Fuch's is commonplace.  1% of the population is quite a lot of
people.  I see people with various stages of Fuch's in my practice on
a weekly basis.

Cataract surgeons are particularly alert to endothelial cell problems
like Fuch's since those patients tend to have a higher rate of
complications than people with healthy endothelial cells.

In its final stages, Fuch's can cause reduced vision, fluctuating
vision, and pain.  However, according to my training and experience,
moderate Fuch's such as you seem to have is not a significant
contributer to reduced vision.  Perhaps you have cataracts, and the
Fuch's has got the attention of your surgeon simply because it could
impact the success of your surgery.  If so, then cataracts is the
primary problem and Fuch's is simply an aggravating circumstance that
complicates your surgery.

Why are you planning on seeing a corneal surgeon?  A corneal
transplant (aka penetrating keratoplasty) is an appropriate treatment
for end-stage Fuch's where the cornea is becoming opaque and acuity is
significantly compromised.  Is that what your doctor is telling you?
Believe me, you don't want a corneal transplant unless its absolutely
necessary because even a successful outcome is generally not very good.

I appreciate your input, and value your opinion.  I am still very
confused.  The polyopia came on overnight.  After about a month it is
not nearly as bad.  Now there a bunch of images close together and
seem to be more smeared than in good focus.  The vision gets better
and worse.  The Muro drops seems to clear it up sometimes.  I put up a
home eye chart and my vision goes from 20/20 to about 20/50.

The cataract surgeon measured corneal thickness of 645 and guttata of
3+.  He said the Fuchs is fairly well advanced.  How is it determined
how far advanced it is?  I am going for a cell count next month.  Does
that shed any more light on the subject?  He said he has seen too many
people with Fuchs that had bad results with cataract surgery that he
does not recommend operating.  John Hopkins says that it is usually OK
for corneal thickness below 640.  When I get motivated I will shop for
a cornea surgeon.  Do you have any recommendation for a good one in
the pacific northwest?  Or would you recommend a different cataract
surgeon?  

From the John Hopkins site:

http://www.hopkinsmedicine.org/wilmer/conditions/fuchs/treatment/fuchs_cataracts.html

Fuchs Endothelial Corneal Dystrophy (FECD) and Cataracts

Some people with cataracts also have Fuchs Endothelial Corneal
Dystrophy (FECD).  If a Fuchs patient undergoes cataract surgery, the
fragile endothelial cells of the cornea may be damaged.  (The
endothelial cells are those cells at the very back of the cornea.  The
endothelial cells deteriorate in patients with FECD.)  The loss of too
many of these cells can lead to edema (swelling) of the cornea.  This
edema can then sometimes lead to painful corneal bullae (blisters),
deterioration of vision, and eventually, the need for a corneal
transplant.

In summary, in a patient with FECD, a cataract surgery may hasten the
need for a corneal transplant.  Because of this risk, the corneas of
FECD patients are examined carefully before cataract surgery.
Sometimes, the eye doctor will decide that the patient should have
both cataract surgery and a corneal transplant at the same time.  By
doing this, two separate surgeries are combined into one procedure,
and recovery time is greatly reduced.

Recent research has helped doctors figure out when a Fuchs patient can
have simple cataract surgery and when a Fuchs patient should have a
combined surgery (cataract surgery plus corneal transplant).  These
researchers showed that many Fuchs patients with corneas thinner than
640 microns can usually have simple cataract surgery.  (A micron is a
very tiny unit of measurement.  Each micron is 0.00004 inches long.)

Whenever a person with FECD has cataract surgery, the surgeon uses
special jelly-like material called viscoelastic gel.  Viscoelastic gel
is put inside the eye to protect the back of the cornea during the
surgery.  The viscoelastic gel is then taken out again at the end of
the surgery.  This gel has been shown to greatly decrease endothelial
cell loss during cataract surgery.

Ophthalmologic researchers are trying to figure out if there is a
minimum number of endothelial cells that everyone has to have in order
to see properly.  Preliminary research, however, indicates that no
absolute number exists for this threshold value.  Instead, it seems to
vary from patient to patient.

I think the first doctor (an optometrist) had it right. He described
yellowing and vacuoles. He blamed the diplopia on vacuoles ("little lenses")
and while that was hogwash, it was closer than anyone else got.

Our OP (ray) said, early on, that his only symptom was monocular polyopia
OU. There just aren't that many things that cause monocular polyplopia OU at
age 67.

Fuch's isn't on the list, short of fresh central erosions. Fuch's is a red
herring, when it comes to explaining the symptoms.

Ray described one LED looking like six, each in focus. He's got refractile
wedges and medicare won't pay until he degrades to 20/40.

I didn't think early Fuch's was such a barrier to surgery, and I suspect
another surgeon might not be so put off.

But waiting for 20/40 seems ill advised.

-MT

thanks, mike, for the clarifications of a number of points that irked
me when I read this thread from the start.

Fuch's is quite easy to diagnose in a simple slit-lamp evaluation.
And its possible but not likely that the original poster really has
this condition anyway so its mention takes the thread off a little off
topic.  I think the most likely conditions that need to be ruled out
are simple refractive changes, cataracts, and potential retinal
problems (diabetic retinopathy, macular degeneration, etc.)  And such
an examination is directly in line with the skills and scope of
practice of optometrists, as well as ophthalmologists, both groups who
have "medical" training regarding the eye.

Fuch's makes the back side of the cornea look a little like frosted glass,
the texture of an orange peel.

There is no blood, and no "blob" to form any image.

The central cornea is usually worst, and the hazy vision isn't usually
concentrated in any particular field or direction.

Fuch's is not rare, and it's difficult to miss if you're paying attention.

-MT, OD

Does Fuchs's appear to be similar to a mass of blood (or similar material)
in that when the eye is not very active it spreads across the vision to
simulate a very thin covering and when the eye is active it coalesces into a
blob that may cover 50 percent of the field of view (sitting in the center)?

It is a long shot but some of the symptoms you are describing are
Fuchs's Corneal Dystrophy.  Many doctors don't find it because it is
rare, but it is easy to diagnose if they are looking for it.  I found
that I have it about 2 months ago.  It only took 3 different doctors
to find it, some have gone to 6 or more before they got a proper
diagnosis.

Did they check you for cataract?  Your desription sounds like it, but of
course it could be something else.  Only a physical examination by a
professional can determine your condition.

I am 65 and my vison in the last two or so years has been getting
worse for reading. I have been buying magnafying reading glass.

Now, when I try to read, it is like looking through glasses that are
smeered with vasaline.  I had my vision checked and got perscription
reading glasses. There is absolutely no difference and I still cannot
focus to read.  My distance vison is failing too.

Reading through various web sites and Usenet Groups, I have concluded
that there so may different possible vision problems that I could
never determine what my problem is over the Internet.

My problem is complicated by my living in Panama. I went to who I
thought was an opthomologist but he was an optometrist. ( There is a
language barrier since my Spanish is not perfect.)  I told him that I
did not think prescription glasses would solve my problem but I went
ahead and had them made anyway.

I am going to see an eye surgeon next week who maybe can help me.