Question
My daughter's vision therapist comments that there is a lot of "instability" in her eyes. She says she tries one lens in her eye and the eyes focus one way, and then tries another lens and the eyes focus differently. Also she just had an expander placed in her mouth by the orthodontist. Can this potentially affect her vision (ie by moving around the bony structures of her face)?
Answer
I honestly do not think the expander is likely to be contributing to the eyes being unstable. But the very fact that your daughter is in vision therapy is a more likely explanation. People needing vision therapy are more likely to have problems like what your therapist calls "instability." Stick with the therapy and the problem will most likely improve.
Tuesday, March 16, 2010
Chronic left eye irritation
Question
29 y/o Male with chronic left eye irritation. Perfect vision. No Problems with right eye.
I did have an eye injury in Marine Corps from a small sliver of metal about 6 years ago. The Metal was removed, but evidently left a small scar on the lens of my eye. I got out of the military and went to college, but was irritated with my left eye the whole 4 years. I don't know if the scar is part of my problem or not, but here are the rest of my symptoms:
-Eye is fine in the mornings for the most part.
-As the day goes on it feels dry and stings.
-There are stringy strands that appear in the eye and eventually end up in the corner of my eye if I don't pick them out first.
-The left eye does not drop tears onto my face like the right eye does when crying.
Eye Doctor said blepharitis a couple of years ago, but treating it as such does not help.
Would you please give your opinion on what is wrong with my left eye.
Ron
Answer
Without seeing you this will be difficult, but let me throw out some ideas:
- the stringy strands are a hallmark of ocular allergy. Now by the other symptoms I am sure allergy is not the only problem, but may be part of it. Try cold compresses and an over the counter anti-histamine drop (ask the pharmacist.)
-the injury from 6 years ago makes me think you may have recurrent corneal erosion - the top layer of the cornea did not heal properly and sometimes the epithelium wears off and exposes the very sensitive nerves beneath it. (however, recurrent erosions are usually worse in the morning) This would need to be treated, preferably by a corneal specialist.
-just plain dry eye. (the stinging and burning) for this I would first try putting in artificial tears every hour or so for a few weeks. If it helps, back down the frequency to see how far you can go between drops to stay comfortable.
-the left eye not tearing makes me wonder if there was more damage from that injury that somehow affected the tear glands. But that sounds far-fetched.
-the fact that you had blepharitis makes me wonder if you might also have meibomian gland dysfunction (also called posterior blepharitis) It is very common and often gets missed by an eye doctor not specifically looking for it. This would have to be diagnosed and treated by an eye doctor.
I would try the anti-histamine drops and artificial tears. If that does not help, try to see a corneal specialist - or someone who specializes in dry eye conditions. They could prescribe better allergy drops than you could get over the counter, check for recurrent erosion and the meibomian gland dysfunction and treat accordingly. There is even a prescription drop for dry eye now called Restasis that might be of some help, depending how the exam goes.
Good luck with solving this problem.
29 y/o Male with chronic left eye irritation. Perfect vision. No Problems with right eye.
I did have an eye injury in Marine Corps from a small sliver of metal about 6 years ago. The Metal was removed, but evidently left a small scar on the lens of my eye. I got out of the military and went to college, but was irritated with my left eye the whole 4 years. I don't know if the scar is part of my problem or not, but here are the rest of my symptoms:
-Eye is fine in the mornings for the most part.
-As the day goes on it feels dry and stings.
-There are stringy strands that appear in the eye and eventually end up in the corner of my eye if I don't pick them out first.
-The left eye does not drop tears onto my face like the right eye does when crying.
Eye Doctor said blepharitis a couple of years ago, but treating it as such does not help.
Would you please give your opinion on what is wrong with my left eye.
Ron
Answer
Without seeing you this will be difficult, but let me throw out some ideas:
- the stringy strands are a hallmark of ocular allergy. Now by the other symptoms I am sure allergy is not the only problem, but may be part of it. Try cold compresses and an over the counter anti-histamine drop (ask the pharmacist.)
-the injury from 6 years ago makes me think you may have recurrent corneal erosion - the top layer of the cornea did not heal properly and sometimes the epithelium wears off and exposes the very sensitive nerves beneath it. (however, recurrent erosions are usually worse in the morning) This would need to be treated, preferably by a corneal specialist.
-just plain dry eye. (the stinging and burning) for this I would first try putting in artificial tears every hour or so for a few weeks. If it helps, back down the frequency to see how far you can go between drops to stay comfortable.
-the left eye not tearing makes me wonder if there was more damage from that injury that somehow affected the tear glands. But that sounds far-fetched.
-the fact that you had blepharitis makes me wonder if you might also have meibomian gland dysfunction (also called posterior blepharitis) It is very common and often gets missed by an eye doctor not specifically looking for it. This would have to be diagnosed and treated by an eye doctor.
I would try the anti-histamine drops and artificial tears. If that does not help, try to see a corneal specialist - or someone who specializes in dry eye conditions. They could prescribe better allergy drops than you could get over the counter, check for recurrent erosion and the meibomian gland dysfunction and treat accordingly. There is even a prescription drop for dry eye now called Restasis that might be of some help, depending how the exam goes.
Good luck with solving this problem.
Posted by
Beacon Lee
question regarding visual acuity
Question
i have applied for a job where the required Vision standards are : 6/6 with out spectacles (or other forms of corrective lensess) and must not suffer from colour / night blindness.
But i put on spectacles with -1.75 D(sph)
so is it 6/6 or not??
Answer
Hi Mayank,
If they require 6/6 withOUT correction, they are being very selective indeed. Your unaided vision would be approximately 6/40 or possibly worse, buy any eye doctor or clinic would be able to measure it for you.
Regards,
Mitch Axelrod,OD
i have applied for a job where the required Vision standards are : 6/6 with out spectacles (or other forms of corrective lensess) and must not suffer from colour / night blindness.
But i put on spectacles with -1.75 D(sph)
so is it 6/6 or not??
Answer
Hi Mayank,
If they require 6/6 withOUT correction, they are being very selective indeed. Your unaided vision would be approximately 6/40 or possibly worse, buy any eye doctor or clinic would be able to measure it for you.
Regards,
Mitch Axelrod,OD
Posted by
Beacon Lee
(Updated) Question on Prescription Problem
Question
Hi, Dr. Placentra Johnston,
I just had my eyes examined by a new eye dr (my old one isn't in the network anymore) for both an eyeglass prescription and contacts. I went through a couple trial lenses before given the contact prescription (monovision lenses). I had the prescription filled by Costco (one year supply) to save money (I have gotten lenses from here before). However, when I put them in, I can't see close-up; I have to put on reading glasses. I asked the dr to double-check the prescription (his wife had written it) and he called me back and said the prescription matched the file, and he didn't know what to tell me. In the meantime I spoke with Costco who compared my old prescription (2 years ago) with this one and said they saw a significant change which they didn't understand, and that may be the problem. Could you take a look at the prescriptions (old contacts, new contacts, new eyeglasses) and tell me what you think the problem could be.
Thank you very much.
Mary
Old contact lens prescription:
Preference Toric; R 8.70, 14.40, -2.25, -.75, 110
L 8.70, 14.40, -.50, -1.25, 50
New contact lens prescription:
Air Optix Toric; R 8.70, 14.50, -3.25, -.75, 120
L 8.70, 14.50, -.50, -1.75, 40
New eyeglass prescription: R -3.75; -0.75, 123
L -2.50; -1.75; 42
Add R +2.25
L +2.25
Answer
It could be the axis shift in the reading eye. The left eye went from axis 50 to axis 40. But your distance eye, the right has gotten much more nearsighted, so that could also be it. Try closing the right eye and see if you can read with the left (with contact lenses on.) If so then the problem is in the right eye. If you can't read well with the left contact lens, the problem would be because your right eye changed so much.
But this should not be your job, or mine. If a patient has a problem with the prescription written, most reputable doctors, will invite the patient to come back in and be re-checked, and usually at no charge. Now, your chances of receiving that invitation decreases significantly when you buy your contact lenses at Costco. In most cases, the doctor is counting heavily on the profit from selling the contact lenses to offset the usually rather low cost (or verylow reimbursement rate from the insurance company) of the eye exam. Your coming back in for a problem visit without having purchased the lenses from him cuts into his profits significantly.
Moreover, if the doctor did not supply the lenses, you are unlikely to be able to trade them back in at Costco if there is a change. This is why it is always better to get your contact lenses from the office that wrote the prescription. You are not just buying materials. There is significant service element that goes along with contact lenses and respect for the need for that service is why the doctor's office may charge a little bit more.
You might ask the doctor to let you come back in for a check-up AND that in the future you will purchase the materials from him.
Hi, Dr. Placentra Johnston,
I just had my eyes examined by a new eye dr (my old one isn't in the network anymore) for both an eyeglass prescription and contacts. I went through a couple trial lenses before given the contact prescription (monovision lenses). I had the prescription filled by Costco (one year supply) to save money (I have gotten lenses from here before). However, when I put them in, I can't see close-up; I have to put on reading glasses. I asked the dr to double-check the prescription (his wife had written it) and he called me back and said the prescription matched the file, and he didn't know what to tell me. In the meantime I spoke with Costco who compared my old prescription (2 years ago) with this one and said they saw a significant change which they didn't understand, and that may be the problem. Could you take a look at the prescriptions (old contacts, new contacts, new eyeglasses) and tell me what you think the problem could be.
Thank you very much.
Mary
Old contact lens prescription:
Preference Toric; R 8.70, 14.40, -2.25, -.75, 110
L 8.70, 14.40, -.50, -1.25, 50
New contact lens prescription:
Air Optix Toric; R 8.70, 14.50, -3.25, -.75, 120
L 8.70, 14.50, -.50, -1.75, 40
New eyeglass prescription: R -3.75; -0.75, 123
L -2.50; -1.75; 42
Add R +2.25
L +2.25
Answer
It could be the axis shift in the reading eye. The left eye went from axis 50 to axis 40. But your distance eye, the right has gotten much more nearsighted, so that could also be it. Try closing the right eye and see if you can read with the left (with contact lenses on.) If so then the problem is in the right eye. If you can't read well with the left contact lens, the problem would be because your right eye changed so much.
But this should not be your job, or mine. If a patient has a problem with the prescription written, most reputable doctors, will invite the patient to come back in and be re-checked, and usually at no charge. Now, your chances of receiving that invitation decreases significantly when you buy your contact lenses at Costco. In most cases, the doctor is counting heavily on the profit from selling the contact lenses to offset the usually rather low cost (or verylow reimbursement rate from the insurance company) of the eye exam. Your coming back in for a problem visit without having purchased the lenses from him cuts into his profits significantly.
Moreover, if the doctor did not supply the lenses, you are unlikely to be able to trade them back in at Costco if there is a change. This is why it is always better to get your contact lenses from the office that wrote the prescription. You are not just buying materials. There is significant service element that goes along with contact lenses and respect for the need for that service is why the doctor's office may charge a little bit more.
You might ask the doctor to let you come back in for a check-up AND that in the future you will purchase the materials from him.
Posted by
Beacon Lee
(Updated) Question on Prescription Problem
Question
QUESTION: Hi, Dr. Placentra Johnston,
I just had my eyes examined by a new eye dr (my old one isn't in the network anymore) for both an eyeglass prescription and contacts. I went through a couple trial lenses before given the contact prescription (monovision lenses). I had the prescription filled by Costco (one year supply) to save money (I have gotten lenses from here before). However, when I put them in, I can't see close-up; I have to put on reading glasses. I asked the dr to double-check the prescription (his wife had written it) and he called me back and said the prescription matched the file, and he didn't know what to tell me. In the meantime I spoke with Costco who compared my old prescription (2 years ago) with this one and said they saw a significant change which they didn't understand, and that may be the problem. Could you take a look at the prescriptions (old contacts, new contacts, new eyeglasses) and tell me what you think the problem could be.
Thank you very much.
Mary
Old contact lens prescription:
Preference Toric; R 8.70, 14.40, -2.25, -.75, 110
L 8.70, 14.40, -.50, -1.25, 50
New contact lens prescription:
Air Optix Toric; R 8.70, 14.50, -3.25, -.75, 120
L 8.70, 14.50, -.50, -1.75, 40
New eyeglass prescription: R -3.75; -0.75, 123
L -2.50; -1.75; 42
Add R +2.25
L +2.25
ANSWER: It could be the axis shift in the reading eye. The left eye went from axis 50 to axis 40. But your distance eye, the right has gotten much more nearsighted, so that could also be it. Try closing the right eye and see if you can read with the left (with contact lenses on.) If so then the problem is in the right eye. If you can't read well with the left contact lens, the problem would be because your right eye changed so much.
But this should not be your job, or mine. If a patient has a problem with the prescription written, most reputable doctors, will invite the patient to come back in and be re-checked, and usually at no charge. Now, your chances of receiving that invitation decreases significantly when you buy your contact lenses at Costco. In most cases, the doctor is counting heavily on the profit from selling the contact lenses to offset the usually rather low cost (or verylow reimbursement rate from the insurance company) of the eye exam. Your coming back in for a problem visit without having purchased the lenses from him cuts into his profits significantly.
Moreover, if the doctor did not supply the lenses, you are unlikely to be able to trade them back in at Costco if there is a change. This is why it is always better to get your contact lenses from the office that wrote the prescription. You are not just buying materials. There is significant service element that goes along with contact lenses and respect for the need for that service is why the doctor's office may charge a little bit more.
You might ask the doctor to let you come back in for a check-up AND that in the future you will purchase the materials from him.
---------- FOLLOW-UP ----------
QUESTION: Dear Dr. Placentra Johnston,
Thank you for taking the time to answer my initial question. What is puzzling to me is why I am having trouble seeing when I went through the trial lens process. I assume it is possible that Costco messed up the order, although I am sure it doesn't happen that often. And you're right, the Dr won't see me again (at least at no charge) based on the fact I didn't get the contacts through him (although I spent a lot more money on the glasses I ordered through him). However, my gut is telling me the prescription wasn't written correctly...that the final trial lens (which I had 3 trials for my left eye) isn't what was ultimately written. Plus I tried two different manufacturers (Accuview and Ciba) although I don't know if that would be a factor. When you look at my eyeglass prescription (I can see out f my glasses fine), how does that translate to contacts? I read that usually the prescription for glasses are stronger than contacts by .25 at least. Perhaps knowing how the eyeglass prescription translates will help me understand what may have happened.
Thanks again for your help.
Mary
Answer
Your contact lens prescription makes sense in view of the glasses Rx. However, the new contact lens prescription is stronger for distance (especially in the right eye) than the old contact lens Rx. This would make it more difficult to read if the increased power were not needed.
Did you try the little exercise I suggested in my first response?
It is indeed very possible that the Rx that got written does not represent the final trial lens you accepted. When there are multiple trial lenses used, it can take a lot of effort of the doctor's part to keep his records straight about which trial lens the patient finally accepted. But....unfortunately, the only one who can solve that for you is the doctor who wrote the Rx. Moreover, even if you and I were able to figure out what the problem is, you would still have to go back through the doctor to get him to rewrite the prescription. The optical shop at Costco is not authorized to change a prescription on the patient's say-so.
I am sorry for your unfortunate situation. As I see it, about the only answer is to bite the dust and pay for another visit with the doctor. ....OR - ask for a copy of all your records and take them to your old doctor (another paid visit of course) to see if he can figure out what you needed. I cannot do this online because in my status here you and I do not have an official doctor/patient relationship and I am not legally able to write or alter a prescription for you.
QUESTION: Hi, Dr. Placentra Johnston,
I just had my eyes examined by a new eye dr (my old one isn't in the network anymore) for both an eyeglass prescription and contacts. I went through a couple trial lenses before given the contact prescription (monovision lenses). I had the prescription filled by Costco (one year supply) to save money (I have gotten lenses from here before). However, when I put them in, I can't see close-up; I have to put on reading glasses. I asked the dr to double-check the prescription (his wife had written it) and he called me back and said the prescription matched the file, and he didn't know what to tell me. In the meantime I spoke with Costco who compared my old prescription (2 years ago) with this one and said they saw a significant change which they didn't understand, and that may be the problem. Could you take a look at the prescriptions (old contacts, new contacts, new eyeglasses) and tell me what you think the problem could be.
Thank you very much.
Mary
Old contact lens prescription:
Preference Toric; R 8.70, 14.40, -2.25, -.75, 110
L 8.70, 14.40, -.50, -1.25, 50
New contact lens prescription:
Air Optix Toric; R 8.70, 14.50, -3.25, -.75, 120
L 8.70, 14.50, -.50, -1.75, 40
New eyeglass prescription: R -3.75; -0.75, 123
L -2.50; -1.75; 42
Add R +2.25
L +2.25
ANSWER: It could be the axis shift in the reading eye. The left eye went from axis 50 to axis 40. But your distance eye, the right has gotten much more nearsighted, so that could also be it. Try closing the right eye and see if you can read with the left (with contact lenses on.) If so then the problem is in the right eye. If you can't read well with the left contact lens, the problem would be because your right eye changed so much.
But this should not be your job, or mine. If a patient has a problem with the prescription written, most reputable doctors, will invite the patient to come back in and be re-checked, and usually at no charge. Now, your chances of receiving that invitation decreases significantly when you buy your contact lenses at Costco. In most cases, the doctor is counting heavily on the profit from selling the contact lenses to offset the usually rather low cost (or verylow reimbursement rate from the insurance company) of the eye exam. Your coming back in for a problem visit without having purchased the lenses from him cuts into his profits significantly.
Moreover, if the doctor did not supply the lenses, you are unlikely to be able to trade them back in at Costco if there is a change. This is why it is always better to get your contact lenses from the office that wrote the prescription. You are not just buying materials. There is significant service element that goes along with contact lenses and respect for the need for that service is why the doctor's office may charge a little bit more.
You might ask the doctor to let you come back in for a check-up AND that in the future you will purchase the materials from him.
---------- FOLLOW-UP ----------
QUESTION: Dear Dr. Placentra Johnston,
Thank you for taking the time to answer my initial question. What is puzzling to me is why I am having trouble seeing when I went through the trial lens process. I assume it is possible that Costco messed up the order, although I am sure it doesn't happen that often. And you're right, the Dr won't see me again (at least at no charge) based on the fact I didn't get the contacts through him (although I spent a lot more money on the glasses I ordered through him). However, my gut is telling me the prescription wasn't written correctly...that the final trial lens (which I had 3 trials for my left eye) isn't what was ultimately written. Plus I tried two different manufacturers (Accuview and Ciba) although I don't know if that would be a factor. When you look at my eyeglass prescription (I can see out f my glasses fine), how does that translate to contacts? I read that usually the prescription for glasses are stronger than contacts by .25 at least. Perhaps knowing how the eyeglass prescription translates will help me understand what may have happened.
Thanks again for your help.
Mary
Answer
Your contact lens prescription makes sense in view of the glasses Rx. However, the new contact lens prescription is stronger for distance (especially in the right eye) than the old contact lens Rx. This would make it more difficult to read if the increased power were not needed.
Did you try the little exercise I suggested in my first response?
It is indeed very possible that the Rx that got written does not represent the final trial lens you accepted. When there are multiple trial lenses used, it can take a lot of effort of the doctor's part to keep his records straight about which trial lens the patient finally accepted. But....unfortunately, the only one who can solve that for you is the doctor who wrote the Rx. Moreover, even if you and I were able to figure out what the problem is, you would still have to go back through the doctor to get him to rewrite the prescription. The optical shop at Costco is not authorized to change a prescription on the patient's say-so.
I am sorry for your unfortunate situation. As I see it, about the only answer is to bite the dust and pay for another visit with the doctor. ....OR - ask for a copy of all your records and take them to your old doctor (another paid visit of course) to see if he can figure out what you needed. I cannot do this online because in my status here you and I do not have an official doctor/patient relationship and I am not legally able to write or alter a prescription for you.
Posted by
Beacon Lee
enopthalamos question
Question
hi
i recently noticed my left eyelid droops lower than my right eyelid. recently i had a maxillary sinus fracture. could a maxillary sinus fracture result in enopthalamos?
Answer
Dear Jonathan,
The superior wall ( roof) of the maxillary sinus is the same as the floor of the orbit. A fracture involving this wall of the maxillary sinus can cause enophthalmos. We shallneed a CT Scan to determine what exactly is the case.
You can e mail the report to dranand@lasikindia.in
Hope this helps,
Best,
Dr Anand Shroff
www.shroffeye.org
hi
i recently noticed my left eyelid droops lower than my right eyelid. recently i had a maxillary sinus fracture. could a maxillary sinus fracture result in enopthalamos?
Answer
Dear Jonathan,
The superior wall ( roof) of the maxillary sinus is the same as the floor of the orbit. A fracture involving this wall of the maxillary sinus can cause enophthalmos. We shallneed a CT Scan to determine what exactly is the case.
You can e mail the report to dranand@lasikindia.in
Hope this helps,
Best,
Dr Anand Shroff
www.shroffeye.org
Posted by
Beacon Lee
can i get my vision back
Question
I sas stabbed in my eye abot 3 years ago and have very minimal vision out my left eye the doctors took out my lens and said that i also suffered from a lot of blood in my eye would a cornea transplant give me my vision back
Answer
I am sorry to say that it is doubtful you could get your vision back from a corneal transplant, or surely the doctors would have recommended it. I am sure you have a lot of corneal scarring if whatever you were stabbed with went through your cornea. But, depending how far into the eye the weapon traveled, there could also have been damage to your retina and that would most likely not be fixable. Since I cannot see your eye, I cannot determine this. However, a visit to almost any eye doctor should result in an answer to your question.
I sas stabbed in my eye abot 3 years ago and have very minimal vision out my left eye the doctors took out my lens and said that i also suffered from a lot of blood in my eye would a cornea transplant give me my vision back
Answer
I am sorry to say that it is doubtful you could get your vision back from a corneal transplant, or surely the doctors would have recommended it. I am sure you have a lot of corneal scarring if whatever you were stabbed with went through your cornea. But, depending how far into the eye the weapon traveled, there could also have been damage to your retina and that would most likely not be fixable. Since I cannot see your eye, I cannot determine this. However, a visit to almost any eye doctor should result in an answer to your question.
Posted by
Beacon Lee
Subscribe to:
Posts (Atom)