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  • Exophoria/Accommodation Spasm/Astigmatism - What should I do?

Hi guys,

After several months I have a quick update on my situation.
Here are my tests I did lately and their results:

wearing different glasses including:
-correcting my small astigmatism (0.5 and 0.25)
-correcting my small nearsightedness (0.5 and 0.25)
-prisms correcting exophoria (of power of 2)
-prisms correcting vertical heterophoria (power of 1)
-plus power glasses (+0.5, +0.5)
Both work in the same way reducing my symptoms from screens up to 50%, but giving me a strong tension around my eyes to the point I have to take them off every half an hour for a while. The tension from glasses appears both at near and far when I'm outdoors. The glasses also makes me a bit dizzy and unfocused all the time I wear them. Waking up after a day with the glasses is a nightmare, tension headache and foggy blurred vision.

-zero power glasses with blue light filter
-zero power glasses
-zero power glasses with strong blue light filter (orange glasses)
This is actually weird, because both zero power glasses work for me in the same way as all the lenses mentioned before, just on a smaller scale. It means they reduce my symptoms by 20-30%, but they also put some pressure on my eye/head muscles. The last ophtalmologist I saw told me it's impossible to feel anything from zero power glasses suggesting it's in my head.

-patching my left eye for half a day
Symptoms reduced up to 50%, but I still feel tension around my left eye even if it's patched.

-wearing plus power glasses and applying tropicamidum drops multiple times to "block" accommodation for half a day
Symptoms reduced up to 50%, but I literally cannot open my eyes in the following day waking up with the worst burning tension headache ever.
-3 days of exercising with accommodation flippers
No change
-7 days of divergence exercises with "Magic Eye" book (I recommed giving the book a try)
No change

-4 days of taking 200mg daily of Tolperisone
Tolperisone is a muscle relaxant suggested by logixoul . Months ago when I first tried it I was pretty sure it worked wonders, however now I know it was more yerba mate I was binge drinking than the drug itself. For some reason mate with catuaba bark works for me very well in general. Unfortunately this time Tolperisone didn't change anything in my symptoms.

Here I am now. Last week I saw another vision specialist who wants to operate my heterophoria. It's not common you undergo a surgery for heterophoria, but looks like I don't have a choice. The problem spreaded all over my life turining it into hell. Before having a surgery my new idea is trying a keto diet (it's my 5th day today) and trying a combo of atropine (for potential accommodation spasm) and amitriptyline in the long term (at least 3 months).

      Dominic What is the heterophoria in prism diopters? Unless it is extremely large, operating on the eye could make it worse. Please get a second opinion, even if somewhere online like: reddit.com/r/optometry. If you buy a Maddox Rod, you can test yourself as to what heterophoria you have.

      Vision Therapy programs take several weeks if not longer. A few days is not going to make big difference. @martin has been doing them for years now. If you have exophoria, the plus lenses are likely going to make it worse, and you need to be doing convergence exercises, not divergence ones.

          ryans

          14 prisms

          I saw many vision specialists before but we never discussed a surgery. Anyway I’m going to see at least two different ophthalmologists who specialize in strabismus surgery before I make up my mind.

          I did a 7 month vision therapy focusing on convergence. It was my worst decision as it made my symptoms much worse. After the VT I feel the symptoms almost all the time and I cannot wear any glasses as they put a lot of pressure on my eye muscles.

          I have a Maddox Rod. It proves I have a heterophoria.

            @Dominic do your symptoms happen, or happen as badly, even with reading paper books and e-readers?

              Deepdeep Yes, even reading a book or an ebook on my Kindle is painful in terms of my symptoms. It’s a bit better than looking at screens but still quite hard.

                  Dominic Then I saw another eye specialist (very reputational, expensive and hard to get a consulation with) who completely denied all the previous diagnosis

                  Classic :-(

                  I understand your despair but this should be a warning when you think about eye surgery. I know nothing about strabismus surgery but I have experience with other forms of "minor" surgery. For instance, I had seven operations at my toes due to ingrown nails. They caused permanent damage and turned out to be completely unnecessary. I would consult a million specialists before going down that way…

                  Dominic I bought a cheap pair of glasses correcting my astigmatism (-0,25 on left and -0,5 on right eye)

                  I have -0.25 astigmatism in my left eye. I tried glasses and letters appeared neater and bolder, but that did not make any difference in terms of eyestrain / neck pain. Most doctors won't give you a prescription for that condition.

                  xelaos Do you have some issues with you jaw?

                  I have had jaw manipulations several times but I did not notice any improvement of my eye condition. I also started wearing a mouth guard three years ago because I was grinding my teeth at night. That is hopefully going to be helpful in the long run to preserve my teeth, but I never observed any correlation with my eye problems.

                  ryans olks who also had all "our" symptoms gone with neck chiropractic care.

                  I have seen chiropractors and osteopaths for twenty years. No progress as to eyestrain. Recently I have moved away from chiropractors and whenever I have a problem I see a physiotherapist or an osteopath.

                  Dominic Hi! Yes, my problems also started when I bought a new laptop - LG Gram 17.

                  How long ago was this? Do you mean that before buying that laptop you had zero issues?!?!?

                  Dominic When the first two are more undestandable as they are close to brain and eyes, getting warm palms and feet is quite a mystery.

                  I gave in using prismatic lenses after three days. I had pain everywhere. It started with my neck, then my arms - both biceps and triceps, then elbows and wrists, and it finally propagated down to my ankles. On my last day I also developed a piercing headache on the top of my left eye and eye burning which I never had before. It took me 8-9 days without glasses to recover decent vision at near. This is a fresh story. Last week.

                  Dominic I had a consultation with an oral surgeon as I cosindered my wisdom teeth as potential culprit, but he ruled it out.

                  I got rid of my wisdom teeth ten years ago. No change in my eye sensitivity afterwards, and my issues have got worse and worse for the past four years.

                  Mrak0020 Whatever damage eyes are taking, it can be accumulated. The best thing to do is avoid accumulation by all costs. Probably it is not a significant damage and can easily be healed with time. More damage you take, more time you need.

                  I agree with these statements. Now I am using my laptop at native resolution (first time ever on any computer) and the latest version of Windows 10 and I am doing better than months ago. I have no idea what I did to improve. I am a very bad sleeper and never found a correlation between eyestrain and lack of sleep, but perhaps adding several hours of sleep for some weeks has helped?

                  Mrak0020 One of my eyes was hit by a laser

                  I had a laser accident too twenty years ago. Those days I was not using screens but studying on paper became really problematic as the hit eye would pour tears and hurt all the time. After a few days I went to an eye doctor who confirmed there was a scar in my left eye, but told me it was superficial and would most likely heal on its own. He prescribed eye drops and glasses for myopia. The eye got better and the glasses quickly began giving me headaches. The next doctor I saw told me not to wear glasses anymore as they were an over-prescription. I guess, if you have a trauma you need to give time to the eyes to heal.

                                      @Dominic Perhaps you can ask your doctor if it could make sense to take a Visual Evoked Potential test. Here for example they explain a bit about the technique.

                                      I took the tests twice at a distance of one year. The first test was negative. The last one evidenced some mild dysfunction of the retina, but I have not discussed the results yet. Also, I get from talking to optometrists and orthoptists that borderline results have to be taken with grain of salt. I guess it is a very pushed technique and, although not new, still in the research phase. In any case, there is currently no cure if a dysfunction is found.

                                        Dominic Sorry for the late response. If you are ok with reading at a distance, using a large (flicker-free) monitor or a projector might be something to try if you havent already.

                                          AGI I have never heard of VEP before, thanks, I booked the first possible date. It will be very useful to rule out some possibilities.

                                          AGI Dominic Hi! Yes, my problems also started when I bought a new laptop - LG Gram 17.

                                          How long ago was this? Do you mean that before buying that laptop you had zero issues?!?!?

                                          Kind of. All the very hard and apparent symptoms started immediately with the new laptop, so it was definitely a huge trigger for my BVD, however now I connect the dots and see I had some mild issues before. I was usually very tired and my vision was temporarily blurry right after looking at screen or reading a book. I was told it was normal, but now I know it was BVD.

                                          • AGI replied to this.

                                                Dominic Any chance your eyes are really tired - sort of eye breakdown - and you need to take a pause?

                                                Do you ever get double vision? What about watching TV? Do you struggle converging at any distance or only at near?

                                                Another thing I thought of giving a go to is CBD oil but so far I have not met a doctor willing to prescribe it. In fact, my GP and neuro-ophthalmologist were not even aware that this product existed.

                                                    AGI I wish I just needed to take a break, but I tried it many times and all the nightmare comes back within seconds with any up-close task.
                                                    I don't get double vision which was very confusing when trying to diagnose a strabismus. The rule is pretty simple, the closer I look the more pain I get, so watching TV is uncomfortable, but less painfull than looking at my phone for example.

                                                    CBD oil is pretty popular and easy accessible in my country and unfortunately doesn't help me at all.

                                                    • AGI replied to this.

                                                        Dominic It looks like your condition has degenerated very quickly if you were sort of symptoms-free one and half year ago. I have been hanging in here forever compared to you. I read online and I was told by one optometrist and one orthoptic that there is a sort of breakpoint, past which rest is the only solution and recovery can really take months without doing any close-up work. It is similar to a nervous breakdown. You do not know if/when you recover. I will confirm with my specialists out of my curiosity as well. I am due to see all of them in September for another round of consultations.

                                                        I have no idea what the degree of your heterophoria is and I am not a trained specialist. However, I hope you ponder well on your idea of having a surgery. Sorry for being very direct, but after what you experienced (multiple pair of glasses, vision therapy) where do you get the confidence that a surgery will solve your issue? Also, at least in my case I do not think that esophoria is the principal culprit. That is what my orthoptists believe too. You know that there are people with severe heterophoria or strabismus who just get tired at the end of a day of computer, whereas in front of certain displays I develop symptoms instantaneously with a mild heterophoria? One of my orthoptists has exophoria and her symptoms are completely different from mine. She can use any phone and any monitor. She only gets tired more quickly that the average person. Both my orthoptists say I should strengthen my vergence and do all I can to have my eyes in the best shape, but are not confident that my symptoms can diminish by more than 10-20% by doing vision therapy. Please stay away from surgeons and medicines unless at least 50 doctors tell you it is the only way out :-)

                                                            AGI You know that there are people with severe heterophoria or strabismus who just get tired at the end of a day of computer, whereas in front of certain displays I develop symptoms instantaneously with a mild heterophoria?

                                                            Neurolens did a study which showed the amount of phoria does not correlate with the symptoms. You could have a very small phoria and feel horrible or an extremely large one and go throughout life without ever knowing.

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                                                                ryans This confirms my fear that heterophoria is not my only / main problem. Since I have nothing else to focus on, though, I try to make my eyes as "robust" as possible.

                                                                By the way, can you pinpoint this study by Neurolens? Thanks.

                                                                    AGI It looks like your condition has degenerated very quickly if you were sort of symptoms-free one and half year ago. I have been hanging in here forever compared to you. I read online and I was told by one optometrist and one orthoptic that there is a sort of breakpoint, past which rest is the only solution and recovery can really take months without doing any close-up work. It is similar to a nervous breakdown. You do not know if/when you recover.

                                                                    That's interesting. Because last moth I was totally fine with my eyes (the whole month). I just change my life style. I started going out more often, meeting friends etc. A couple of days ago I used my ipad looking at it up close.. too close.. while lying on my bed and beng... It all came back and has persisted until now. My eyes are getting tired much faster again.

                                                                      AGI

                                                                      AGI It looks like your condition has degenerated very quickly if you were sort of symptoms-free one and half year ago.

                                                                      It's not exactly like that. Considering my exophoria diagnosis is right I was never really 100% symptoms-free. I was always a slow reader and was getting very tired easily after reading or working up-close with computer screen. Back then I didn't blame my eyes at all. I thought it was normal or it was just an anxiety. I used to get a slight blurry vision after looking at my "good" screen, but as it was just a slight deterioration of my vision it was bearable, so I didn't complain. Now I know it was probably all my heterophoria.
                                                                      I just think my brand new laptop screen was too demanding for my eyes with BVD and my heterophoria exploded with its worst symptoms I had never had before.

                                                                      AGI I read online and I was told by one optometrist and one orthoptic that there is a sort of breakpoint, past which rest is the only solution and recovery can really take months without doing any close-up work. It is similar to a nervous breakdown.

                                                                      One of orthoptists I saw told me I had a nervous breakdown and it manifested with my eyes. It didn't make sense as I was not very anxious in the time before I bought a new laptop. It was an easy diagnosis because she couldn't prove it and her treatment plan was financially and functionally demanding for me.
                                                                      I was thinking of quitting any up-close tasks for months, but let's be honest, it's almost impossible. Maximum time I did was two weeks and all the symptoms came back immediately with the very first look at my phone. Sorry, but I don't think it's the way.

                                                                      AGI I have no idea what the degree of your heterophoria is and I am not a trained specialist.

                                                                      14 pd at near, measured a month ago. As others said, mostly there is no correlation between amount of your deviation and symptoms, but the last eye specialist told me that anything above 10 may be symptomatic. I found people having less than 10 and being extremely symptomatic.
                                                                      Here are normative values from a good source and near lateral phoria is 3 XP +/-3.

                                                                      AGI Sorry for being very direct, but after what you experienced (multiple pair of glasses, vision therapy) where do you get the confidence that a surgery will solve your issue? Also, at least in my case I do not think that esophoria is the principal culprit. That is what my orthoptists believe too.

                                                                      I really believe people here suffer from different conditions which cause different symptoms, so your esophoria may indeed not be the culprit. After two years of wandering around all types of conventional and unconventional specialists I learnt one thing, always listen to your body and try to logically connect your main symptoms with conditions/diseases. I made many mistakes like letting having my neck muscles "corrected" (due to specialists it was the cause) and it resulted in constant neck pain I feel everyday ever since.
                                                                      I just can feel my tired eye muscles everytime I finish looking at near screen and that's already a lot telling me what's the source of my symptoms. There is no magic.
                                                                      I don't build up my opinion only on online posts, but I found many guys on reddit suffering from heterophoria and having the same symptoms.
                                                                      Example 1
                                                                      Example 2
                                                                      Example 3 - this guy even did a surgery and 70% of his symptoms disappeared

                                                                      The difference between them and us (probably most of us or at least some part) is that our condition became symptomatic with a new device, so it looks more like a magic than some health issues and that's why it's so hard and time-consuming to be properly diagnosed.

                                                                      Anyway, I cannot be 100% certain if a surgery will help me, but it looks like it's the last resort for me. The last ophtalmologist (and surgeon) told me "You got the most of your VT, you tried different prisms, there's only a surgery left". I also asked her about anxiety as possible reason for me problems and she admitted it makes it worse, but the source is somewhere else.

                                                                      AGI Please stay away from surgeons and medicines unless at least 50 doctors tell you it is the only way out :-)

                                                                      Sure, I still have a few appointments booked to get more opinions.

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                                                                                    Dominic 14 pd at near

                                                                                    How was it measured? Did you notice any change from week to week? In my case, a week later the value had halved. I wonder how a doctor can prescribe glasses in this situation…I am sure you know where I am heading.

                                                                                    Dominic I just can feel my tired eye muscles everytime I finish looking at near screen

                                                                                    Is it totally unbearable? I am thinking in terms of the surgery. Clearly your decision, but I would go for the last resort only if I could not read anything at all. At times I feel like crying and recently I have become less productive, but I am hanging in there. Sometimes I also notice improvements that I cannot explain, as I cannot explain why all of a sudden a usable device hurts.

                                                                                    Dominic You got the most of your VT

                                                                                    I have seen three VT specialists so far and I just realized that my condition is a puzzle (maybe I should call it a mess). The specialists give me some directions but it is up to me to put the pieces together. I am still trying to clarify if there was a real change of my condition from exophoria to esophoria - currently it seems so, and the reasoning might be excessive exercising.

                                                                                    Sometimes I need to reject input from the specialist that makes little sense. For instance, very recently I have been wondering why I am still given a lot of exercises that are typically prescribed for exophoria when I am affected by convergence excess. I believe that the specialists think that my problem with electronic devices is that I can converge but I cannot hold the convergence. I can do those exercises very easily, though. In fact I am always able to do the next-next level exercises with respect to what they prescribe. But now I clearly have pain afterwards. So these days I have been using the same stereograms but I am focusing on a point meters away instead of in-between the sheet and my nose. That is way more challenging. My "next-level stereograms" (I have made some myself) contain tiny letters, and reading the letters neatly while diverging looked impossible at the start. 1-2 days later I have already made good progress - I start believing that the goal is reachable. I am also doing more loose prisms exercises with the base in instead of out. This relaxes my eyes and diminish my symptoms. I just discovered it a few days ago after "studying" my primastic lenses and consulting with @Lauda89.

                                                                                    Maybe I am just trying to be over-positive, but I like the feeling of hope, that I can work hard at something that I have not yet explored, and "dream" of improving my condition. I bought four pairs of glasses in the last 3 years and I never used them for longer than 2-3 days. A complete disaster. Besides, I watched this video. The specialist compares prisms to crutches. If you can, you should try to walk without or you won't get better.

                                                                                    I have been long-winded, but perhaps you are willing to reconsider your statement that you already got most out of your VT. Cheers.

                                                                                            AGI

                                                                                            AGI @Dominic Have you (or anyone else) tried Syntonic Phototherapy?

                                                                                            I have not, but I can't find it anywhere in my country, at least not for eye purpose.

                                                                                            AGI Dominic 14 pd at near

                                                                                            How was it measured? Did you notice any change from week to week? In my case, a week later the value had halved. I wonder how a doctor can prescribe glasses in this situation…I am sure you know where I am heading.

                                                                                            Measured by cover test. Honestly I didn't write down my previous measurements and it doesn't look like my optimetrists liked this idea either as I cannot find it anywhere on the papers I have gathered. Next week I'm having the next appointment, so we will see if 14 pd is up to date.
                                                                                            However, I think there is a way to properly measure your deviation. My latest ophtalmologist told me to patch my left eye (as it's more symptomatic one) from the very first moment when I wake up and keep it untill I come for the appointment. Then I took off the patch right before the cover test. I think it makes sense as your covered eye squints to its maximum. Other than that way of doing a cover test may differ from each other because your eyes can be simply more or less tired. I think that's why I sometimes had a succes with devices at the first moment, but exactly the same device would had induced the symptoms an few hours later.

                                                                                            AGI I have seen three VT specialists so far and I just realized that my condition is a puzzle (maybe I should call it a mess). The specialists give me some directions but it is up to me to put the pieces together. I am still trying to clarify if there was a real change of my condition from exophoria to esophoria - currently it seems so, and the reasoning might be excessive exercising.

                                                                                            So you were diagnosed with exo before?
                                                                                            That's puzzling to me as well because I am always diagnosed with exophoria, but after months of excessive exercising when I wear my glasses the strain I feel is located between my eyes, not on the sides, what could indicate more of esophoria. To make it more complicated, base out prisms help me more than base in prisms. It should be the other way round for someone having an exophoria.
                                                                                            I'm still in doubt if it's certainly an exophoria or eso or some kind of vertical heterophoria (Maddox test shows a little bit of it), but I'm telling myself I saw some many eye specialists and literally all of them diagnosed me with exo deviation not even saying a word about other types of strabismus.

                                                                                            AGI For instance, very recently I have been wondering why I am still given a lot of exercises that are typically prescribed for exophoria when I am affected by convergence excess. I believe that the specialists think that my problem with electronic devices is that I can converge but I cannot hold the convergence. I can do those exercises very easily, though. In fact I am always able to do the next-next level exercises with respect to what they prescribe. But now I clearly have pain afterwards.

                                                                                            I have figured out something new to me recently. Most of those eye exercises strenghten eye muscles (medial rectus or lateral rectus muscles), but what if the trouble is that your muscles are too strong/tight? I think especially if your medial rectus muscles are too tight (then you are probably esophoric) you make it worse by doing convergence execises. If they are all right, but your lateral muscles are too strong then doing convergence exercises won't really help you to loosen your lateral rectus. Obviously there are still divergence exercises, but again they are made to strenghten your muscles, just the other way round than convergence exercises.
                                                                                            What I mean is that there is not many effective eye exercises loosening your muscles. This would explain why VT made my condition worse. It gave me a good convergence/fusion, but no essential change in my exophoria.

                                                                                            AGI I am also doing more loose prisms exercises with the base in instead of out. This relaxes my eyes and diminish my symptoms. I just discovered it a few days ago after "studying" my primastic lenses and consulting with @Lauda89.

                                                                                            This is very interesting. Given you have esophoria, most specialists would prescribe you base out prisms. I have the same problem, but in the other direction, with exophoria. Did you think up any possible explanation?

                                                                                            AGI I bought four pairs of glasses in the last 3 years and I never used them for longer than 2-3 days. A complete disaster. Besides, I watched this video. The specialist compares prisms to crutches. If you can, you should try to walk without or you won't get better.

                                                                                            I bought 20 pairs in the last 2 years, luckily they were not that expensive where I live. Dependency on prisms is something I fear of. I read stories people couldn't take a shower or wake up and open their eyes up even for a second withour wearing their prisms. Besides, I had my LASIK done 8 years ago thus I'm not happy with being glued to any kind of lenses.

                                                                                            AGI I have been long-winded, but perhaps you are willing to reconsider your statement that you already got most out of your VT. Cheers.

                                                                                            There's a long waiting line to have a surgery, so I still have months to try other things. For now, I do "exercises" by playing 3D games with cheap VR headset. After two days I'm sure it's not indifferent for my eyes because I feel their muscles right after a VR session.

                                                                                            By the way, I did VEP test this morning and they didn't find anthing alarming.

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