Rotational Image shift, Monocular

[SoundShoreVision]

Has anyone dealt with a patient complaining of looking at a clock face and seeing the 12 and 6 o'clock markers rotated (torqued) to the left when viewing in one eye(OS) only? Binocular vision is clear and single.

Pt has had retinal surgery with scleral buckles in both eyes.

OD -7.50 -2.00 x 005 2 Prism Base Down 20/25+
OS -7.50 -2.00 x 180 2 Prism Base Up 20/25+

Is this Anisokonia secondary to the scleral buckle? (there was no need for prism before the scleral buckle about 12 years ago)

Any suggestions?

[sharpstick777]

Just to clarify, pt had the scleral buckles put in 12 years ago? What was the pathology, retinal detachment OU? is there any other pathologies? Are the pts pupils similar in size?

[SoundShoreVision]

Just to clarify, pt had the scleral buckles put in 12 years ago? What was the pathology, retinal detachment OU? is there any other pathologies? Are the pts pupils similar in size?

Pathology was retinal detachments OU. Pupils are Equal, Round, Reactive to Light. they dilate well.

[sharpstick777]

I would suspect a macular pucker given equal pupil sizes. Was there a large RX change from previous RX? Is this a new patient or one that you have seen before? I have seen a new (and better) spectacle RX reveal flaws that were previously there but masked by poor VA. Its possible that the patient had the waves before and just did not have the acuity to notice them.

Either way, an OCT would be helpful.

Note: since you are new to the board, I am not an OD, but I am an Optician with 11 years experience in managing clinics in both Optometry and Opthalmology and being the person the Drs came to when they had something baffling. I am not qualified to diagnose, but have over many years solved some optical problems that defied convention.

[Ory]

How long has the rotational shift been around - is it dating back to the buckle?

I wonder if the patient had some retinal translocation when it was stuck back down. Translocation was (is?) an experimental Sx for AMD where they would deliberately detach the retina to move the macula to a better perfused area. One surgeon I spoke to who was doing the surgery said that often patients had some kind of rotational complaint because the retina was rotated.

[sharpstick777]

Oh by the way, Welcome to Optiboard SoundShoreVision! There are some amazing people here... and I count many among them as friends.

[OHPNTZ]

Two tests I would do would be amsler grid to determine metamorphopsia, if any. Second, topography to rule out corneal involvement.

I would nix the macular translocation theory due to the 20/25 acuity. Check your cyl power and axis as well...

[SoundShoreVision]

The acuity has been quite good throughout the years. He has been coming to see me for about 18 years. He has complained of similar problems in years past, but since the problem is only monocular, it has not needed to be addressed. He has just gotten a new pair of glasses this month. So I am trying to address this issue at this time.

There has been no translocation, and surgical procedures for many years. I think it is torsion from the scleral buckle, but I am interested in other eye care professional's thoughts.

I try not to discriminate between the three O's. I will accept any answer that makes sense!

Thank you for helping me to help my patient.

[sharpstick777]

QUOTE=OHPNTZ;361932] Second, topography to rule out corneal involvement./QUOTE]

I LOVE topography for eliminating issues, but on the West Coast most insurance carriers will deny a claim for topography used for screening. Expect the patient to pay out of pocket.

[SoundShoreVision]

QUOTE=OHPNTZ;361932] Second, topography to rule out corneal involvement./QUOTE]

I LOVE topography for eliminating issues, but on the West Coast most insurance carriers will deny a claim for topography used for screening. Expect the patient to pay out of pocket.

Worth a shot to see if the cornea is distorted.

Thanks.

[sharpstick777]

Worth a shot to see if the cornea is distorted.
Thanks.

It is, especially on those tough 20/25 patients. I still think irregular astigmatism is responsible for far more problems that end up getting blamed on the eyewear than we realize, but that is another subject.

[cleyes]

Try putting RGP on the eye and do sphero-cyl over-refraction. If image persists then retinal "wrinkle" due to buckle. IMHO


Welcome neighbour from one newbie to another, you'll like it here!! :bbg:

[cleyes]

Outcome??