Contact Lens wearer sees double at night

**Joann Raytar** · 10-15-2002, 08:47 PM

I have a co-worker who sees double images of lights such as car headlights, car breaklights and street lights at night time only and only when he is wearing his contact lenses. He doesn't notice any difference in vision before or after blinking. His right lens appears to be 2 degrees off axis with an RX of
OD -0.50 -1.00 X090
OS -0.50 -1.00 X085
SofLens 66 Toric

Double vision at night only doesn't sound like the axis issue that he has been told is causing the problem. Can 2 degrees cause his problems; if not what else could be happening here?

**chip anderson** · 10-15-2002, 10:43 PM

Double vision with each eye individually, one eye only, or both eyes in combination only?

**mullo** · 10-15-2002, 11:25 PM

As Chip had said, which eye(s) is the problem in? What C/L Rx is the patient wearing? The Rx given must be spectacle because axis availability is in 10° increments in the given lens. What are the K reading also? And is the lens centred well?

**Tim Hunter** · 10-16-2002, 01:37 AM

If it's at night only, it sounds like a pupil size issue but I'm not clear how that would be a problem with a soft toric. With an RGP I'd be looking at the BOZD being too small, could it be a problem withe the FOZD especially if it's a front surface toric.

Not particularly familiar with the parameters of this lens, I'm sure Chip wil put me right if that's not possible.

**Joann Raytar** · 10-16-2002, 06:45 AM

chip anderson said:
Double vision with each eye individually, one eye only, or both eyes in combination only?

Chip,
Double vision with each eye individually and also both eyes in combination. (This is the main reason why I don't think it is an issue with the axis OD)

Mullo,
I will take a look at the chart tomorrow and get back to you.

Tim,
I know he has a small aperature and has a hard time getting the lenses in. He previously tried Frequency 55 Aspheric, another soft toric, but was never able to see clearly out of them. I would have to look at the chart to be able to tell you why.

**chip anderson** · 10-16-2002, 07:27 AM

These are just hints and not solutions:

1) Most soft contacts have smaller Oz's than rigid lenses.
2) At night the pupil is larger and possibly fissure, this means that cylinder may be more appearent (i.e. the number of low cyl patients who complain only at night). If the fissure is larger the lens many not orient at the same axis with the eye open wider.
3) Have you checked for "K readings" over the lens-on-eye? Are they good and clear? Are they pretty much in sync with neutralizing the corneal/refractive cylinder?
4) Is the lens holding an near absolute stable position in relation to axis?

Chip

**mullo** · 10-16-2002, 08:35 AM

chip anderson said:
These are just hints and not solutions:

1) Most soft contacts have smaller Oz's than rigid lenses.
2) At night the pupil is larger and possibly fissure, this means that cylinder may be more appearent (i.e. the number of low cyl patients who complain only at night). If the fissure is larger the lens many not orient at the same axis with the eye open wider.
3) Have you checked for "K readings" over the lens-on-eye? Are they good and clear? Are they pretty much in sync with neutralizing the corneal/refractive cylinder?
4) Is the lens holding an near absolute stable position in relation to axis?

I would shoot for the OZ........Pretty common when double vision, especially with the pupil dilation at night. Also check centration.....

**Joann Raytar** · 10-18-2002, 07:36 PM

Tim,
Yes, he has small pupils.

Chip,
When I work with him again, I will get back to you with the information.

Thank you all for your thoughts on this one! :)

**Optom** · 10-19-2002, 04:56 PM

I don't know the age of this patient or if he/she is on medications that has side effects of causing dry eyes. Dry eyes can cause double vision(monocular especially)particularly looking at lights during night time.
Advise more opti tears or other lubricants if it can help.

**Joann Raytar** · 10-20-2002, 07:24 AM

Shabbir,

He is 36 years old.

**Optom** · 10-22-2002, 04:28 PM

Jo, I sent you a lengthy email on monocular diplopia experienced by contact lens wearer with dry eye problems.
Please let us all know what finally helped your colleague.Thanks.
Rgd,
Shabbir

**Joann Raytar** · 10-22-2002, 11:35 PM

Shabbir,

I will. He is trying rewetting drops.

**yzf-r1** · 10-23-2002, 12:16 PM

Shabbir Kapasi said:
Jo, I sent you a lengthy email on monocular diplopia experienced by contact lens wearer with dry eye problems.

Any chance of posting the contents of that email on the board so the rest of us can benefit?...ok, alright, fine, any private bits can be filtered out:bbg:

yahya

**Optom** · 10-23-2002, 05:32 PM

YZ-it says ophthalmic optics forum is not for faint of heart.Unless you are strong at heart you'll be able to read my mails:bbg: Jo to you!
Rgd,
Shabbir

**chip anderson** · 10-23-2002, 07:24 PM

Jo: Have you taken corneal (K readings) over the contacts while they are worn. Are they good an crisp before and after the blink?

Chip

**Stopper** · 01-23-2003, 09:05 PM

Soflens 66 doesn't have the best DK so after wearing the lenses all day he may be getting some corneal edema which will give a halo or ghost image effect which patients will sometime call double vision. Also the first step which i'm sure you have already done is recheck the refraction. When things don't seem to be making sense it helps to verify that you are starting with the correct information. Also verify that the patient is putting the lenses in the correct eyes. This may seem simple but you would be amazed at the number of patients who insist that they are wearing them correctly but really are not. also check to insure he doesn't have them inverted. Some times the solution is simple. If all else fails just try a different lens

**Mary Deas** · 03-02-2003, 12:47 PM

Did we cover test this patient? He may be exhausted from fusing all day, thus manifesting a phoria. Corneal edema, SPK, coated lens debris are also possibilities. Some MD's/OD's use Alphagan PRN for large pupil issues (miotic side effect).

**chip anderson** · 03-02-2003, 01:53 PM

1) See if the corneal astigmatism is completely neutralized. Hense K's over contact, it the reduction in cylinder is the same as spectacle cylinder, it is.
2) Are the lenses holding axis near perfectly?
3) The base curve (posterior ) on this lens is rather steep (8.5) which is why I asked if the over the lens K's were chrisp. (You ain't said yet.)
4) How big is the pupil under dim light.
5) Re-wetting drops last about long enogh for the patient to get out of your chair to the car. Don't waste your time unless you are making money out of the sale of same. (If he really has a "dry eye" which I doubt, Have him put a drop of Castor Oil in on removal of the lenses, this actually cures the problem.
6) If all of this fails then concider a larger Oz. But I don't think this is the problem if the lens centers and holds axis well.

Chip

Would also help to know what the corneal K readings are.