Diplopia: Is Astigmatism the Cause of Your Visual Disturbances?

Q: Diplopia: Is Astigmatism the Cause of Your Visual Disturbances?

Hello： Astigmatism is a common refractive error that occurs when the curvature of the cornea or lens is uneven, causing light to focus improperly on the retina. <br>It typically affects vision, making objects appear blurry or distorted. <br>This phenomenon is particularly noticea

Diplopia issue (Sequence 208956)

I apologize for the inconvenience, but I would like to ask Dr.
Gao if astigmatism issues might only arise when looking at specific objects.
I have observed that I can only see a faint line next to a very dark straight line; could this be related to brain nerve activity? I had an OCT scan of the macula and retina a week or two ago, and everything appeared normal.

Additionally, I would like to inquire about eye relaxation and whether latent strabismus can occur in both eyes simultaneously.
I noticed while reviewing a video that when I initially focused on the camera lens while recording with my phone, it lost focus for a moment and appeared as two images (it seemed to focus better on objects in the background or to the side).
Once I refocused, it became a single image, but during playback, it seemed to slightly drift outward.
When I held the phone further away and recorded while relaxed and out of focus, the side objects appeared clearer, and the sensation of eye movement was less noticeable.
Is this normal? Thank you, Dr.
Gao.
🙏🙏🙏

Hua Hua, 30~39 year old female. Ask Date: 2024/06/04

Dr. Gao Pilin reply Ophthalmology

Hello: Astigmatism is a common refractive error that occurs when the curvature of the cornea or lens is uneven, causing light to focus improperly on the retina.
It typically affects vision, making objects appear blurry or distorted.
This phenomenon is particularly noticeable when viewing specific objects, such as the faint shadow next to the black line you described, which is a typical manifestation of astigmatism.
Based on your description, the recent optical coherence tomography and examinations of the macula and retina showed normal results, which usually rule out most pathologies related to the retina or macula.
If structural eye problems are excluded, the cause of this phenomenon is more likely to be a refractive error, such as astigmatism, rather than a neurological issue in the brain.
As for latent strabismus, this is a type of ocular misalignment that typically occurs when the eyes are relaxed.
Normal vision involves both eyes working together to see a single image; in the case of strabismus, one eye may fixate while the other deviates.
It is not always the same eye; for example, the left eye may be aligned while the right eye deviates, and vice versa.
This can lead to the phenomenon of double vision.
If you are recording a video with your phone from a distance and the focus is lost, nearby objects may appear clearer, while the movement of both eyes feels less pronounced, which is also normal.
As the focal distance changes, the coordination of the eyes adjusts accordingly, and this change may not be as noticeable at longer distances.

Reply Date: 2024/06/04

More Info

Understanding diplopia, or double vision, can be complex, especially when considering various underlying causes such as astigmatism. Astigmatism is a common refractive error caused by an irregular shape of the cornea or lens, leading to blurred or distorted vision. It can indeed contribute to visual disturbances, but it is essential to understand how it relates to your specific symptoms.

In your case, you mentioned that you only notice the visual disturbances when observing specific conditions, such as dark lines against a black background. This phenomenon could be attributed to the way astigmatism affects light entering your eyes. When light rays are not focused evenly on the retina due to the irregular curvature of the cornea, it can lead to visual distortions, particularly in low-contrast situations. This might explain why you see faint lines or double images under certain lighting conditions.

However, it is also crucial to consider other potential causes of your symptoms. The presence of visual disturbances, especially if they are transient or occur under specific conditions, could indicate issues related to the brain or the visual processing system. For instance, if you are experiencing diplopia only when focusing on certain objects, it might suggest a problem with how your brain is interpreting the signals from your eyes. This could be related to a condition known as convergence insufficiency, where the eyes do not work together effectively when focusing on near objects.

Regarding your question about latent strabismus (hidden squint), it is indeed possible for both eyes to be affected simultaneously. In some cases, individuals may not notice any misalignment until they are fatigued or focusing on a challenging task. When you observed the video recording and noticed the focus shifting, it could indicate that your eyes were struggling to maintain alignment, especially if you were switching focus between different distances. This is a common occurrence in individuals with latent strabismus, where the eyes may appear to work together under normal circumstances but diverge when under strain.

To address your concerns about eye relaxation and the potential for hidden strabismus, it is essential to practice good eye care habits. Regular breaks during activities that require intense focus, such as using a smartphone or computer, can help reduce eye strain. The 20-20-20 rule is a helpful guideline: every 20 minutes, look at something 20 feet away for at least 20 seconds. This practice allows your eye muscles to relax and can help alleviate some of the symptoms you are experiencing.

If your symptoms persist or worsen, it would be prudent to consult with an eye care professional who can conduct a comprehensive examination. They may recommend additional tests, such as a visual field test or a comprehensive eye alignment assessment, to determine if there are any underlying issues that need to be addressed.

In summary, while astigmatism can contribute to visual disturbances, it is essential to consider other factors, including potential neurological influences and eye alignment issues. Regular eye examinations and good eye care practices can help manage your symptoms and ensure your visual health remains optimal. If you have further concerns, do not hesitate to reach out to your eye care provider for personalized advice and treatment options.

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