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Medical Forum / General / Vision / March 2006follow up to my issues...
I've been noticing the fuzzy text appearing a bit more often over the past week. It's really got me puzzled. I mean, i thought it was due to tired eyes, and it can't be. Im on 150 mcg thyroxine, and pretty much buzzing. I put on my 20w Halogen bulb and everything cleared up. I think there's a certain something to do with light. How does all that correlate into my symptoms and possible diagnosis? Thank you Simon > I've been noticing the fuzzy text appearing a bit more often over the > past week. [quoted text clipped - 9 lines] > Thank you > Simon Simon- Obviously, you've got a pretty complicated set of issues going on here. I get it. So do it. I'm taking a few stabs here, and could be totally off base, but you may have--in addition to everything else--a dysfunctional accommodative mechanism. I know you had cycloplegia performed. Do you have the chart yet, so that you can post the quantitative results? For example: I'm curious about your cycloplegic and non-cycloplegic refractions (prescriptions). In May 05, you were slightly farsighted and slightly astigmatic. Right +0.50 Sph, -0.75 Cyl, 135 Axis Left +0.75 Sph, -0.50 Cyl, 35 Axis In December 05, you had no (were masking?) farsigtedness, but still had astigmatism: Right (sideways 8 symbol) Sph, -0.50 Cyl, 135 Axis Left (sideways 8) Sph, -0.25 Cyl, 30 Axis I'm curious how much additional farsightedness your cycloplegia uncovered. My totally uneducated guess is ... some ... and that I would either fit you with bifocals (remember: I'm not a doctor. I don't play one on TV, and I didn't stay in a Holiday Inn Express last night), or push additional plus on you in your corrective lenses. I'd also still guess that you need prisms in your glasses, and/or eye exercises to stimulate your convergence (you're EXOphoric, right?). The prisms will also help, dramatically, to overcome the -tropia (up/down turn)--something that we're just not good at doing without prisms (it's unnatural. Turning in/out is more natural) The thyroid stuff?? Above my pay grade. That's one reason I repeat that I don't know sh*t from sh*nola. Your case needs careful monitoring, and to be managed by somebody who understands the tightly-coupled nature of your eye issues -- how one thing affects all the others -- because it will.... Neil >> I've been noticing the fuzzy text appearing a bit more often over >> the past week. [quoted text clipped - 21 lines] > about your cycloplegic and non-cycloplegic refractions > (prescriptions). Oh, Im afraid I might have misled you. I had cycloplegic drops, but that was only so they could check the back of the eyes. I too would be curious about a cycloplegic refraction test, as, just from observation, I pointed out in another post what I noticed under the influence of the drops... quite a lot of stuff... like metal, stopped being metallic, became dull, lifeless, with a ghostly ethereal glow, pastel shades, severe double vision, distance vision was perfect, but close up vision was far too blurry, though my hyperopic glasses (made up in May 2005), gave a little comfort. > In May 05, you were slightly farsighted and slightly astigmatic. > [quoted text clipped - 6 lines] > Right (sideways 8 symbol) Sph, -0.50 Cyl, 135 Axis Left (sideways 8) > Sph, -0.25 Cyl, 30 Axis Yes, curious about how my vision is up and down like that from year to year. I put it down to thyroid... but who knows. > I'm curious how much additional farsightedness your cycloplegia > uncovered. My totally uneducated guess is ... some ... and that I [quoted text clipped - 4 lines] > I'd also still guess that you need prisms in your glasses, and/or eye > exercises to stimulate your convergence (you're EXOphoric, right?). Well, that's what the opticians have said. The nurse who performed the test said esotropia. Dr Grant says "convergence insufficiency exotropia". > The prisms will also help, dramatically, to overcome the -tropia > (up/down turn)--something that we're just not good at doing without > prisms (it's unnatural. Turning in/out is more natural) Again though, i just think it bizarre, if it is an upwards downwards bit, why am I Ok on the horizontal green line mallet test, and why were the worth FIVE dots to the left and right of each other, as opposed to up and down? Seems weird to me. > The thyroid stuff?? Above my pay grade. That's one reason I repeat > that I don't know sh*t from sh*nola. > > Your case needs careful monitoring, and to be managed by somebody who > understands the tightly-coupled nature of your eye issues -- how one > thing affects all the others -- because it will.... Im at a loss, I don't know quite what to do. im in the UK, and don't know if Im entitled to get my notes, or indeed even make a complaint. I was very unhappy and extremely angry that they performed all these tests, then said everything was normal and when I told them that I knew W4D wasn't normal, they had the nerve to suggest it wasn't done and would not explain anything to me. If they're not going to listen and respond to the results, or even ask my questions, why test in the first place! I'll have to put that in place at the start of next week I guess. Cheers Simon I don't know anything about the NHS system, but I've learned a *great deal* about how to navigate these murky medical waters. First: stay calm ... best you can. Deep breaths. Call the physician's office to ask about a copy of your chart. Sweet talk and charm. You may get it. The variability in your farsightedness likely could be chalked up to any number of things, but the mere fact that it /was or is/ variable would lead me (joe blow) to do a cycloplegic refraction--measuring the "total" amount of farsightedness once the accommodative mechanism is shut down. Still a WAG, but I'm guessing you have more than that 0.75d, and -- even at age 28 -- you might need some extra oomph for near work. The issue of the W4D is bafling, for sure. I still think you ought to get: cycloplegic refraction, including measuring your Rx at near, appropriate prism glasses to help your alignment issues, vision therapy--again, to help the CI issue, and somebody really good to watch over the entire process. Simon, I've been at this (battling eye issues) for over twenty years, so believe me when I say that I understand your anger and frustration. It can only get in your way, though, when dealing with the doc's. Try to stay as level, calm, and professional as you can in your dealings with these (any?) folks, though. You'll get farther. Simon, Worth 4 dot tests for eye suppression. Technically you pass as you weren't suppressing, but you fail because you were seeing double. It was not the right reading regardless. You are antitled to copies of your records by law. They cannot be refused. This can be done by photocopying the results or writing a report. You are not entitled to the originals as they are property of the practitioner. Eso/Exo? Get someone to look at you. Hold a pencil 30cm from your nose and look at it. Do you see one or 2 pencils? If 2, close the left eye, is the remaining image the left or right one? Left = exo. If you see one, cover one eye and keep looking at the pencil. Now move the cover to the other eye. Did the observer see your eye move toward your nose or away from your nose? Toward the nose = exo. dr grant > Simon, Worth 4 dot tests for eye suppression. Technically you pass as > you weren't suppressing, but you fail because you were seeing double. > It was not the right reading regardless. I did find this on a website: "The Worth four dot test is a subjective test of visual alignment, suppression, dominance, and diplopia." That's from http://www.eyetec.net/group6/M29S1.htm Going on to suggest: "Two red lights to the right of the green lights indicates an eso deviation (tropia or phoria)." Sorry, read your opening paragraph as "Worth 4 Dot tests only test for eye suppression and not for double". > You are antitled to copies of your records by law. They cannot be > refused. This can be done by photocopying the results or writing a > report. You are not entitled to the originals as they are property of > the practitioner. I will give it a try. Mnoday morning I'll give the hospital a call. Thanks for everyone's encouragement. > Eso/Exo? Get someone to look at you. Hold a pencil 30cm from your nose > and look at it. Do you see one or 2 pencils? If 2, close the left eye, > is the remaining image the left or right one? Left = exo. If you see > one, cover one eye and keep looking at the pencil. Now move the cover > to the other eye. Did the observer see your eye move toward your nose > or away from your nose? Toward the nose = exo. Hrm. Im fresh out of observers here Im afraid. Can't do this test just yet. I know I definitely see one though. Well, Im pretty sure on that. Seems like a fine line. Thanks Simon >Im at a loss, I don't know quite what to do. im in the UK, and don't >know if Im entitled to get my notes, You can get your notes. You need to write to the hospital and ask for copies. They have to provide you with copies of your notes within a certain time.. something like 4 weeks but I forget. They can charge you photocopying charges. You are also entitled to ask for a second opinion. If you are anywhere near London, ask your GP to refer you to Moorfields. Ann or indeed even make a complaint. I >was very unhappy and extremely angry that they performed all these >tests, then said everything was normal and when I told them that I knew [quoted text clipped - 7 lines] >Cheers >Simon >> Im at a loss, I don't know quite what to do. im in the UK, and >> don't know if Im entitled to get my notes, [quoted text clipped - 6 lines] > You are also entitled to ask for a second opinion. If you are > anywhere near London, ask your GP to refer you to Moorfields. Sorry, im in Birmingham. I have asked for my notes, but apparently I need to speak to the secretary first, who isn't in until Monday! So. A long weekend wait. As I was driving back from work today, twilight hit rather rapidly, sort of, not dark, but not exactly light either, and all vision turned blurry. I don't normally think of anything when that happens, I just blink it off... as I did this time, relax, or "reset" my eyes and things are back to normal. But it just had me wondering what with this blurry vision vision I have at the moment. Something to think about maybe? Maybe not though. Cheers Simon > I've been noticing the fuzzy text appearing a bit more often over the > past week. > I put on my 20w Halogen bulb and everything cleared up. > > I think there's a certain something to do with light. How does all that > correlate into my symptoms and possible diagnosis? It's a simple fact of physics that applies to everybody. More light translates to a greater range of focus (depth of field). This is due to the constriction of your pupil. If you are a young person with good vision, this isn't very important. If you have poor vision, for whatever reason, sometimes more light will help eliminate the fuzzies.  SignatureDan Abel dabel@sonic.net Petaluma, California, USA >>I've been noticing the fuzzy text appearing a bit more often over the >>past week. [quoted text clipped - 9 lines] > vision, this isn't very important. If you have poor vision, for > whatever reason, sometimes more light will help eliminate the fuzzies. Is that why people think pinhole glasses work? Yes, I've heard this phenomenon explained on Home Improvement, where Wilson made two pin pricks in pieces of paper for Mark... though Mark it would transpire I think was a Myope. Ok, so it's fiction. I don' care. Knew TV would come in useful at some stage. So get a bigger bulb, will mask the problem? Presume also, my night vision could be adversely affected... in what regards, who knows. But worth getting checked out too? Thanks Simon > > It's a simple fact of physics that applies to everybody. More light > > translates to a greater range of focus (depth of field). This is due to [quoted text clipped - 3 lines] > > Is that why people think pinhole glasses work? They certainly work. As long as all you ever do is look at Snellen charts, that's the way to go. I don't recommend them for real life, though. > So get a bigger bulb, will mask the problem? It will alleviate the symptoms. > Presume also, my night vision could be adversely affected... in what > regards, who knows. But worth getting checked out too? I haven't driven at night for years. It isn't safe. If your vision is fuzzy in low light levels, that means you can't see well at night. The next kid you kill could be mine. :-( SignatureDan Abel dabel@sonic.net Petaluma, California, USA >> I've been noticing the fuzzy text appearing a bit more often over the >> past week. [quoted text clipped - 9 lines] >vision, this isn't very important. If you have poor vision, for >whatever reason, sometimes more light will help eliminate the fuzzies. Well.... While Dan is, of course, correct as far as he goes, your situation may require a bit more attention than that band-aid. At 28, and with other known eye issues, I might increase the wattage of my task lighting, but I'd pursue those other paths, too (cycloplegic refraction, evaluate for accommodative dysfunction, possible need for increased plus in glasses, or bifocals, vision therapy). Neil > >> I've been noticing the fuzzy text appearing a bit more often over the > >> past week. [quoted text clipped - 14 lines] > While Dan is, of course, correct as far as he goes, your situation may > require a bit more attention than that band-aid. Absolutely. If you hurt your leg, crutches might help you walk, but they won't do a thing about fixing your problem. See if you can't get the problem fixed. If, like me, you can't, then buy more and bigger lights. :-( SignatureDan Abel dabel@sonic.net Petaluma, California, USA A bright light will make your pupils smaller. This causes a broader depth of focus thereby making your vision less fuzzy. The same thing happens in a camera with a smaller aperture, focus is less critical. A broader depth of focus means it helps myopic, hyperopic, and astigmatic errors. A pinhole effect is a real phenomenon; people don't just "think" it works. It appears as though you have a convergence insufficiency which means you have difficulty pointing your eyes in to observe near objects. This can be detected and measured with a Worth Four Dot test. Sometimes convergence exercizes can help this. Put your glasses on, turn on the light, and carry on. Quit obsessing. Ted > A bright light will make your pupils smaller. This causes a broader > depth of focus thereby making your vision less fuzzy. The same thing [quoted text clipped - 6 lines] > Four Dot test. Sometimes convergence exercizes can help this. Put > your glasses on, turn on the light, and carry on. Quit obsessing. No. According to my last eye test, I don't need glasses, as apart from a very tiny slight astigmatism, everything returned to normal, erm, plano, they said I was better than six months previously where I was slightly hyperopic. And while Im more than happy to switch on extra lights, I can't help but knowing this is cheating. I surely should be able to see properly under a 60 watt normal light bulb? >> A bright light will make your pupils smaller. This causes a broader >> depth of focus thereby making your vision less fuzzy. The same thing [quoted text clipped - 11 lines] >they said I was better than six months previously where I was slightly >hyperopic. I just don't believe that you're "better" in terms of farsightedness/hyperopia. I believe you have some residual refractive error that's giving you symptoms and messing with your ocular alignment. But that's just me.... >And while Im more than happy to switch on extra lights, I can't help but >knowing this is cheating. I surely should be able to see properly under >a 60 watt normal light bulb? The light's a band-aid. Use it while you fix the other stuff. Simon, If you wish access to your records the following link provides all the details (comes off the NHS web site) http://www.dh.gov.uk/PolicyAndGuidance/InformationPolicy/PatientConfidentialityA ndCaldicottGuardians/AccessHealthRecordsArticle/fs/en?CONTENT_ID=4084411&chk=wsr EF9 As I said in an email to you I am sure you had a Lees Screen test done and from your description it showed the possibilty of a paresis/paralysis of an extraocular muscle. Hypothyroidism can cause all sorts of problems and certainly using a bright light will help at near. Regarding the differences between Mallett, Worth 4 Dot, and Bagolini and you also at some point seem to have been tested with Maddox Rod. All test in one form or another for suppression the Worth and Maddox tests are known as dissociation tests, whereas the Mallet and Bagolini tests are not and allow the eyes to work together, thus give a more 'real world' reading.By using a suppression test IF you have a paresis/paralysis the result gives an idea of how longstanding the problem is. If a Lees Screen Test was done and did show a problem then it is of recent onset, otherwise you would not be having problems, also if it is a paresis this would be as is consistent with your (net)reported results of variability of prism value (angle of deviation). At this point what is more important is not the symptoms BUT the cause of the problem (re my earlier email). Glad to see you have joined the local sport of Otis Baiting - a harmless sport but amusing all the same. Just hope that nothing he has ever designed or built exists on this side of the pond! Regards Ian Hodgson - Isle of Man > I've been noticing the fuzzy text appearing a bit more often over the > past week. [quoted text clipped - 9 lines] > Thank you > Simon > Simon, > [quoted text clipped - 5 lines] > done and from your description it showed the possibilty of a > paresis/paralysis of an extraocular muscle. Yes, thats right... It was a Lees screen, and I did receive your email, and did reply... > Hypothyroidism can cause all sorts of problems and certainly using a > bright light will help at near. [quoted text clipped - 7 lines] > a paresis/paralysis the result gives an idea of how longstanding the > problem is. Well the nurse who performed the tests, believed I would have had my problem for quite a long time, and she thought it was bizarre I was only experiencing problems now. I gather the real world reading is very slight, based on my experiences on the Mallett and Bagolini? I gather from the results of Maddox and Worth that Im not suppressing? > If a Lees Screen Test was done and did show a problem then it is of > recent onset, otherwise you would not be having problems, also if it > is a paresis this would be as is consistent with your (net)reported > results of variability of prism value (angle of deviation). At this > point what is more important is not the symptoms BUT the cause of the > problem (re my earlier email). Would two squares out on the majority of the lees dots be considered normal? It's all getting quite confusing now. With possible paresis of the extraocular muscles, convergence insufficiency, dysfunctional accomodative mechanism, decompensating exophoria, esotropia... Too many choices. :-) Cya Simon |
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