Medical Forum / General / Vision / June 2005
Why would vision worsen throughout the day?
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Mike - 30 May 2005 12:30 GMT I've been having a somewhat strange vision problem for about the last two years: the near and far vision in my right eye is fine for about the first 1-2 hours after I wake up in the morning, but after that, I tend to see double images out of that eye (and only that eye). An ophthalmologist tested me (in a late afternoon appointment) and found that the standard eye machine (whatever it's called)wasn't able to correct the problem, but that it could be somewhat corrected through the use of some prisms he had me look through, which seemed to help sort of align things better in my right eye. He also suggested that pencil push-ups might help.
But I still don't understand why this problem wouldn't be present for the first few hours of every day. I initially thought it might have something to do with computer use, but this happens regardless of whether I sit at a computer. Any thoughts?
Thanks, Mike
Mike Tyner - 30 May 2005 14:45 GMT > I've been having a somewhat strange vision problem for about the last > two years: the near and far vision in my right eye is fine for about > the first 1-2 hours after I wake up in the morning, but after that, I > tend to see double images out of that eye (and only that eye). In young healthy people, most monocular diplopia comes from irregularities in the shape of the cornea.
With the eyes closed overnight, the cornea swells slightly. Its inner layer, the endothelium, is constantly removing water from the cornea and it slows down when the eyes are closed, with less oxygen.
In your case, it appears that the normal diurnal swelling makes your cornea smoother.
People who have problems with too much swelling use hypertonic solutions (or a hair dryer) to remove water from the cornea. You might find that these treatments, early in the morning, bring on the diplopia faster.
>An > ophthalmologist tested me (in a late afternoon appointment) and found > that the standard eye machine (whatever it's called)wasn't able to > correct the problem, but that it could be somewhat corrected through > the use of some prisms he had me look through, which seemed to help > sort of align things better in my right eye. Prism wouldn't affect monocular diplopia. Refracting lenses (sphere-cylinder) might well make it less noticeable.
> He also suggested that > pencil push-ups might help. PPUs are a cookbook treatment for _binocular_ diplopia. I'm not sure he understood that you are seeing double with one eye closed.
> but this happens regardless of > whether I sit at a computer. Any thoughts? Diurnal tissue variation.
-MT, OD
John Yasar - 30 May 2005 15:10 GMT I was going to ask about this topic also since I have something similar in one eye, however it is not always double image, it is sometimes double image and not completely same images, for example it is usually noticeable when looking at vertical objects like light posts, and one image is foggy, hazy, every blink it comes and goes, every blink it changes the clarity of the image in that eye, I would blink and see a perfectly clear and sharp image and blink the next second, this time, same image and a faint double of it slightly conjoined. Am I describing astigmatism or this is more serious issue. I would like to start a new thread for my symptoms though, thanks...
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Mike Tyner - 30 May 2005 17:30 GMT > same image and a faint double of it slightly conjoined. Am I describing > astigmatism or this is more serious issue. Technically, yes. "Astigmatism" literally means "lack of a point."
In common usage, though, it's assumed we mean _regular_ astigmatism, a smooth surface, slightly bent more in one direction and less in the other, a "football" shape.
But in real life, not all astigmatism is "regular". Look at a corneal topograph and you'll see steeper and flatter areas, hills and valleys, that aren't entirely correctable with lenses.
-MT
Tom - 30 May 2005 17:56 GMT >> same image and a faint double of it slightly conjoined. Am I describing >> astigmatism or this is more serious issue. [quoted text clipped - 4 lines] >smooth surface, slightly bent more in one direction and less in the other, a >"football" shape. A football is round. What do you mean?
Tom
>But in real life, not all astigmatism is "regular". Look at a corneal >topograph and you'll see steeper and flatter areas, hills and valleys, that >aren't entirely correctable with lenses. > >-MT Mike Tyner - 30 May 2005 18:52 GMT > A football is round. What do you mean? Even though it isn't spherical, a football (American) is "regular" meaning the curves are consistently symmetrical everywhere.
If you shaped a crude football, freehand, in clay, it would have irregularities, bumps, departures from "regularity."
So it is with the eye, small departures from ideal shape that aren't "coaxial," meaning they don't focus to the same neat point. It's obvious from topographs of normal cornea. The bumps and valleys give rise to monocular diplopia.
Look through a pinhole, or wear a rigid contact, and the diplopia goes away.
"Regular" astigmatism is a football. "Irregular" astigmatism is non-uniform, which can apply to either football-shaped or spherical surfaces.
-MT
Tom - 30 May 2005 19:29 GMT >> A football is round. What do you mean? > >Even though it isn't spherical, a football (American) Okay.. we aren't all from America.. ho hum!
Tom
B. Janse - 30 May 2005 19:39 GMT >> Technically, yes. "Astigmatism" literally means "lack of a point." Ah, so yesterday the header of my thread should have been 'mirror cylinder axes' instead of 'mirror astigmatic axes'.
The Real Bev - 31 May 2005 01:48 GMT > >In common usage, though, it's assumed we mean _regular_ astigmatism, a > >smooth surface, slightly bent more in one direction and less in the other, a > >"football" shape. > > A football is round. What do you mean? American footballs aren't round, they're, um, football-shaped. Take a circle. Cut out a chord. Make a mirror image of that chord and put the ends together. Sort of an ellipse or oval with points on the ends.
Carry on...
 Signature Cheers, Bev ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ Why should I be tarred with the epithet "loony" merely because I have a pet halibut? --Monty Python
Tom - 02 Jun 2005 20:40 GMT >> >In common usage, though, it's assumed we mean _regular_ astigmatism, a >> >smooth surface, slightly bent more in one direction and less in the other, a [quoted text clipped - 5 lines] >circle. Cut out a chord. Make a mirror image of that chord and put the ends >together. Sort of an ellipse or oval with points on the ends. I know. Rugby ball shaped. I'll read it again now. :-)
>Carry on... Mike - 30 May 2005 15:50 GMT Thanks much for the speedy and informative reply. Is this a treatable condition, or am I more or less stuck with it as is?
Mike Tyner - 30 May 2005 17:14 GMT > Thanks much for the speedy and informative reply. Is this a treatable > condition, or am I more or less stuck with it as is? Theoretically, wavefront-guided LASIK could give permanent relief, but it's expensive and drastic for such a subtle problem. Most surgeons would probably not want to attempt it.
Rigid contacts (or perhaps even soft lenses) could improve the problem but only while you wear them. Rigid contacts used to "reshape" the cornea could give more lasting results but that treatment is somewhat unpredictable and expensive.
The most practical treatment is glasses, prescribed late in the day. That won't give perfect results but will probably reduce the appearance of double vision when you need it.
-MT
dumbstruck - 30 May 2005 20:02 GMT If your doc doesn't find clear evidence of a problem and can only speculate about unappealing treatments, there is a possible simple alternative you can test yourself. These descriptions of come-and-go cloudiness and multiple images are something I also get from time to time, and can snap out of it by covering up the "good" eye for an hour or so.
I forget the tech term for the problem... something about poor binocular coordination leading to your brain tiring of resolving the two images and just giving up the fine tuning of one of your eyes focus. A vernacular term used to be lazy eye, and you would see kids long ago with an eyepatch (over good eye) to correct this. The underlying problem of the bad eye may be negligible and you might work on just stopping the shutdown once in a great while.
My doc used to treat this with eye exercises, including using prism glasses to intentionally seperate the images. A simple approach is to close one eye while watching TV for a while, but it doesn't work well straining like that in a passive environment. Rather cover the good eye in some comfortable fashion and do a (safe!) task that requires some medium distance acuity yet takes your mind off your situation. You may find a 15-30 minutes later, POW! things snap back in perfect focus, but may want to do it longer or the good results may be temporary. I have to do this sometimes twice a year, and there is a lot of possible speculation about underlying reasons, but on the other hand the solution is so darned simple...
Mike Tyner - 30 May 2005 20:06 GMT > I forget the tech term for the problem... something about poor > binocular coordination leading to your brain tiring of resolving the > two images Yes, but the OP concerned diplopia with _only one eye._
Whole different kettle o' fish.
-MT
dumbstruck - 30 May 2005 21:10 GMT > Yes, but the OP concerned diplopia with _only one eye._ > > Whole different kettle o' fish. > > -MT Dunno what you are referring to; the original post described exactly the type of things I have experienced. As if the brain gets tired of resolving the images, and gives up driving the focusing of one of the eyes and tries to rely mainly (but imperfectly) on a dominant eye. Seems to make a fresh effort for the weak one some mornings, but then fades. In OP case, the underlying cause may have been a pointing issue, where his doc thought a prism would make it easier to get a straight-ahead image that could resolve easier with the other eye.
Of course the underlying conditions can hardly be diagnosed online, but sometimes they can't be perfectly diagnosed in person either. Thus some simple experiments may show that the problem can be overcome by employing natural capabilities. Try vacuuming your house with the good eye closed. This isn't a great experiment since it should employ longer vision and more time, but may just give a clue whether the bad eye is capable of snapping back...
Philip D Izaac - 31 May 2005 06:43 GMT The original post also said that prisms helped somewhat. a little confusing, huh
Roland J. Izaac
> > I forget the tech term for the problem... something about poor > > binocular coordination leading to your brain tiring of resolving the [quoted text clipped - 5 lines] > > -MT Mike Tyner - 31 May 2005 07:08 GMT > The original post also said that prisms helped somewhat. a little > confusing, > huh Yes.. I guessed it was combined in the phoropter with pl-050.
-MT
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