July of 2003 I had surgery on my right eye at the
Wilmer Eye Institute at John Hopkins to correct a
macular pucker.  This entailed a vitreectemy.  Post
surgery I had a fairly large black spot below and to
the left of my focal point which has since become
relatively unobjectionable.  I was also informed that
I could expect a cataract to form in that eye, which
occurred within six months or so to a point where I
had surgery to correct that here in Grand Rapids
Mich in January of last year.  Prior to the puck
problems I suspect my right eye required about 1
diopter more of correction thatn the left eye, and
part of the objective of the cataract surgery was
to end up with an eye
glass prescription that would be one diopter weaker
than the left eye.  Instead, I ended up with needing
a prescription in the right eye that is one diopter
stronger than in the left eye, i.e., two or more
diopters off from what the doctor was aiming for.

There is a consdierable sense
of disparity between the two eyes and when I look
through them one at a time the images in my right
eye, the eye that had the surgery, appear to be
about 20% larger than those in the left eye, at
least when looking at objects within about twenty
feet or so.  Its also in a different location,
to the left and above the image in the left eye.
This is even more extreme when I take
my glasses off, although I can't be certain because
my vision is so poor in the right eye that I can't
see very well without my glasses.  I remeber how
depressed I was when I couldn't even read the
single big E on the eye chart.  My latest eye
glass prescription was:

             spherical    cylindrical   axis
     O.D.       -4.75        -3.50       175
     O.S.       -2.50        -3.00       178

I can't remember for sure if this disparity existed
after the pucker surgery and before the cataract surgery,
but I believe it was the
result of the G.R. Dr's assistant having trouble with
the readings when measuring the distance to the back
of the eye.  I remember she was getting disparate
readings and had to call another assistant in to
see if she could get the readings to stabilize.
In hindsight, I believe my G. R. Doctor should have
been doing those measurements himself.

The problem is, no one here in Grand Rapids is familiar
with this sort of problem, there really isn't any eye
test for image size disparity.  I am currently wearing
a pair of glasses of my own design in which I have the
right lense out about 1/4 of an inch further than the
left lense to try to pick up some demagnification effect.
But the image size in the right eye is still significantly
larger than the left eye, and still very distracting,
expecially when inside most buildings.  The disparity
is less apparent at long distances.

There is a local doctor here who is supposed to be quite
knowledgeable about these things, and even the folks
at John Hopkins all thought if there were a size disparity
it should be that the right eye image should be smaller
not larger.  The local doctor has wondered if this
disparity might be related more to the macular pucker
surgery than the measurement errors associated with
the catract surgery resulting in an eyeglass prescription
one or more diopters stronger rather than weaker.  I
suspect this is related to the measurement error myself.
In any event, I'm wondering if anyone has some insight
into this matter.  I've read several of the older
posts on diopter disparities.  My right eye doesn't
really test all that bad, 20/30 I think, its just that
it seems to be at war with my left eye due at least in
part the image size disparity, and its somewhat surprising
to me that eye tests simply don't pick up on this sort of
problem.  But perhaps just as troubling is the fact that
the image seems to be located to the left and above the
image in the left eye.

Phil Roberts, Jr.