pre-symptomatic". You might never have optical
problems resulting from Fuch's. Many don't. The important thing is, if you
do, it'll be fog, not diplopia.
Not saying your surgeon was wrong, just I have trouble explaining static
polyopia on the basis of asymptomatic fuch's. He prolly would too, if he
slowed down to think about it.
Don't change your treatment on my advice. But he didn't recommend any
treatment, right?
So just re the physics of monocular diplopia, I still think yours is
lenticular.
> symptoms. I don't seem to have the symptoms attributed to the
> condition. Any insight would be appreciated.
Fuch's is usually detectable in the microscope long before there are
symptoms. Sometimes it never causes symptoms. It's a 10-20 year disease, but
even at 20 years they aren't all "bullous", and keratoplasty is a safe and
effective treatment if it ever went that far.
You still _could_ have corneal irregularities that produce diplopia, but
FWIW, it's still likely your diplopia is just loss of uniformity in the
crystalline lens.
-MT
"ray" <spammers@do.not.reply . com > wrote
>
> I went to the eye surgeon. He said my cataracts were very small and
> not the cause of my problem.
It's the "small" or "early" cataracts that cause monocular diplopia.
> He said that I had Fuch's Endothelial
> Corneal dystrophy. This was based on see divots in the cornea and
I'm very familiar with Fuch's and it's very common. The optical effects are
negligible in early Fuch's.
You haven't described essential Fuch's symptoms - morning erosions, diurnal
haze - so presumably you're "pre-symptomatic". You might never have optical
problems resulting from Fuch's. Many don't. The important thing is, if you
do, it'll be fog, not diplopia.
Not saying your surgeon was wrong, just I have trouble explaining static
polyopia on the basis of asymptomatic fuch's. He prolly would too, if he
slowed down to think about it.
Don't change your treatment on my advice. But he didn't recommend any
treatment, right?
So just re the physics of monocular diplopia, I still think yours is
lenticular.
> symptoms. I don't seem to have the symptoms attributed to the
> condition. Any insight would be appreciated.
Fuch's is usually detectable in the microscope long before there are
symptoms. Sometimes it never causes symptoms. It's a 10-20 year disease, but
even at 20 years they aren't all "bullous", and keratoplasty is a safe and
effective treatment if it ever went that far.
You still _could_ have corneal irregularities that produce diplopia, but
FWIW, it's still likely your diplopia is just loss of uniformity in the
crystalline lens.
-MT
Re: cataracts and diplopia
On Tue, 29 Apr 2008 15:50:09 -0500, "Mike Tyner"
<mtyner@mindspring . com > wrote:
Thank you for your informative response. As you might guess I am
confused and frustrated.
My symptoms are not really those of Fuch's and mostly not cataracts.
Question, if it were the cataracts would the polyopia come and go in
both eyes at the same time? If just an optical problem how does one
eyeball know what the other is doing?
The doctor said to use a 5% salt solution eye drops 4 times a day and
a ointment at night. He says this will slow down the progression of
the process. He said come back in 2 months. Other than the
outrageous price of an ounce of salt water ($20) it seems to be a
reasonable course of action if I really do have Fuch's? The doctor
diagnosed based on microscopic inspection of the cornea and a device
that measures corneal thickness. Is this a definitive diagnose, or is
it very much subject to interpretation?
Ray
>
>"ray" <spammers@do.not.reply . com > wrote
>>
>> I went to the eye surgeon. He said my cataracts were very small and
>> not the cause of my problem.
>
>It's the "small" or "early" cataracts that cause monocular diplopia.
>
>> He said that I had Fuch's Endothelial
>> Corneal dystrophy. This was based on see divots in the cornea and
>
>I'm very familiar with Fuch's and it's very common. The optical effects are
>negligible in early Fuch's.
>
>You haven't described essential Fuch's symptoms - morning erosions, diurnal
>haze - so presumably you're "pre-symptomatic". You might never have optical
>problems resulting from Fuch's. Many don't. The important thing is, if you
>do, it'll be fog, not diplopia.
>
>Not saying your surgeon was wrong, just I have trouble explaining static
>polyopia on the basis of asymptomatic fuch's. He prolly would too, if he
>slowed down to think about it.
>
>Don't change your treatment on my advice. But he didn't recommend any
>treatment, right?
>
>So just re the physics of monocular diplopia, I still think yours is
>lenticular.
>
>> symptoms. I don't seem to have the symptoms attributed to the
>> condition. Any insight would be appreciated.
>
>Fuch's is usually detectable in the microscope long before there are
>symptoms. Sometimes it never causes symptoms. It's a 10-20 year disease, but
>even at 20 years they aren't all "bullous", and keratoplasty is a safe and
>effective treatment if it ever went that far.
>
>You still _could_ have corneal irregularities that produce diplopia, but
>FWIW, it's still likely your diplopia is just loss of uniformity in the
>crystalline lens.
>
>-MT
>
>
On Tue, 29 Apr 2008 15:50:09 -0500, "Mike Tyner"
<mtyner@mindspring . com > wrote:
Thank you for your informative response. As you might guess I am
confused and frustrated.
My symptoms are not really those of Fuch's and mostly not cataracts.
Question, if it were the cataracts would the polyopia come and go in
both eyes at the same time? If just an optical problem how does one
eyeball know what the other is doing?
The doctor said to use a 5% salt solution eye drops 4 times a day and
a ointment at night. He says this will slow down the progression of
the process. He said come back in 2 months. Other than the
outrageous price of an ounce of salt water ($20) it seems to be a
reasonable course of action if I really do have Fuch's? The doctor
diagnosed based on microscopic inspection of the cornea and a device
that measures corneal thickness. Is this a definitive diagnose, or is
it very much subject to interpretation?
Ray
>
>"ray" <spammers@do.not.reply . com > wrote
>>
>> I went to the eye surgeon. He said my cataracts were very small and
>> not the cause of my problem.
>
>It's the "small" or "early" cataracts that cause monocular diplopia.
>
>> He said that I had Fuch's Endothelial
>> Corneal dystrophy. This was based on see divots in the cornea and
>
>I'm very familiar with Fuch's and it's very common. The optical effects are
>negligible in early Fuch's.
>
>You haven't described essential Fuch's symptoms - morning erosions, diurnal
>haze - so presumably you're "pre-symptomatic". You might never have optical
>problems resulting from Fuch's. Many don't. The important thing is, if you
>do, it'll be fog, not diplopia.
>
>Not saying your surgeon was wrong, just I have trouble explaining static
>polyopia on the basis of asymptomatic fuch's. He prolly would too, if he
>slowed down to think about it.
>
>Don't change your treatment on my advice. But he didn't recommend any
>treatment, right?
>
>So just re the physics of monocular diplopia, I still think yours is
>lenticular.
>
>> symptoms. I don't seem to have the symptoms attributed to the
>> condition. Any insight would be appreciated.
>
>Fuch's is usually detectable in the microscope long before there are
>symptoms. Sometimes it never causes symptoms. It's a 10-20 year disease, but
>even at 20 years they aren't all "bullous", and keratoplasty is a safe and
>effective treatment if it ever went that far.
>
>You still _could_ have corneal irregularities that produce diplopia, but
>FWIW, it's still likely your diplopia is just loss of uniformity in the
>crystalline lens.
>
>-MT
>
>
Re: cataracts and diplopia
"ray" <spammers@do.not.reply . com > wrote
> Thank you for your informative response. As you might guess I am
> confused and frustrated.
>
> My symptoms are not really those of Fuch's and mostly not cataracts.
> Question, if it were the cataracts would the polyopia come and go in
> both eyes at the same time?
Depends. Lenticular diplopia, if present in both eyes, could easily vary
with external conditions (background illumination, target
brightness/contrast) but it would be the same each time you reproduce the
conditions.
If there is diurnal variation, like it's worst in the morning, then
lenticular problems don't do that. A cycle of corneal edema could make
diplopia appear to wax and wane but there'd also be haze.
> If just an optical problem how does one
> eyeball know what the other is doing?
Pupils normally change the same in each eye, and accommodation likewise is
lockstep left/right. Both eyes inhabit the same environment, optically but
both eyes also swell at night.
> The doctor said to use a 5% salt solution eye drops 4 times a day and
> a ointment at night. He says this will slow down the progression of
> the process.
I didn't know it was standard to treat asymptomatic Fuch's so aggressively.
You've had no erosions and no morning haze, right? I'll have to check on
that.
> He said come back in 2 months. Other than the
> outrageous price of an ounce of salt water ($20) it seems to be a
> reasonable course of action if I really do have Fuch's? The doctor
> diagnosed based on microscopic inspection of the cornea and a device
> that measures corneal thickness. Is this a definitive diagnose, or is
> it very much subject to interpretation?
It's hard to miss Fuch's in the microscope, so you can be sure you have some
endothelial changes. But that doesn't guarantee you'll have symptoms.
I'm no expert but it seems you'd have to measure corneal thickness at least
twice to demonstrate edema in Fuch's.
I've always held off using salt solutions and ointments until there was
observable swelling or morning erosions, but I could be a few years behind.
-MT
"ray" <spammers@do.not.reply . com > wrote
> Thank you for your informative response. As you might guess I am
> confused and frustrated.
>
> My symptoms are not really those of Fuch's and mostly not cataracts.
> Question, if it were the cataracts would the polyopia come and go in
> both eyes at the same time?
Depends. Lenticular diplopia, if present in both eyes, could easily vary
with external conditions (background illumination, target
brightness/contrast) but it would be the same each time you reproduce the
conditions.
If there is diurnal variation, like it's worst in the morning, then
lenticular problems don't do that. A cycle of corneal edema could make
diplopia appear to wax and wane but there'd also be haze.
> If just an optical problem how does one
> eyeball know what the other is doing?
Pupils normally change the same in each eye, and accommodation likewise is
lockstep left/right. Both eyes inhabit the same environment, optically but
both eyes also swell at night.
> The doctor said to use a 5% salt solution eye drops 4 times a day and
> a ointment at night. He says this will slow down the progression of
> the process.
I didn't know it was standard to treat asymptomatic Fuch's so aggressively.
You've had no erosions and no morning haze, right? I'll have to check on
that.
> He said come back in 2 months. Other than the
> outrageous price of an ounce of salt water ($20) it seems to be a
> reasonable course of action if I really do have Fuch's? The doctor
> diagnosed based on microscopic inspection of the cornea and a device
> that measures corneal thickness. Is this a definitive diagnose, or is
> it very much subject to interpretation?
It's hard to miss Fuch's in the microscope, so you can be sure you have some
endothelial changes. But that doesn't guarantee you'll have symptoms.
I'm no expert but it seems you'd have to measure corneal thickness at least
twice to demonstrate edema in Fuch's.
I've always held off using salt solutions and ointments until there was
observable swelling or morning erosions, but I could be a few years behind.
-MT
Re: cataracts and diplopia
On Tue, 29 Apr 2008 21:28:09 -0500, "Mike Tyner"
<mtyner@mindspring . com > wrote:
>
>"ray" <spammers@do.not.reply . com > wrote
>
>> Thank you for your informative response. As you might guess I am
>> confused and frustrated.
>>
>> My symptoms are not really those of Fuch's and mostly not cataracts.
>> Question, if it were the cataracts would the polyopia come and go in
>> both eyes at the same time?
>
>Depends. Lenticular diplopia, if present in both eyes, could easily vary
>with external conditions (background illumination, target
>brightness/contrast) but it would be the same each time you reproduce the
>conditions.
>
>If there is diurnal variation, like it's worst in the morning, then
>lenticular problems don't do that. A cycle of corneal edema could make
>diplopia appear to wax and wane but there'd also be haze.
>
>> If just an optical problem how does one
>> eyeball know what the other is doing?
>
>Pupils normally change the same in each eye, and accommodation likewise is
>lockstep left/right. Both eyes inhabit the same environment, optically but
>both eyes also swell at night.
>
>> The doctor said to use a 5% salt solution eye drops 4 times a day and
>> a ointment at night. He says this will slow down the progression of
>> the process.
>
>I didn't know it was standard to treat asymptomatic Fuch's so aggressively.
>You've had no erosions and no morning haze, right? I'll have to check on
>that.
>
I tend to only notice changes. I didn't realize how bad my shoulder
felt until I had my torn rotator cuff repaired. I didn't feel all the
problems associated with hypothyroidism until I started thyroid
treatment. So it is difficult for me to judge what is "normal" vision
unless I can compare normal to what I have at present. So I have a
hard time judging morning haze or other subtle symptoms, but no
problem recognizing two images.
The condition comes and goes and will or will not be present under
conditions that I judge to be the same. I have been looking for this.
I have read that Fuch's can cause blisters on the cornea. This would
seem to be consistent with what I am seeing, but I am not sure that
completely explains it happening in both eyes at the same time. When
I have undergone pupil dilation the condition did not appear.
I was not prepared for the diagnoses so I did not have a list of
questions to ask. The doctor's description was the cells on the
endothelial layer were dying and therefore the layer is thinner than
normal and can't pump out excess water from the cornea. He also said
there were "divots", might that be the same as erosion? The doctor
said he sees about one case a month like mine, but it is usually after
cataract surgery. The treatment is supposed to slow the progress of
the condition. It will not cure, reverse or stop it.
>> He said come back in 2 months. Other than the
>> outrageous price of an ounce of salt water ($20) it seems to be a
>> reasonable course of action if I really do have Fuch's? The doctor
>> diagnosed based on microscopic inspection of the cornea and a device
>> that measures corneal thickness. Is this a definitive diagnose, or is
>> it very much subject to interpretation?
>
>It's hard to miss Fuch's in the microscope, so you can be sure you have some
>endothelial changes. But that doesn't guarantee you'll have symptoms.
>
>I'm no expert but it seems you'd have to measure corneal thickness at least
>twice to demonstrate edema in Fuch's.
>
>I've always held off using salt solutions and ointments until there was
>observable swelling or morning erosions, but I could be a few years behind.
>
I go back in 2 months so I will be better prepared to ask questions.
The corneal thickness will be measured again and compared. What are
the downsides to using the salt solutions? Thanks again for your
knowledgeable answers.
>-MT
>
On Tue, 29 Apr 2008 21:28:09 -0500, "Mike Tyner"
<mtyner@mindspring . com > wrote:
>
>"ray" <spammers@do.not.reply . com > wrote
>
>> Thank you for your informative response. As you might guess I am
>> confused and frustrated.
>>
>> My symptoms are not really those of Fuch's and mostly not cataracts.
>> Question, if it were the cataracts would the polyopia come and go in
>> both eyes at the same time?
>
>Depends. Lenticular diplopia, if present in both eyes, could easily vary
>with external conditions (background illumination, target
>brightness/contrast) but it would be the same each time you reproduce the
>conditions.
>
>If there is diurnal variation, like it's worst in the morning, then
>lenticular problems don't do that. A cycle of corneal edema could make
>diplopia appear to wax and wane but there'd also be haze.
>
>> If just an optical problem how does one
>> eyeball know what the other is doing?
>
>Pupils normally change the same in each eye, and accommodation likewise is
>lockstep left/right. Both eyes inhabit the same environment, optically but
>both eyes also swell at night.
>
>> The doctor said to use a 5% salt solution eye drops 4 times a day and
>> a ointment at night. He says this will slow down the progression of
>> the process.
>
>I didn't know it was standard to treat asymptomatic Fuch's so aggressively.
>You've had no erosions and no morning haze, right? I'll have to check on
>that.
>
I tend to only notice changes. I didn't realize how bad my shoulder
felt until I had my torn rotator cuff repaired. I didn't feel all the
problems associated with hypothyroidism until I started thyroid
treatment. So it is difficult for me to judge what is "normal" vision
unless I can compare normal to what I have at present. So I have a
hard time judging morning haze or other subtle symptoms, but no
problem recognizing two images.
The condition comes and goes and will or will not be present under
conditions that I judge to be the same. I have been looking for this.
I have read that Fuch's can cause blisters on the cornea. This would
seem to be consistent with what I am seeing, but I am not sure that
completely explains it happening in both eyes at the same time. When
I have undergone pupil dilation the condition did not appear.
I was not prepared for the diagnoses so I did not have a list of
questions to ask. The doctor's description was the cells on the
endothelial layer were dying and therefore the layer is thinner than
normal and can't pump out excess water from the cornea. He also said
there were "divots", might that be the same as erosion? The doctor
said he sees about one case a month like mine, but it is usually after
cataract surgery. The treatment is supposed to slow the progress of
the condition. It will not cure, reverse or stop it.
>> He said come back in 2 months. Other than the
>> outrageous price of an ounce of salt water ($20) it seems to be a
>> reasonable course of action if I really do have Fuch's? The doctor
>> diagnosed based on microscopic inspection of the cornea and a device
>> that measures corneal thickness. Is this a definitive diagnose, or is
>> it very much subject to interpretation?
>
>It's hard to miss Fuch's in the microscope, so you can be sure you have some
>endothelial changes. But that doesn't guarantee you'll have symptoms.
>
>I'm no expert but it seems you'd have to measure corneal thickness at least
>twice to demonstrate edema in Fuch's.
>
>I've always held off using salt solutions and ointments until there was
>observable swelling or morning erosions, but I could be a few years behind.
>
I go back in 2 months so I will be better prepared to ask questions.
The corneal thickness will be measured again and compared. What are
the downsides to using the salt solutions? Thanks again for your
knowledgeable answers.
>-MT
>
Re: cataracts and diplopia
"ray" <spammers@do.not.reply . com > wrote
> unless I can compare normal to what I have at present. So I have a
> hard time judging morning haze or other subtle symptoms, but no
> problem recognizing two images.
I think you would have no trouble noticing AM haze. It's like looking
through dirty cellophane, hard to miss.
> I have read that Fuch's can cause blisters on the cornea. This would
> seem to be consistent with what I am seeing, but I am not sure that
> completely explains it happening in both eyes at the same time.
Except not many Fuch's patients get to the blister stage, and you couldn't
miss it because it's _painful_ and it's usually preceded by a decade of
other problems.
I don't think you have erosions either. They hurt. They hurt enough to drive
people to the doctor. You haven't described corneal erosions or bullous
keratopathy.
> I was not prepared for the diagnoses so I did not have a list of
> questions to ask. The doctor's description was the cells on the
> endothelial layer were dying and therefore the layer is thinner than
> normal and can't pump out excess water from the cornea.
That's what creates morning haze. Closing the eyes overnight reduces the
oxygen and the endothelial pump slows down.
> He also said
> there were "divots", might that be the same as erosion?
Erosions might look like "divots" but they HURT. You aren't hurting. So your
divots probably aren't erosions.
Normal endo looks like a carpet of hexagonal tiles. "Missing tiles" are the
only finding you've described and I think that's what he meant by divots.
> The doctor
> said he sees about one case a month like mine, but it is usually after
> cataract surgery. The treatment is supposed to slow the progress of
> the condition. It will not cure, reverse or stop it.
I didn't know it would slow the progress. I'll find someone soon to ask.
> I go back in 2 months so I will be better prepared to ask questions.
> The corneal thickness will be measured again and compared. What are
> the downsides to using the salt solutions?
None. Just cost. Don't try to make your own.
-MT
"ray" <spammers@do.not.reply . com > wrote
> unless I can compare normal to what I have at present. So I have a
> hard time judging morning haze or other subtle symptoms, but no
> problem recognizing two images.
I think you would have no trouble noticing AM haze. It's like looking
through dirty cellophane, hard to miss.
> I have read that Fuch's can cause blisters on the cornea. This would
> seem to be consistent with what I am seeing, but I am not sure that
> completely explains it happening in both eyes at the same time.
Except not many Fuch's patients get to the blister stage, and you couldn't
miss it because it's _painful_ and it's usually preceded by a decade of
other problems.
I don't think you have erosions either. They hurt. They hurt enough to drive
people to the doctor. You haven't described corneal erosions or bullous
keratopathy.
> I was not prepared for the diagnoses so I did not have a list of
> questions to ask. The doctor's description was the cells on the
> endothelial layer were dying and therefore the layer is thinner than
> normal and can't pump out excess water from the cornea.
That's what creates morning haze. Closing the eyes overnight reduces the
oxygen and the endothelial pump slows down.
> He also said
> there were "divots", might that be the same as erosion?
Erosions might look like "divots" but they HURT. You aren't hurting. So your
divots probably aren't erosions.
Normal endo looks like a carpet of hexagonal tiles. "Missing tiles" are the
only finding you've described and I think that's what he meant by divots.
> The doctor
> said he sees about one case a month like mine, but it is usually after
> cataract surgery. The treatment is supposed to slow the progress of
> the condition. It will not cure, reverse or stop it.
I didn't know it would slow the progress. I'll find someone soon to ask.
> I go back in 2 months so I will be better prepared to ask questions.
> The corneal thickness will be measured again and compared. What are
> the downsides to using the salt solutions?
None. Just cost. Don't try to make your own.
-MT
Re: cataracts and diplopia
Mike,
Maybe you could give me your interpretation of the test results.
Guttata grade 3 plus. Corneal pressure 17 right 15 left. Corneal
thickness .630 right .645 left. Corneal cell count not done. Can be
done in Seattle. The vision tends to come and go. When I visited
this doctor my visual acuity was 20/20. A month ago when I was
having moderate doubling it was 20/30. When bad it is somewhat worse
than that. Doctor still maintains that the saline solution will keep
more cells from dying. I wasn't thinking of making my own, just
commenting that $2,500 a gallon seems like a lot for salt water.
So it looks like guttata grade is not so good, cornea are a little
thick, pressure is OK. So what does that really mean?
Thanks
Ray
On Thu, 1 May 2008 10:31:16 -0500, "Mike Tyner"
<mtyner@mindspring . com > wrote:
>
>"ray" <spammers@do.not.reply . com > wrote
>
>> unless I can compare normal to what I have at present. So I have a
>> hard time judging morning haze or other subtle symptoms, but no
>> problem recognizing two images.
>
>I think you would have no trouble noticing AM haze. It's like looking
>through dirty cellophane, hard to miss.
>
>> I have read that Fuch's can cause blisters on the cornea. This would
>> seem to be consistent with what I am seeing, but I am not sure that
>> completely explains it happening in both eyes at the same time.
>
>Except not many Fuch's patients get to the blister stage, and you couldn't
>miss it because it's _painful_ and it's usually preceded by a decade of
>other problems.
>
>I don't think you have erosions either. They hurt. They hurt enough to drive
>people to the doctor. You haven't described corneal erosions or bullous
>keratopathy.
>
>> I was not prepared for the diagnoses so I did not have a list of
>> questions to ask. The doctor's description was the cells on the
>> endothelial layer were dying and therefore the layer is thinner than
>> normal and can't pump out excess water from the cornea.
>
>That's what creates morning haze. Closing the eyes overnight reduces the
>oxygen and the endothelial pump slows down.
>
>> He also said
>> there were "divots", might that be the same as erosion?
>
>Erosions might look like "divots" but they HURT. You aren't hurting. So your
>divots probably aren't erosions.
>
>Normal endo looks like a carpet of hexagonal tiles. "Missing tiles" are the
>only finding you've described and I think that's what he meant by divots.
>
>> The doctor
>> said he sees about one case a month like mine, but it is usually after
>> cataract surgery. The treatment is supposed to slow the progress of
>> the condition. It will not cure, reverse or stop it.
>
>I didn't know it would slow the progress. I'll find someone soon to ask.
>
>> I go back in 2 months so I will be better prepared to ask questions.
>> The corneal thickness will be measured again and compared. What are
>> the downsides to using the salt solutions?
>
>None. Just cost. Don't try to make your own.
>
>-MT
>
Mike,
Maybe you could give me your interpretation of the test results.
Guttata grade 3 plus. Corneal pressure 17 right 15 left. Corneal
thickness .630 right .645 left. Corneal cell count not done. Can be
done in Seattle. The vision tends to come and go. When I visited
this doctor my visual acuity was 20/20. A month ago when I was
having moderate doubling it was 20/30. When bad it is somewhat worse
than that. Doctor still maintains that the saline solution will keep
more cells from dying. I wasn't thinking of making my own, just
commenting that $2,500 a gallon seems like a lot for salt water.
So it looks like guttata grade is not so good, cornea are a little
thick, pressure is OK. So what does that really mean?
Thanks
Ray
On Thu, 1 May 2008 10:31:16 -0500, "Mike Tyner"
<mtyner@mindspring . com > wrote:
>
>"ray" <spammers@do.not.reply . com > wrote
>
>> unless I can compare normal to what I have at present. So I have a
>> hard time judging morning haze or other subtle symptoms, but no
>> problem recognizing two images.
>
>I think you would have no trouble noticing AM haze. It's like looking
>through dirty cellophane, hard to miss.
>
>> I have read that Fuch's can cause blisters on the cornea. This would
>> seem to be consistent with what I am seeing, but I am not sure that
>> completely explains it happening in both eyes at the same time.
>
>Except not many Fuch's patients get to the blister stage, and you couldn't
>miss it because it's _painful_ and it's usually preceded by a decade of
>other problems.
>
>I don't think you have erosions either. They hurt. They hurt enough to drive
>people to the doctor. You haven't described corneal erosions or bullous
>keratopathy.
>
>> I was not prepared for the diagnoses so I did not have a list of
>> questions to ask. The doctor's description was the cells on the
>> endothelial layer were dying and therefore the layer is thinner than
>> normal and can't pump out excess water from the cornea.
>
>That's what creates morning haze. Closing the eyes overnight reduces the
>oxygen and the endothelial pump slows down.
>
>> He also said
>> there were "divots", might that be the same as erosion?
>
>Erosions might look like "divots" but they HURT. You aren't hurting. So your
>divots probably aren't erosions.
>
>Normal endo looks like a carpet of hexagonal tiles. "Missing tiles" are the
>only finding you've described and I think that's what he meant by divots.
>
>> The doctor
>> said he sees about one case a month like mine, but it is usually after
>> cataract surgery. The treatment is supposed to slow the progress of
>> the condition. It will not cure, reverse or stop it.
>
>I didn't know it would slow the progress. I'll find someone soon to ask.
>
>> I go back in 2 months so I will be better prepared to ask questions.
>> The corneal thickness will be measured again and compared. What are
>> the downsides to using the salt solutions?
>
>None. Just cost. Don't try to make your own.
>
>-MT
>
Re: cataracts and diplopia
"ray" <spammers@do.not.reply . com > wrote
> So it looks like guttata grade is not so good, cornea are a little
> thick, pressure is OK. So what does that really mean?
It looks like you have early Fuch's, nothing more. It doesn't explain your
monocular diplopia, IMO.
-MT
"ray" <spammers@do.not.reply . com > wrote
> So it looks like guttata grade is not so good, cornea are a little
> thick, pressure is OK. So what does that really mean?
It looks like you have early Fuch's, nothing more. It doesn't explain your
monocular diplopia, IMO.
-MT
Re: cataracts and diplopia
ray schreef:
> I have monocular double vision in both eyes. It comes and goes fairly
> quickly. It lasts between a few hours and a couple days. It occurs
> in both eyes at the same time, but not to the same degree. Sometimes
> I see two images quite clearly focused, other times it can be multiple
> images. The double vision goes away completely if I look through a
> pin hole. I went to an MD ophthalmologist who recommended new
> glasses. I tried them and it makes little difference. I went to an
> OD who thinks it is probably cataracts and referred me to a cataract
> surgeon. I have an appointment at the end of the month.
>
> From my reading double vision can be a symptom of cataracts. I don't
> think I have other symptoms. With cataracts does the double vision
> come and go quickly? Any ideas of what else it might be that I
> should have checked?
Did one of the two eyecare specialists explained that the size of the
pupil and the changing of it could make the difference?
You mentioned the use of a pinhole and by using it you didn't have
double vision in one eye at the time.
Think about that in bright light conditions, your pupil act like a
pinhole at that moment being small in diameter.
On the other hand, dark(er) light conditions are resulting in a larger
pupil diameter, the image passes a greater area (in diameter) of your
inner lens (the lens behind your pupil)
If you are suffering of cataract it is possible that in that large area
the power of the lens differs on several places in that area due to
imperfections such as changes in refraction indices or obstructions.
Such differences are causing different images which are seen simultaneously.
With a small pupil, there are less such differences and there fore less
"different" images.
Hope this helps.
Jan (normally Dutch spoken)
ray schreef:
> I have monocular double vision in both eyes. It comes and goes fairly
> quickly. It lasts between a few hours and a couple days. It occurs
> in both eyes at the same time, but not to the same degree. Sometimes
> I see two images quite clearly focused, other times it can be multiple
> images. The double vision goes away completely if I look through a
> pin hole. I went to an MD ophthalmologist who recommended new
> glasses. I tried them and it makes little difference. I went to an
> OD who thinks it is probably cataracts and referred me to a cataract
> surgeon. I have an appointment at the end of the month.
>
> From my reading double vision can be a symptom of cataracts. I don't
> think I have other symptoms. With cataracts does the double vision
> come and go quickly? Any ideas of what else it might be that I
> should have checked?
Did one of the two eyecare specialists explained that the size of the
pupil and the changing of it could make the difference?
You mentioned the use of a pinhole and by using it you didn't have
double vision in one eye at the time.
Think about that in bright light conditions, your pupil act like a
pinhole at that moment being small in diameter.
On the other hand, dark(er) light conditions are resulting in a larger
pupil diameter, the image passes a greater area (in diameter) of your
inner lens (the lens behind your pupil)
If you are suffering of cataract it is possible that in that large area
the power of the lens differs on several places in that area due to
imperfections such as changes in refraction indices or obstructions.
Such differences are causing different images which are seen simultaneously.
With a small pupil, there are less such differences and there fore less
"different" images.
Hope this helps.
Jan (normally Dutch spoken)
