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?

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?

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 assume this is a progressive condition. If so how fast does it
normally progress?

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?

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

symptoms. I don't seem to have the symptoms attributed to the
condition. Any insight would be appreciated.

"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

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" <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

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.

-MT

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 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.

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.

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?

"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