Chronic Monocular Diplopia, ideas?
Little about myself: 30yrs old, male, Caucasian. I have had the monocular diplopia to some degree for the past 2years or so.. give or take. It seems fairly stable, with any ‘change’ probably being merely my paying attention to it rather than a progression ( at least that is what I am going to believe for now
).
What I mean by this is what I described,.. Double vision in each eye , alone. — If I cover one eye, I see ‘vertical’ double vision — more adequately described as a ghost image.. as the ghost image doesn’t 100% separate from the real/original source image. But it is your typical diplopia.
Very noticeable from LED’s, lights, lamps, digital clocks,.. but also appears on non ‘light sources’. It *is* more pronounced the darker it is (ie: the larger the pupil) — but most aberrations are I would have to guess.. in general.
Not much to say about what I see here, except you could probably reproduce some form of this if you went outside at night and looked at a street light and squinted your eyes until the light started to blur and distort. The rays coming out are what I see with my eyes normally. Very obviously, and prominently ghost images.
Just to add to this, if it might be of relevance,.. is I see halo’s around light sources, and starbursts on car headlights, computer power/hd leds (or any led) for that matter.
Thing that just a few years ago were very clear, and sharp.. are now a blur (light sources). IE: I used to love LED’s for their look, brightness, clarity, low heat and so on .. now I cannot stand them because they (for I suspect by design) , really bring out this problem in my vision. They are piercingly bright now.. where even on the newer cars that have LED’s as their primary source for things such as brake lights make me look in another direction as they are too bright (when they used to just look ‘nice’ a few years ago).
I am 30,.. as I mentioned, this started in my late 20′s.. so it isn’t exactly a huge ‘age’ factor.
Vision wise: — I have had 2 Optometric exams , dilated fundus, etc.. and visual acuity is 20/16, with no significant astigmatism, or any other low order aberration found that needed correction. *They have found a slight degree of astigmatism, something like .25D – but being so minor I noticed no improvement with correction, so it isn’t prescribed (nor does the correction take away the diplopia) (I did not specifically mention this at my last exam.. but will in the future).
One optometrist mentioned that I seem to have ‘hawk eyes’.. hinting that my eyes ‘over-do’ something.. which gives me my acuity but makes convergence harder (IIRC).
At any rate,.. from all the research I have done monocular diploplia is extremely rare — and nothing seems to really explain it in my case. I do think it is affecting my vision more than just the obvious ghosting I notice on light sources and to some degree on normal objects. As I am having a more difficult time reading, concentrating, focusing, and so on. I know visual problems often are the culprit for problems such as these and people don’t realize how much so until they get the problem treated.
The only piece of possible explanation is that this is created by some HOA (High Order Aberration), which standard testing poorly, or does not, detect. I have contacted a local opthalmologist and have a standing appointment for a thorough exam for this.. and importantly the use of Wavefront technology to map my eyes for such HOA’s. (This is by my request not theirs).
I just wanted to be very thorough with the question and line of thought so maybe you eye experts could give me your thoughts, or if you have anything to add, ideas,.. potential Dx’s, etc.
Don’t worry I don’t take anything online as ‘official’.. but I would appreciate educated (professional or well-read ) opinions on the matter.
Thank you,
You are describing HOA’s. I would be suspicious of something in the cornea and that would be the part of the optical media that I would examine most thoroughly. If the cornea appears normal in slit lamp then I would definitely take a closer look with a topography. What you are describing is most often seen after refractive surgery (LASIK, LASEK, PRK) and as you very well describe get worse when the pupil is dilated and more of the refracted light from the cornea is allowed into the eye. HOA’s after refractive surgery are a result of an irregular corneal surface or the result of the treated area being smaller than the pupil. If you haven’t had refractive surgery before, then I would be interested in corneal dystrophy’s that affect the surface of the cornea – Epithelial Basement Membrane Dystrophy, Reis-Buckler’s, Salzman.
The lens is also not to be forgotten as slightly displaced lenses or misshaped lenses can cause monocular diplopia.
I am sure that your ophthalmologist will be able to shed light on the matter after your planned examination.
take care,
March 10th, 2010 at 7:32 pm
From you very thorough description, I suspect higher order aberrations are the culprit. What are the source of these? Most likely changes in the crystalline lens.
The Wavefront exam should confirm this. The problem is that even when the source is defined, there will not be a treatment. There is one company that attempted to incorporate HOA into glasses;it was not successful. Other contact lens companies are trying to incorporate HOA into a contact lens. This is still in development.
In the future, there will be treatments for HOA, but not yet.
References :
March 10th, 2010 at 8:22 pm
Most of the time monocular diplopia is due to astigmatism. You have ruled that out. I agree that HOA is probably the problem. I think you have had a corneal topography. If not, it will surely be a part of your next exam. If there is any chance that this is coming from your cornea, rigid gas permeable lenses may help.
References :
optometrist
March 10th, 2010 at 8:57 pm
You are describing HOA’s. I would be suspicious of something in the cornea and that would be the part of the optical media that I would examine most thoroughly. If the cornea appears normal in slit lamp then I would definitely take a closer look with a topography. What you are describing is most often seen after refractive surgery (LASIK, LASEK, PRK) and as you very well describe get worse when the pupil is dilated and more of the refracted light from the cornea is allowed into the eye. HOA’s after refractive surgery are a result of an irregular corneal surface or the result of the treated area being smaller than the pupil. If you haven’t had refractive surgery before, then I would be interested in corneal dystrophy’s that affect the surface of the cornea – Epithelial Basement Membrane Dystrophy, Reis-Buckler’s, Salzman.
The lens is also not to be forgotten as slightly displaced lenses or misshaped lenses can cause monocular diplopia.
I am sure that your ophthalmologist will be able to shed light on the matter after your planned examination.
take care,
References :