Double Vision: Causes and Solutions for Eyeglass Users

Q: Double Vision: Causes and Solutions for Eyeglass Users

Hello Merlinkuo： Based on your description, removing the astigmatism in your right eye should resolve the issue, which suggests that it may be caused by the astigmatic lens. <br>The causes of astigmatism are complex, and sometimes the prescription obtained during an eye exam cann

Glasses and diplopia?

At least five years ago, I got a pair of glasses from K Optical in Taichung: R_2.00_0.50x105 L_1.75_0.25x135.
(I usually wear my original myopia glasses R_1.50 L_1.25 when not driving.) One day, while driving on the highway with these new glasses, I suddenly noticed that a car in the same lane appeared as two separate images stacked vertically, especially on curved roads.
Consequently, I took the new glasses to an ophthalmologist in Tainan.
During the refraction process (while wearing R_2.00_0.50x105 L_1.75_0.25x135), I repeatedly informed the doctor that I saw two independent images stacked vertically.
The doctor responded that it was a phenomenon of visual persistence, but I was not convinced and felt helpless, as the doctor seemed uninterested in my issue and just wanted to move on to the next patient.
This was the case with doctors at Veterans General Hospital, National Cheng Kung University Hospital, and various eye clinics.
I returned to the optical shop to report this phenomenon, and the optometrist rechecked my prescription, stating that I needed prisms for correction.
Thus, the matter was left unresolved.
Last month, on September 13, I went back to the same optical shop for a new refraction and received R_2.75_1.25x110 L_1.75_0.50x120.
During the process, I still saw two independent images stacked vertically.
After the optometrist added prism testing, he mentioned that my eyes were alternating and using both simultaneously, making prism correction impossible.
During the trial fitting, I kept telling him that I easily saw two independent ghost images when looking at a single target.
Nevertheless, he proceeded to make the glasses based on this data.
Once home, I noticed that watching TV resulted in even more pronounced vertical double vision, so I was hesitant to wear the new glasses.
On September 18, I accidentally wore a pair of non-toric prescription sunglasses (R2.25 L1.75) and discovered that I no longer saw the vertical double images.
On September 19, I returned to the optical shop to report this phenomenon, and they suggested that I would adapt to the new glasses over time.
That evening, I went to Taichung Century Eye Clinic, where Dr.
Tsai stated that my astigmatism was very low, almost nonexistent.
To be thorough, on September 20, I visited two other optical shops, Baodao and Ren'ai, for a complete refraction.
On September 26, I went to Chung Shan Medical University Hospital for a full eye exam and found that the refraction data from both eye clinics and the two optical shops (Baodao and Ren'ai) were nearly identical: left eye: myopia 1.75, astigmatism 0.5; right eye: myopia 2.75, astigmatism 0 to 0.25.
After multiple trials at Ren'ai Optical, I chose a suitable prescription for night driving: right eye myopia 2.75, left eye myopia 1.75, astigmatism 0.25, and I no longer experienced vertical double vision when looking at a single target.
I have slight wrinkling in the macula of my left eye, which I check with OCT every six months, showing little change.
I also have mild cataracts and slightly elevated blood pressure and cholesterol (currently on medication).

Could you please explain, Doctor, why I no longer see vertical double images after removing the astigmatism data from my right eye prescription? What is the underlying issue?

merlinkuo, 60~69 year old female. Ask Date: 2016/10/13

Dr. Gao Pilin reply Ophthalmology

Hello Merlinkuo: Based on your description, removing the astigmatism in your right eye should resolve the issue, which suggests that it may be caused by the astigmatic lens.
The causes of astigmatism are complex, and sometimes the prescription obtained during an eye exam cannot be directly used for fitting glasses.
If double vision occurs with one eye, it indicates a refractive issue; if double vision occurs with both eyes, it is likely due to strabismus.
The ophthalmology department at E-Hospital in Puzi, Taiwan, is open Monday to Friday from 8:00 AM to 12:00 PM and Wednesday afternoons from 1:00 PM to 4:30 PM.
Online responses should only be used as a reference; it is essential to seek medical attention at a healthcare facility if necessary.
I hope to have the opportunity to assist you.
Gao Pilin

Reply Date: 2016/10/13

More Info

Double vision, or diplopia, can be a perplexing and frustrating condition, particularly for those who wear glasses. Your experience of seeing two separate images, especially while driving or focusing on distant objects, is indicative of a potential misalignment or focusing issue between your eyes. Understanding the underlying causes and potential solutions can help alleviate your concerns and improve your visual experience.

Causes of Double Vision
1. Refractive Errors: The most common cause of double vision in individuals who wear glasses is related to refractive errors, such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. If the prescription of your glasses does not accurately correct these errors, it can lead to visual disturbances, including diplopia.

2. Eye Alignment Issues: Conditions such as strabismus (misalignment of the eyes) can cause double vision. When the eyes do not work together properly, the brain receives two different images, leading to confusion and the perception of double vision.

3. Visual Processing: Sometimes, the brain struggles to merge the images from both eyes, particularly if there is a significant difference in the visual acuity between the two eyes. This can happen if one eye has a higher prescription or if there are other underlying conditions affecting vision.

4. Changes in Prescription: As you mentioned, your recent experiences with different prescriptions indicate that your eyes may have changed over time. A new prescription that does not account for these changes can exacerbate issues like double vision.

5. Eye Health Conditions: Conditions such as cataracts, macular degeneration, or other retinal issues can also contribute to visual disturbances. You noted having some concerns about your macula and cataracts, which could play a role in your visual symptoms.

Solutions and Recommendations
1. Accurate Prescription: It is crucial to have an accurate and up-to-date prescription. If you are experiencing double vision with your new glasses, it may be beneficial to revisit your optometrist or ophthalmologist for a thorough examination. They can assess your visual acuity and eye alignment to ensure that your prescription is appropriate.

2. Prism Correction: In some cases, adding a prism to your glasses can help align the images seen by each eye, reducing or eliminating double vision. However, as you experienced, if your eyes are not working together properly, prism correction may not be effective.

3. Regular Eye Exams: Given your history of eye conditions, regular check-ups with an eye care professional are essential. This will help monitor any changes in your vision and eye health, allowing for timely interventions if necessary.

4. Vision Therapy: If eye alignment issues are contributing to your double vision, vision therapy may be recommended. This involves exercises designed to improve coordination and focusing abilities between the eyes.

5. Considerations for Eye Health: Since you have noted some concerns about cataracts and macular changes, discussing these with your eye care provider is essential. They can provide guidance on managing these conditions and their potential impact on your vision.

6. Lifestyle Adjustments: If you find that certain activities exacerbate your symptoms, such as prolonged screen time or specific lighting conditions, consider making adjustments. Taking regular breaks, using proper lighting, and ensuring your workspace is ergonomically set up can help reduce eye strain.

Conclusion
Your experience with double vision is not uncommon among eyeglass users, particularly when there are underlying refractive errors or alignment issues. The fact that you found relief with a different pair of glasses suggests that your previous prescription may not have been suitable for your current visual needs. It is essential to work closely with your eye care provider to ensure that your vision is accurately assessed and that any necessary corrections are made. Regular monitoring of your eye health, especially given your history of macular changes and cataracts, will also be crucial in maintaining optimal vision.

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