Question
Hello Dr. Johnston,
My husband has been experiencing gradual vision loss, best described as dimness of vision or lowering of contrast. He doesn't have MS, macular degeneration, or any problem with transmission via the optic nerve. He doesn't have a brain tumor. He doesn't recall any associated eye pain, and the loss has been quite gradual. My husband's vision problems haven't resulted in a loss of acuity; he describes it as "like looking through a screen." He does need to have brighter light on his work. It's been 5 years since he started noticing problems in dim light, and in the last two years has also been experiencing problems in normal light. He is still fine to drive, but feels that if his vision worsens much more this will change. He does experience headaches when doing reading-intensive work (he's a computer programmer). He's 48. He has had several complete ophthalmic exams, and does not have cataracts or glaucoma. He hasn't ever had any head trauma. All his blood work appears normal -- no thyroid problems, no signs of systemic infection.
The doctors don't have any new avenues to suggest, and his vision continues to worsen. Any suggestions would be appreciated.
Answer
Ok, the information you added this time helps me understand. There are two things I can suggest but they kind of depend how close you live to a major metropolitan area.
1) If you can find a neuro-ophthalmologist (there are not very many of them, and most likely are only available in metropolitan areas) I would go there for an evaluation. They may be able to test for conditions your general eye doctors might not have.
2) On a related note, there are some types of electro-physiological tests done at some research institutions that might shed light on his problem. Something called Visual Evoked Potentials and a few other electro-physiological tests are available in some places. A quick search online brought up this information: http://webeye.ophth.uiowa.edu/dept/service/elecphys/elecphys.htm. If you have an optometry school in your area, you could start by calling them. Or you could search further online for a center you can reach that has these facilities available. This type of equipment is not at all likely to be available in a regular ophthalmic office.
I wish you luck finding a solution to this issue. The reason I needed to know your husband's age is that in old age, vision just does tend to decline gradually. What you describe might be normal for an 85 year old, but is not acceptable for a 48 year old. One more thing - the headaches doing reading-intensive work may be a separate issue. I know you say he has had several ophthalmic exams. But - sometimes when the exam is focused on the medical aspects, regular vision problems may get less attention than they should have. Considering the computer and reading-intensive nature of your husband's work, may I suggest a computer workstation analysis by an eye doctor who specializes in this? This type of eye doctor can be found at www.Prio.com or possibly by looking under "developmental" or "occupational" vision evaluations.
