Strange worsening and return of vision

Discussion in 'Eye-Care' started by norman_conway, May 2, 2006.

  1. I had something happen to me a few months ago that I am completely
    unable to understand. I'm mildly farsighted (about +1 in both eyes,
    with an add of 2 and some cyl for astigmatism), and wear a combination
    of glasses. I have notice from time to time that wearing contacts for a
    long period of time makes me a bit more farsighted, but usually not
    much.

    One night a few months ago I took out my contacts and felt *very*
    farsighted--like my glasses did little to help it, except when looking
    through the reading part and even then it was not enough power. Next
    morning, the same thing. I wore my glasses throughout the day,
    struggling to see, and made a last-minute appointment with the doc to
    get it checked. My Rx had jumped to +3.75 in both eyes, with about the
    same amout of cyl. I told her the story, and she told me to come back
    tomorrow, which I did, and got the same Rx again.

    I had the glasses made, and at first they worked fine, but after a
    period of several weeks my eyes returned to the previous Rx of +1 or
    so. I checked my blood sugar, which was fine; otherwise my health is
    great for a 45 year old. Can anyone explain this? Could I have gotten
    the wrong base curve on my contacts and remolded my cornea? Maybe a lot
    of latent hyperopia which appeared for no reason? I have no clue
     
    norman_conway, May 2, 2006
    #1
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  2. norman_conway

    Neil Brooks Guest

    I don't know my rear end from second base, but ... I feel a presbyope
    coming on.

    Like ... maybe you were always a +3.75, but -- as a younger man -- your
    accommodative mechanism happily bridged the gap for you.

    But now -- now that you are an OLDER man (I turned 42 today, so I can
    tease) -- it's not quite so easy, so your accommodation is sort of
    going out the window, leaving you with a clear look at your "full
    refractive error."

    Should that sort of thing happen *suddenly?* No. Not to MY limited
    knowledge, but ... that doesn't mean that presbyopia isn't what you're
    experiencing. It may be that it hasn't really been sudden, but that
    you sort of just got to your limit. Were you experiencing any problems
    going from far to near vision recently? Any other visual symptoms??

    Doc's?
     
    Neil Brooks, May 2, 2006
    #2
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  3. I've been a presbyope since my mid thirties, and have stabilized with
    an add of +2 for the past several years. In any case, this does not
    explain why it happened suddenly, then slowly returned to my usual
    prescription. I have no other vision symptoms, and my health is
    otherwise fine.
     
    norman_conway, May 2, 2006
    #3
  4. norman_conway

    Dr. Leukoma Guest

    There are no presbyopes in their mid-thirties. You appear to be a
    hyperope with accommodative spasm. One way to tell would be to have a
    cycloplegic refraction. If that is close to +3.50, then there you have
    it.

    DrG
     
    Dr. Leukoma, May 2, 2006
    #4
  5. I've had multiple cycloplegic refractions, and aside from this one I've
    never had a script anywhere near +3.50. I may gain 0.50D or so when
    cyclopleged, but not 2-3D.
     
    norman_conway, May 2, 2006
    #5
  6. norman_conway

    CatmanX Guest

    I concur with Greg, I would be leaning towards a temporary loss of
    ciliary tone as the cause of increased plus. An OK shift of 2.75D is
    highly unlikely (although I won't say impossible).

    dr grant
     
    CatmanX, May 2, 2006
    #6
  7. norman_conway

    Neil Brooks Guest

    Maybe I *am* back in the game here....

    If you have an accommodative spasm, then it is quite possible (was all
    too true for me) that your 'garden variety' cycloplegic -- say
    Tropicamide -- will NOT elicit ALL of your hyperopia.

    In my (extreme) case, it took six months of nightly use of cycloplegia
    and then ... bam ... one morning, I awoke with about 2.50 diopters of
    additional farsightedness.

    [again: Docs??] Might be worth hitting you with Cyclogyl??
     
    Neil Brooks, May 3, 2006
    #7
  8. norman_conway

    Dr. Leukoma Guest

    I repeat: a 35 year/old who needs a bifocal is not a presbyope, but a
    latent hyperope. I'm not ruling out the influence of a contact lens.
    Even a soft lens can change the shape of the cornea. However, this
    would happen each and every time you wore the contact lens.

    I am still of the opinion that you have more latent hyperopia. As
    someone suggested, you may need a stronger cycloplegic. I am willing
    to take bets that over the next 10 years, your manifest prescription
    will shift increasingly towards more plus.

    DrG
     
    Dr. Leukoma, May 3, 2006
    #8
  9. norman_conway

    LarryDoc Guest

    FYI, tropicamide is considered to be a mydriatic (causes pupilary
    dilation), not a true cycloplegic. It's cyclo effect is secondary,
    highly variable and generally of little consequence.

    LB, O.D.
     
    LarryDoc, May 3, 2006
    #9
  10. norman_conway

    Dom Guest

    Were the contacts Focus Night&Day or Purevision? If so, you may have
    been wearing them inside-out without realising, and given yourself
    unintentional ortho-K. It happened to a patient of mine, who recovered
    fully a few weeks after discontinuing lens wear. There are other case
    reports out there - it's a known phenomenon.

    Just one idea.

    Dom
     
    Dom, May 3, 2006
    #10
  11. norman_conway

    Dr. Leukoma Guest

    IMHO, I don't understand how a person could wear a Purevison inside out
    and not know it, and in both eyes at the same time, but I guess it
    could happen.

    In "what will they think of next" department, would you believe that a
    group of OD's has already "patented" the use of soft lenses for
    orthokeratology?

    DrG
     
    Dr. Leukoma, May 3, 2006
    #11
  12. It is very easy to tell when my CLs are inside out, and I am sure this
    was not the case.

    I have thought a bit more about this being latent hyperopia, and it
    might be. I have had problems w/ eyestrain since I was a kid, and
    reading has never been easy. Also, I have noticed for many years now
    that my vision has a myopic shift during the day--perhaps up to 1D at
    times, though I can't be sure--which makes getting a refraction
    difficult. If I am refracted in the morning, my glasses seem
    over-plussed by the evening, and vice versa.

    I guess the one thing that puzzles me, though, is that I never get used
    to wearing higher plus glasses. My understanding is that, over time,
    accomdative spasm should be relieved with higher plus glasses. And
    since my glasses range from +.075 to +3.75, I am wondering why the
    higher Rx does not eventually become acceptable.

    So what type of cycloplegic might work if this is a case of latent
    hyperopia? Is this something I can use that, over time, might stabilize
    my Rx (albeit at a higher level than I would like) and potentially
    relieve eyestrain? I'm an MD so I could get hold of it and give it a
    trial and see what happens.

    Thnaks for all the thought and suggestions on this!!
     
    norman_conway, May 3, 2006
    #12
  13. norman_conway

    Neil Brooks Guest

    Thanks, Dr. B, for the additional info.
     
    Neil Brooks, May 3, 2006
    #13
  14. norman_conway

    Neil Brooks Guest

    Hi. Ol' Johnny One-Note here again:

    I think you could get pretty thorough cycloplegia with either a couple
    of drops of Cyclogyl -- maybe 15 minutes apart, or with Homatropine
    (maybe a touch less effective), or -- if you want to remove all doubt,
    and can live with 10d - 2wks of symptoms -- four days of Atropine.

    The last is the gold standard of "total cycloplegia."

    If what you have is accommodative spasm, or accommodative infacility,
    or ciliary spasm, or--more generally--accommodative dysfunction, then
    you will likely want to have the doctor push the most plus power on
    you that you can accept, both in a distance Rx and in a near Rx
    (whether using bifocals or separate reading glasses), watching your
    eye alignment carefully to check for any esodeviation that might need
    to be managed through adjustments to the powers or through addition of
    prism.

    In some cases, you've developed enough "hypertonicity" in your ciliary
    muscles that it's difficult for you to accept much additional plus. In
    MY experience, I used cycloplegic drops every night (lower-strength;
    effects gone by morning) for months, eventually "breaking the cycle."

    But ... NOTE WELL: virtually all cycloplegic drops use a preservative
    called Benzalkonium Chloride that has known cytotoxic effects to
    corneas. They should not be used long-term, *especially* if you have
    any pre-existing ocular surface issues OR dry eyes.

    It *IS* possible to get your "cramped," or "spasmed" eyes to learn to
    "relax," with time.

    Another thing that I do is what's called "periocular warming" to help
    relieve small amounts of accommodative spasm.

    Make/buy yourself a corn/rice bag ... like so:

    http://www.quilt.com/MiscQuilting/RiceBags.html

    Warm it in the microwave (I use about 2min on high) until it's warm
    (NOT hot). Place it over your closed eyes for about 10 minutes a
    couple times a day.

    It works. No voodoo. Actual science. Here:

    http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=15885788&dopt=Abstract

    OR http://tinyurl.com/obpyd

    Best of luck!

    Neil
     
    Neil Brooks, May 3, 2006
    #14
  15. norman_conway

    acemanvx Guest

    Very interesting story. If he in fact has pseudomyopia or latent
    hyperopia and relieves it, wont he see worse with latent hyperopia? He
    will need a higher plus glasses and see worse without glasses. I have
    pseudomyopia, probably about 1.5 diopters left of it. Natural vision
    improvement helped relax some of my pseudomyopia.
     
    acemanvx, May 4, 2006
    #15
  16. Well, given that it has always been hard for me to do close work for
    any length of time, I would be happy w/ stronger glasses if I could see
    comfortably.
     
    norman_conway, May 4, 2006
    #16
  17. norman_conway

    acemanvx Guest

    bifocals may be your answer
     
    acemanvx, May 7, 2006
    #17
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