Double Vision From Progressives?

[sheltie57]

Ok...I'll try to give the condensed version. I just spent the last 20 minutes writing a post and lost it. :(

Here is my last prescription (oct 2003):
OD: Sphere +2.25 Cyl. -1.75 Axis 095 Add +2.00
OS: Sphere +0.75 Cyl. -0.75 Axis 125 Add +2.00

I've been having problems with double vision in my left eye (mostly) for the past few years. It has been getting progressively worse. It shows up after I do anything where I have to concentrate. That is, reading, watching tv, computer work. My occupation is in the accounting field so you can see why I'm getting very concerned about it.

I've been to see an ophthalmologist who did extensive testing. He then sent me to another professional to test that my eye muscles were working together. After that I was referred to a neurologist and still nothing.

Could it be the progressive lenses or my prescription that is causing the problem?

I purchased these lenses from LensCrafters in October 2003. I've also had progressives from Rodenstock and Essilor previously.

I would appreciate any help that you can give me. :)

[Robert Martellaro]

Ask the optician about trying a separate pair of glasses optimized for near tasks only. Frame should be deep vertically to allow the lowering of the optical centers (due to VI_ your optician will explain).

It's a long shot but worth trying since a separate pair of reading glasses will increase the field of vision, decrease a variety of induced and inherent irregularities found in all progressive addition lenses, particularly with your type of Rx, resulting in less fatigue when performing extended periods of close tasks.

Hope this helps

Robert

[Andrew Weiss]

Agree with Robert to try reading glasses only to see what happens, but for a first step, read on . . .

You have a fair degree of difference in the prescriptions required by your two eyes. In some people, this can cause problems with use of a progressive.
I'd also wonder whether you had the same problem with your previous Rodenstock and Essilor progressives. Not all progressives are created equal, and you can be reasonably sure that the progressive used by Lenscrafters is likely not to be as sophistocated as the Rodenstock or Essilor. Also fitting progressives is an art, and the more experienced and careful the trained optician is who fits you, the better your chances of success.

Some independent offices (like ours) will, as a courtesy, verify the relevent fitting measurements. Sometimes a simple adjustment will rectify the problem.

So I'd suggest first having the glasses verified by an independent optician whose skills you trust. If you don't know someone like that, look for someone who's American Board of Opticianry (ABO) certified or (ideally) ABO Advanced Certified or an ABO Master. If everything checks out well, then I'd suggest trying the reading glasses and see what happens: do you have the same result? If not, then perhaps progressives are not for you. A line bifocal might work, but might also require something called slab-off prism -- something more detailed than you really need to know :)

[Jacqui]

The Rx is a good candidate for a slab off, and this could be causeing the problems. I agree with Andrew see an independent optician and have it checked out.

[Andrew Weiss]

Jacqui, this is a bit off-thread, but what's been your experience with slab-off in progressives? Ours has been dismal

[Jacqui]

I've only done 1 and it was successful, BUT.......

[CME4SPECS]

I've done many slabs on Pals, they work fine. Terry

[drk]

A little more information would be helpful.

Are you talking about true double vision, like when you press on one eyelid with both eyes open, causing two completely distinct images, or a "ghost image" which is more a low-contrast second image?

If distinctly double images, is your double vision vertical, horizontal, or diagonal? Is it double in straight-ahead gaze, or only on downgaze or sidegaze?

It is apparently intermittent, and not constant, correct? And the exacerbating factors seem to be using your eyes for long periods of time at any distance: far, near, and intermediate (therefore any portion of your lens)? How long does it last when you get it? Does the double vision disappear when you close the right eye, or does it persist with the left eye open by itself?

It may not even be a binocular vision problem at all, and likely not, if the clinicians are competent.

And this has been going on for 2 years or so, so the onset preceeds these glasses. What has the trend been in the last 2-3 Rx changes? Decreasing plus power in the left eye, creating a slow-onset anisometropia? Or, do you have a nuclear sclerotic cataract beginning in the left eye? Then, double-focus cataract should be ruled out.

Look for dry eye as well. If lubricating your eye will alleviate the double vision, then you have your diagnosis. Do your eyes get dry?

You don't have any other neurological symptoms, I'd suppose, or the neuro consult would have turned something up. That's what you really want to avoid: demyelinating disease,palsy or tumor.

I'm willing to bet it's not binocular, at this point.

Taking Robert's advice about making near-only lenses may be worth the diagnostic value, though, to rule out anisometropia-based diplopia, and be useful to boot.

Post again.

[Stopper]

I'm with you DrK, I would be interested to know the Rx in the previous glasses. (particularly the cyl and axis)And if it hasn't been done yet a recheck of the refraction may be warranted. Also trying the Rx in a trial frame for distance and or near may help us understand if it is a problem with the progressive.

[Shutterbug]

I'm guessing the double vision is up and down, not in and out. In this case a slab off prism would fix the problem. This would cause a line in the lens which is visible, but would fix the issue. With different prescriptions like yours, the farther the eye moves down through the lenses, the more pronounced the double vision will become and reading becomes very difficult.

Any optician can get the slab-off for you. They are a bit pricey, but if it helps you see it will be worth it. Their lab can calculate the exact amount of prism you need.

shutterbug

[Jubilee]

I'd also wonder whether you had the same problem with your previous Rodenstock and Essilor progressives. Not all progressives are created equal, and you can be reasonably sure that the progressive used by Lenscrafters is likely not to be as sophistocated as the Rodenstock or Essilor. Also fitting progressives is an art, and the more experienced and careful the trained optician is who fits you, the better your chances of success.

Just to set the record straight, LensCrafters does use Essilor (Natural and Ovations), Sola (SolaMax), and Rodenstock (XS) progressives. We also have access to Varilux lenses including the Ellipse as well.

Cassandra

[Chris Ryser]

...................Not all progressives are created equal, and you can be reasonably sure that the progressive used by Lenscrafters is likely not to be as sophistocated as the Rodenstock or Essilor........................

Having been involved in this business since the inception of progressive lenses and followed the track .............I would say they are ALL basically the same and looking at the the actuallt are.............whatever any body claims. A liottle shorter corridor of prgressive power a little larger reading area...........a little more distoprtion or little less distyortion to the side, ..........they are all the same baby in different colors.

Nobody seems to be able to help, ..........Get rid of them, get a pair of single vision for distance...........get a pair of singel vision for close up................ be patient for a few weeks and find out if double vision persists. If YES see another neurologist if NO get a new pair of whatever you want and make the optican make a new pair every time the double vision re-appears.

[For-Life]

When it comes to progressives it does not matter if you are wearing the Zeiss Individual or Super Nolines. What matters is how they are fit.

[sheltie57]

I'd also wonder whether you had the same problem with your previous Rodenstock and Essilor progressives.

So I'd suggest first having the glasses verified by an independent optician whose skills you trust. If you don't know someone like that, look for someone who's American Board of Opticianry (ABO) certified or (ideally) ABO Advanced Certified or an ABO Master. If everything checks out well, then I'd suggest trying the reading glasses and see what happens: do you have the same result? If not, then perhaps progressives are not for you. A line bifocal might work, but might also require something called slab-off prism -- something more detailed than you really need to know :)

I did have a similar problem with the Rodenstock and Essilor but it was not as bad. I guess the question is this: Is the type of progressive emphasing the problem or is the condition just getting worse because of the Add increasing?

I did have some reservations about going to a place like Lenscrafters. I'm not trying to slam them, please forgive me all that work for Lenscrafters, because they are great people that worked there. I do remember having a hard time with my first pair of progressives (the Rodenstocks) and even went back to have my prescription checked again by the doctor. This last time I again had the optometrist check my prescription because of the double vision. She could not find anything wrong with the prescription.

A line bifocal!! AAACCCKKKKK I might have to shoot myself them.

[sheltie57]

Are you talking about true double vision, like when you press on one eyelid with both eyes open, causing two completely distinct images, or a "ghost image" which is more a low-contrast second image?

It is apparently intermittent, and not constant, correct? And the exacerbating factors seem to be using your eyes for long periods of time at any distance: far, near, and intermediate (therefore any portion of your lens)? How long does it last when you get it? Does the double vision disappear when you close the right eye, or does it persist with the left eye open by itself?

And this has been going on for 2 years or so, so the onset preceeds these glasses. What has the trend been in the last 2-3 Rx changes? Decreasing plus power in the left eye, creating a slow-onset anisometropia? Or, do you have a nuclear sclerotic cataract beginning in the left eye? Then, double-focus cataract should be ruled out.

Taking Robert's advice about making near-only lenses may be worth the diagnostic value, though, to rule out anisometropia-based diplopia, and be useful to boot.

Post again.

Now that I'm seeing a more clearing explanation of double vision, I believe that what I'm experiencing is a "ghost image". Thank you for helping me explain it better!

No...I don't always have it. It only seems to be evident after reading, watching tv, computer work...etc.

It lasts depending on how long I perserve to read, do computer work, etc. It can last up to an hour at times. If I close my left eye (the bad one) I can see without the ghosting. If I close my right eye, the ghosting is there or if both eyes are open.

My Rx has not changed very much in the past 3 glasses. The most change has been in the reading part only. I've been thoroughly checked for cataracts and any other abnormalities. My ophthalmologist is a very sweet elder man who I believe to be very experienced. I don't think there's a stone that he's left unturned for any physical reasons that might be causing this.

I don't think dry eye is the problem. I mean, I get tired eyes like most people, but they don't feel excessively dry.

What do you mean by near only lenses? Does that mean I can only use them for computer or close work? Do I then need two pairs of glasses? I guess I'm concerned about the cost. What if I do get these near only glasses only to find out that it does not make any difference? I'm thinking that you can't take them back like you could an oversized sweater.

Shelley

[sheltie57]

I'm with you DrK, I would be interested to know the Rx in the previous glasses. (particularly the cyl and axis)And if it hasn't been done yet a recheck of the refraction may be warranted. Also trying the Rx in a trial frame for distance and or near may help us understand if it is a problem with the progressive.

I'm sorry but I don't have a copy of my previous prescriptions. But if I do recall, there was little or no change with it. The only change was in the Add.

I don't know if this is normal or not, but it did just came to mind. When the optometrists assistant checked the reading part of my previous pair of glasses, I could not read with the one eye, but could read perfect with the other eye. Unfortunately, I can't remember which eye saw clear with my old Add and which one needed a stronger Add.

[drk]

You are much closer to a correct diagnosis, now.

You have monocular diplopia, or a "ghost image". Forget everything that has been done regarding eye muscles and prescriptions and neurology, because the immediate reaction EVERYONE has when you say "double vision" is to look for binocular problems. You do not need new glasses.

The good news: there are few causes of monocular diplopia. It's a problem with your tears, your cornea, or your lens. It's most likely your tears. Try this test: lubricate frequently before and during long periods of eye use and see if it disappears, or at least is reduced, and get back to us.

(Chris...shame on you. Neurologist!)

[Chris Ryser]

(Chris...shame on you. Neurologist!)

I am totally ashamed...................and will never ever recommend a Neurologist again to cure a teardrop problem.

[Shutterbug]

drk - nice call. I had not thought to ask if the double vision remained if you close one eye :0)


shutterbug

[chip anderson]

Has anyone thought of sending this poor soul to a pediatric ophthalmologist who treats adult strabismus? Many of us have muscle problems that appear with fatigue only (I have this) and the longer I work into the wee hours the more my images diverge.


Chip

[Ryan]

Jacqui, this is a bit off-thread, but what's been your experience with slab-off in progressives? Ours has been dismal

I have fit around 5 or so. The experience has been fine. I was wondering if the poster has AR coating on the lens. THis can only help.

[sheltie57]

You are much closer to a correct diagnosis, now.

The good news: there are few causes of monocular diplopia. It's a problem with your tears, your cornea, or your lens. It's most likely your tears. Try this test: lubricate frequently before and during long periods of eye use and see if it disappears, or at least is reduced, and get back to us.

(Chris...shame on you. Neurologist!)

Thanks, Chris.

It certainly can't hurt to try lubricating my eyes regularly. I'll pick some natural tears drops up this weekend.

Shelley

[sheltie57]

Has anyone thought of sending this poor soul to a pediatric ophthalmologist who treats adult strabismus? Many of us have muscle problems that appear with fatigue only (I have this) and the longer I work into the wee hours the more my images diverge.


Chip

I was sent to a pediatric ophthalmologist. It was quite an experience sitting in the waiting room surrounded by wee ones. Needless to say, I did feel totally out of place. :D

She said my eye muscles were fine and that my problem was a focusing issue. Whatever that meant. I guess I should have asked her for more info. :o

Shelley

[sheltie57]

I have fit around 5 or so. The experience has been fine. I was wondering if the poster has AR coating on the lens. THis can only help.

Yes...I do have AR coating on the lenses. I wouldn't own a pair of glasses without it. :D

[Andrew Weiss]

drk, many bows of thanks for the education. Great example of how assumptions can get in our way in diagnosing a problem . . .