Light Sensitivity and Night Vision Issues in Myopia

Photophobia and nocturnal diplopia?

Hello, Doctor.
I have high myopia (L: -9.25, R: -9.0, latest refraction) but I usually wear glasses with a prescription of L: -7.5, R: -7.25 (from four years ago when I was 22).
My left eye has 25 degrees of astigmatism and I experience floaters.
I am concerned about macular degeneration, so I take 10 mg of a compound lutein supplement daily.
I noticed earlier this year that I have developed photophobia; while I can see normally, I feel uncomfortable when exposed to light sources or luminous objects (like the display lights of electronic devices).
It’s not painful, but it is uncomfortable, especially with blue light.
Even when the LED blue display light source is very small, I end up covering it with black tape because it is really uncomfortable.
I even feel discomfort from the reflection of sunlight on a black marble floor.
Worried that there might be an issue with my eyes (such as glaucoma or retinal disease), I went to a university hospital last month for a comprehensive eye examination, which included a refraction test, intraocular pressure measurement, and fundus examination of the retina and macula.
The doctor said my eyes were fine, with normal intraocular pressure and visual fields, and no signs of glaucoma.
The retina and macula appeared healthy, but I was diagnosed with pseudomyopia, and the doctor only prescribed a cycloplegic agent.
However, the reason for my photophobia remains unclear.
When I look at light sources, there is a large halo around them, but it doesn’t appear foggy like in glaucoma-related halos, so I am hesitant to look directly at lights.
My glasses have an adequate astigmatism correction.
What other possible causes could there be for this photophobia? Should I see a neurologist or have my optic nerve examined? I am really worried...
Thank you!

A Xuan, 20~29 year old female. Ask Date: 2014/03/12

Dr. He Jianxian reply Ophthalmology

It is recommended that you visit an ophthalmology specialist for an examination and consultation, as this may help identify the underlying cause more easily.

Reply Date: 2014/03/12

More Info

Your concerns about light sensitivity and night vision issues, particularly in the context of high myopia, are quite valid and deserve careful consideration. Given your history of high myopia (-9.25 in the left eye and -9.0 in the right eye), along with astigmatism and the presence of floaters, it is understandable that you are worried about potential complications such as retinal degeneration or macular diseases.

Firstly, it is important to clarify that light sensitivity, or photophobia, can arise from various factors, especially in individuals with high myopia. In your case, the discomfort you experience when exposed to bright lights, particularly blue light from electronic devices, could be attributed to several reasons:
1. Retinal Sensitivity: High myopia can lead to structural changes in the eye, including thinning of the retina and changes in the vitreous body. These changes can make the retina more sensitive to light, resulting in discomfort when exposed to bright sources.

2. Corneal Sensitivity: Individuals with high myopia may also experience changes in corneal sensitivity. This can lead to increased discomfort in bright light conditions, as the cornea plays a crucial role in focusing light onto the retina.

3. Visual Fatigue: The presence of astigmatism and high myopia can contribute to visual fatigue, especially when engaging with screens or bright lights. This fatigue can exacerbate your sensitivity to light and lead to discomfort.

4. Psychological Factors: Anxiety and stress about your vision can also heighten your perception of discomfort in bright light. This is particularly relevant if you have been preoccupied with potential eye diseases.

5. Possible Underlying Conditions: While your recent comprehensive eye examination showed no signs of glaucoma or retinal issues, it is still possible that other conditions could contribute to your symptoms. For example, conditions like uveitis or even migraines can cause light sensitivity.

Regarding your question about whether you should see a neurologist or have your optic nerve checked, it may be worthwhile to consult with an ophthalmologist who specializes in retinal diseases or a neuro-ophthalmologist. They can perform more specialized tests to evaluate the health of your optic nerve and assess any neurological factors that might be contributing to your symptoms.

In terms of managing your light sensitivity, here are some strategies you might consider:
- Use of Tinted Lenses: Consider using glasses with anti-reflective coatings or tinted lenses that can help reduce glare from bright lights and screens.

- Screen Filters: Applying filters to your screens can help reduce blue light exposure, which you find particularly uncomfortable.

- Regular Breaks: When using screens, practice the 20-20-20 rule: every 20 minutes, look at something 20 feet away for at least 20 seconds to reduce eye strain.

- Consultation for Dry Eye: Sometimes, light sensitivity can be exacerbated by dry eye syndrome. If you experience dryness or irritation, discussing artificial tears or other treatments with your eye care provider may be beneficial.

In conclusion, while your recent eye exams have shown no significant issues, your symptoms warrant further exploration. Consulting with a specialist can provide you with peace of mind and help identify any underlying causes of your light sensitivity. Remember, maintaining regular check-ups is crucial, especially with your history of high myopia.

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