Results 1 to 24 of 24

Thread: Need Help Solving Double Vision

  1. #1
    OptiBoard Apprentice
    Join Date
    Mar 2018
    Location
    AZ
    Occupation
    Dispensing Optician
    Posts
    13

    Unhappy Need Help Solving Double Vision

    Any suggestions would be greatly appreciated, that being said. I have a patient that has had cataract surgery on one eye due to the other not being bad enough for insurance to cover. Her Rx is now:
    -2.00 +2.00
    -10.75 -.50 x 90 +2.00
    She sees double even with slab off in.

  2. #2
    One eye sees, the other feels. OptiBoard Gold Supporter
    Join Date
    Jul 2002
    Location
    Wauwatosa Wi
    Occupation
    Dispensing Optician
    Posts
    5,124
    Quote Originally Posted by btoe32 View Post
    Any suggestions would be greatly appreciated, that being said. I have a patient that has had cataract surgery on one eye due to the other not being bad enough for insurance to cover. Her Rx is now:
    -2.00 +2.00
    -10.75 -.50 x 90 +2.00
    She sees double even with slab off in.
    OS IOL out of pocket.

    CL(s).

    Min occlusion.

    Hope this helps,

    Robert Martellaro
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    Science is a way of trying not to fool yourself. - Richard P. Feynman

    It is easier to fool a man, than to convince a man he has been fooled. -Mark Twain

  3. #3
    Master OptiBoarder optical24/7's Avatar
    Join Date
    May 2006
    Location
    Down on the Farm
    Occupation
    Dispensing Optician
    Posts
    5,470
    I can’t believe a doc would let a patient walk out the door with 10D of power imbalance or he couldn’t “find” the OS “bad enough” to need catx on it too. Robert’s right, their only choice will be to pay for the OS surgery, CL at least on the OS or occluded it.

  4. #4
    OptiWizard
    Join Date
    Sep 2012
    Location
    West Scranton, Pa
    Occupation
    Dispensing Optician
    Posts
    322
    Ungh. Usually the threshold for surgery on cataracts is when it becomes a nuisance for daily life. Doesn't this meet that standard? I'm not a doctor - just an opinion - but tragic circumstances to drop in the lap of an optician.

  5. #5
    OptiWizard
    Join Date
    Sep 2012
    Location
    West Scranton, Pa
    Occupation
    Dispensing Optician
    Posts
    322
    And in the most timid and respectful way I will disagree with Robert. Occluding a healthy eye is a bad idea. Call the doctor. Get the whole story.

  6. #6
    What's up? drk's Avatar
    Join Date
    Mar 2004
    Location
    Ohio
    Occupation
    Optometrist
    Posts
    8,182
    No, it's not "not covered". That's not the case. The answer is getting the surgery. Don't waste effort otherwise. If you need to use a Bangerter foil or something for minimal occlusion in the meanwhile, that's OK. I think the CL idea is the best for functionality.

  7. #7
    Master OptiBoarder
    Join Date
    Jun 2012
    Location
    Mitten State
    Occupation
    Ophthalmic Technician
    Posts
    687
    CL really seems best, if they are truly unwilling to go for the OS IOL. I'd be extremely concerned about fall potential, and the related sequelae, for someone of sufficient age (assuming this is a condition that doesn't have a congenital or hereditary element, and thus unusual early onset) to have cataracts if occlusion is used.

  8. #8
    What's up? drk's Avatar
    Join Date
    Mar 2004
    Location
    Ohio
    Occupation
    Optometrist
    Posts
    8,182
    There may be some weird extenuating circumstance since the patient has terrible myopia...maybe the retina will detach or something?

  9. #9
    Master OptiBoarder
    Join Date
    Feb 2013
    Location
    PA
    Occupation
    Dispensing Optician
    Posts
    1,365
    Hmmm. I'm not sure about "not covered." I thought there was something where it was covered due to the power difference? I could be wrong but I thought that was the case?

  10. #10
    OptiBoardaholic
    Join Date
    Mar 2007
    Location
    Connecticut
    Occupation
    Dispensing Optician
    Posts
    262
    Not a Dr. Never even played one on TV.
    But 2D cyl. OD post cat, and only .50 OS pre surgery? Remember, "God doth love symmetry".
    It would be interesting to see the manifest refraction pre cataract surgery.

    See later post.
    Read the original too quickly and thought I knew what I was taking about. Wrong again.
    Last edited by waynegilpin; 03-17-2021 at 02:05 PM.

  11. #11
    What's up? drk's Avatar
    Join Date
    Mar 2004
    Location
    Ohio
    Occupation
    Optometrist
    Posts
    8,182
    Wayne, I think you're seeing the add as a +cylinder.

  12. #12
    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
    Join Date
    Dec 2004
    Location
    At a position without dimension...
    Occupation
    Dispensing Optician
    Posts
    4,710
    Quote Originally Posted by btoe32 View Post
    Any suggestions would be greatly appreciated, that being said. I have a patient that has had cataract surgery on one eye due to the other not being bad enough for insurance to cover. Her Rx is now:
    -2.00 +2.00
    -10.75 -.50 x 90 +2.00
    She sees double even with slab off in.
    How long ago was the surgery?

    My 2 cents.

    If CL's are not possible than a gentle explanation that requires patience, as the war between the eyes needs to be settled by the brain, and hopefully the right eye can defeat the left eye and he becomes functionally monocular until the left lens ripens will help.

    With the option of frosting or bangerter foil to force it.

    https://www.hilcovision.com/f/bangerter-occlusion-foils
    Last edited by Uncle Fester; 03-17-2021 at 03:31 PM. Reason: tweek...

  13. #13
    OptiBoardaholic
    Join Date
    Mar 2007
    Location
    Connecticut
    Occupation
    Dispensing Optician
    Posts
    262
    Quote Originally Posted by drk View Post
    Wayne, I think you're seeing the add as a +cylinder.
    Hadn't finished my coffee. My apologies to the doc.

  14. #14
    Master OptiBoarder
    Join Date
    Jun 2012
    Location
    Mitten State
    Occupation
    Ophthalmic Technician
    Posts
    687
    Quote Originally Posted by drk View Post
    There may be some weird extenuating circumstance since the patient has terrible myopia...maybe the retina will detach or something?
    Good question. Beyond my knowledge. Anyone know better on this?

  15. #15
    Master OptiBoarder DanLiv's Avatar
    Join Date
    Sep 2009
    Location
    Denver, CO
    Occupation
    Dispensing Optician
    Posts
    537
    Not that this is a great solution, others suggested already are more ideal, but did you do a single slab-off? There's too much imbalance for that, you'd need to do slab-off one eye and reverse slab-off the other to overcome that prism.

  16. #16
    One eye sees, the other feels. OptiBoard Gold Supporter
    Join Date
    Jul 2002
    Location
    Wauwatosa Wi
    Occupation
    Dispensing Optician
    Posts
    5,124
    Quote Originally Posted by drk View Post
    There may be some weird extenuating circumstance since the patient has terrible myopia...maybe the retina will detach or something?
    Right. We don't have the history, but if the fellow eye was inoperable, then leave the right eye at -10 D and call it a day.

    Off the record, it sure smells bad though- why write an Rx for contraindicated spectacle lenses?

    Best regards,

    Robert Martellaro
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    Science is a way of trying not to fool yourself. - Richard P. Feynman

    It is easier to fool a man, than to convince a man he has been fooled. -Mark Twain

  17. #17
    OptiBoard Apprentice
    Join Date
    Mar 2018
    Location
    AZ
    Occupation
    Dispensing Optician
    Posts
    13
    Thank you all for your responses! She has no extending circumstances. I was just told her BCBS wont pay for the surgery yet by the patient. She had her OD done about 6 months ago. She does currently wear contact lenses with no issues. She is just needing something for when she is not wearing them. She is very understanding and patient and knows there may not be anything we can do until that left eye gets fixed. Just wanted to reach out to all the experts on here for your knowledge. :) Do you think if I reach out to the Ophthalmologist and explain the circumstances they may be able to get that covered?

  18. #18
    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
    Join Date
    Dec 2004
    Location
    At a position without dimension...
    Occupation
    Dispensing Optician
    Posts
    4,710
    Quote Originally Posted by btoe32 View Post
    Thank you all for your responses! She has no extending circumstances. I was just told her BCBS wont pay for the surgery yet by the patient. She had her OD done about 6 months ago. She does currently wear contact lenses with no issues. She is just needing something for when she is not wearing them. She is very understanding and patient and knows there may not be anything we can do until that left eye gets fixed. Just wanted to reach out to all the experts on here for your knowledge. :) Do you think if I reach out to the Ophthalmologist and explain the circumstances they may be able to get that covered?
    The MD I'm sure is well aware of the issue. I'd stick to occluding an eye and on second thought maybe ask the MD if that's acceptable and see how the conversation proceeds from there.

  19. #19
    Master OptiBoarder
    Join Date
    Jun 2012
    Location
    Mitten State
    Occupation
    Ophthalmic Technician
    Posts
    687
    Quote Originally Posted by Uncle Fester View Post
    The MD I'm sure is well aware of the issue. I'd stick to occluding an eye and on second thought maybe ask the MD if that's acceptable and see how the conversation proceeds from there.
    I would say there is really no better answer here.

  20. #20
    One eye sees, the other feels. OptiBoard Gold Supporter
    Join Date
    Jul 2002
    Location
    Wauwatosa Wi
    Occupation
    Dispensing Optician
    Posts
    5,124
    I wish you had included existing CL wear in your first post. I was ready to tell your client to call a malpractice lawyer.

    There's no binocular solution with spectacle lenses for the above, but one workaround is to correct the right eye and leave the left plano.

    Trial frame before proceeding to gauge the client's visual comfort with monocular SV or multifocal. Do they have diplopia when the CL is removed? That would be one clue if you don't have a trial frame. Or send them back to the refractionist and have them Rx it if appropriate.

    Hope this helps,

    Robert Martellaro
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    Science is a way of trying not to fool yourself. - Richard P. Feynman

    It is easier to fool a man, than to convince a man he has been fooled. -Mark Twain

  21. #21
    What's up? drk's Avatar
    Join Date
    Mar 2004
    Location
    Ohio
    Occupation
    Optometrist
    Posts
    8,182
    Maybe trial frame -2.00 OD, and -4.00 OS.

    If this is temporary, I'd go cheap-o SV lenses. Forget the rest.

  22. #22
    OptiWizard
    Join Date
    Sep 2012
    Location
    West Scranton, Pa
    Occupation
    Dispensing Optician
    Posts
    322
    Separate pairs for distance and near (and any other focal lengths). Mabye isekonic?

  23. #23
    One eye sees, the other feels. OptiBoard Gold Supporter
    Join Date
    Jul 2002
    Location
    Wauwatosa Wi
    Occupation
    Dispensing Optician
    Posts
    5,124
    Quote Originally Posted by Jason H View Post
    Separate pairs for distance and near (and any other focal lengths). Maybe isekonic?
    Hi Jason,

    There's too much image size disparity for spectacle lens wear, about 9%, using the clinical rule of 1% per diopter.

    Iseikonic lenses can help, maybe enough to reduce the image size difference to less than 5% (usually the minimum required for some degree of fusion) but the right lens would have to be a steep biconcave with a 10mm+ center thickness.

    However, I wouldn't try it due the expense and very low chances of wearability, instead trying suppression, occluding, or when appropriate, cat sx & IOL in the OS eye to balance the refractive error.

    Best regards,

    Robert Martellaro
    Roberts Optical Ltd.
    Wauwatosa Wi.
    www.roberts-optical.com
    ~~~~~~~~~~~~~~~~~~
    Science is a way of trying not to fool yourself. - Richard P. Feynman

    It is easier to fool a man, than to convince a man he has been fooled. -Mark Twain

  24. #24
    OptiBoard Apprentice
    Join Date
    Mar 2018
    Location
    AZ
    Occupation
    Dispensing Optician
    Posts
    13
    Update! I contacted the Ophthalmologist and my patient is scheduled for surgery! Thank you all so much for all the input.

Thread Information

Users Browsing this Thread

There are currently 1 users browsing this thread. (0 members and 1 guests)

Similar Threads

  1. double vision
    By lisareneecarll in forum General Optics and Eyecare Discussion Forum
    Replies: 15
    Last Post: 07-02-2015, 04:12 PM
  2. double vision
    By terrance in forum General Optics and Eyecare Discussion Forum
    Replies: 15
    Last Post: 04-16-2012, 10:58 AM
  3. double vision
    By call me al in forum General Optics and Eyecare Discussion Forum
    Replies: 5
    Last Post: 04-06-2006, 12:45 AM
  4. Double Vision
    By sailor4life61 in forum General Optics and Eyecare Discussion Forum
    Replies: 1
    Last Post: 03-08-2006, 02:09 PM
  5. I have double vision - can you help?
    By Silly Billy in forum General Optics and Eyecare Discussion Forum
    Replies: 9
    Last Post: 02-06-2004, 02:28 AM

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
OptiBoard is proudly sponsored by:
Younger Optics and Vision Equipment