Went to a good optometrist; please advise

logixoul

I went to a good optometrist. He found some slight BVD and slight astigmatism in me. Especially in a test that looked like this:

(my eyes, with special polarized glasses, saw the vertical line moved a bit to the left, and not centered on the blank space in the middle)

I showed him this pic which shows how I have a slight "vertically doubled" effect (on high-contrast white-on-black text) (like @bkdo does):

(even when looking with just one eye open)

So he focused on trying to combat this diplopia (double vision) via prism and/or astigmatism lenses. Nothing he did fixed this diplopia so he thought that prism/astigmatism lenses won't help my screen strain.

Maybe my diplopia is a red herring though. (i.e. it may not be the cause of my screen strain).

Can you guys advice? Should I get prism/astigmatic lenses (despite them not fixing my diplopia)?

The other thing I'm worried about is: When I slightly overwork some muscle (eye muscle, leg muscle...), my spasticity (in that part of the body) gets worse permanently. I.e. it doesn't get better afterwards. (the reason is: "chronic withdrawal syndrome" caused by a sharp decreasing of the dose of powerful medications). So if I get prism/astig lenses, and they start "training" my eyes anew, this "training" might overwork the eye muscles, causing a permanent worsening of my condition. What do you think?

martin

logixoul Diplopia is definately your isse or a big part of it. If you have vertical heterophoria, those especially are known to cause really bad issues. I think possibly the worst issues come from vertical heterophorias. I read articles about people being dizzy and not even being able to walk properly when big deviation was present (https://www.linkedin.com/pulse/how-our-research-vertical-heterophoria-began-dr-debby-feinberg/).

I suggest try more specialists if you can, or possibly any kind of visual therapy that you can find. I offer consultations on this now (https://heteroforie.webnode.cz/consulting-konzultace/), but its best to get a proper training plan first, as I am not a certified specialist myself, just a patient🙂

Also a proper prism has to fix the diplopia, at least temporarily, just by physically redirecting the light.

I am sorry theres also the added chronic issue.

bkdo

logixoul

logixoul I showed him this pic which shows how I have a slight "vertically doubled" effect (on high-contrast white-on-black text) (like @bkdo does):

Do you have this issue at all times? At least in my case, my optometrist told me that the vertical doubling effect is a result of my eye muscles being fatigued. I usually only had this issue at the end of the day after a long day of screens, is it similar for you?

logixoul The other thing I'm worried about is: When I slightly overwork some muscle (eye muscle, leg muscle...), my spasticity (in that part of the body) gets worse permanently. I.e. it doesn't get better afterwards. (the reason is: "chronic withdrawal syndrome" caused by a sharp decreasing of the dose of powerful medications). So if I get prism/astig lenses, and they start "training" my eyes anew, this "training" might overwork the eye muscles, causing a permanent worsening of my condition. What do you think?

Sorry to hear that you have to deal with this, it sounds very frustrating. I think you should speak with your primary care provider or optometrist about these specific questions, I think they'd definitely be able to address those concerns 🙂

Also, from my understanding, prism lenses are supposed to relieve eye muscle strain, not exacerbate it, so hopefully you'll be able to use prism lenses without affecting the spasticity. Again though, I think your doctor would definitely be able to talk you through it and figure out what the right move is for your unique situation.

Also, did the optometrist recommend any kind of vision therapy for you?

logixoul

Thanks guys!

martin Diplopia is definately your isse or a big part of it.

Well, it's monocular diplopia (i.e. it's present even with one eye covered/closed). So it should be unrelated to any heterophoria, right? (even considering I was diagnosed with BVD)

martin I suggest try more specialists if you can, or possibly any kind of visual therapy that you can find.

👍

I'll consider doing a consultation with you in the future.

bkdo Do you have this issue at all times?

Yes, though it does worsen a lot when my eyes are fatigued. But it's almost invisible when reading dark text on a light background.

bkdo Also, from my understanding, prism lenses are supposed to relieve eye muscle strain, not exacerbate it, so hopefully you'll be able to use prism lenses without affecting the spasticity. Again though, I think your doctor would definitely be able to talk you through it and figure out what the right move is for your unique situation

👍

bkdo Also, did the optometrist recommend any kind of vision therapy for you?

No, he didn't.

logixoul

bkdo Also, from my understanding, prism lenses are supposed to relieve eye muscle strain, not exacerbate it, so hopefully you'll be able to use prism lenses without affecting the spasticity.

Thanks!

I noticed (in the one-eye-success thread) that your prism lenses increased your eye strain (or pain) for the first 3-4 weeks, before they finally decreased it. But in the above quote you seem to say the opposite? Please tell me what you think 🙂

bkdo Again though, I think your doctor would definitely be able to talk you through it and figure out what the right move is for your unique situation.

Agreed. 👍

logixoul

I called my optometrist to ask about visual therapy (i.e. eye exercises). He said that it's effective only on children.

I have an appointment with him for Monday. Will ask him to show me some eye exercises despite what he said. Also I'll ask him to give me an exact BVD diagnosis (e.g. "convergence insufficiency" or something). So that I can later research it by myself. 🙂

mike

logixoul

I got almost the same answer from the last optometrist I visit. It really sucks. Hope you get some eye exercises that do good.

bkdo

logixoul

Sure, here's a quick summary -

Before prism lenses, my usual flicker symptoms would usually be a 8/10 (Higher is worse) and my general eye strain from normal eye usage would be a 4/10.

When I got the prism lenses, I pretty much instantly noticed the flicker symptoms were now lower around 4-5/10 and the general eye strain was more like a 5/10.

When I finally adjusted to the lenses a few weeks later, the flicker was still at 4-5/10 and the eye strain went to maybe a 3/10.

So, overall, these prism lenses have thankfully reduced the flicker symptom intensity, but have not really helped that much with the general eye strain and fatigue from normal eye usage.

I'm sure each of our individual cases are pretty unique though, so you could definitely have a different experience. My understanding is that you should experience less overall eye strain from prism lenses if you have the right prescription.

logixoul

So yesterday I finally went to the optometrist (again). 🙂

He diagnosed me with exophoria (purely horizontal). Exophoria is a kind of heterophoria. My exophoria has different strength at different distances.

He gave me temporary prism clip-ons to put on my usual eyeglasses, and he asked that I return them in 3-4 days after I've seen how they affect my screen strain.

He didn't put full-strength prisms in there - just medium-strength. Because he wanted the clip-on to be usable both at near distances and far distances. He said that if that doesn't help, he'll give me full-strength ones (i.e. fully-correcting for my exophoria) and they'll be usable only at near distances.

Another thing is that I've been doing visual therapy for the last 5 days (the first 4 brock-string exercises from @martin's blog) but I cannot give definite feedback on that yet. I'm not sure I'm doing them correctly, and my optometrist hasn't heard of brock strings.

My questions:

Do you think 3-4 days will really be enough to test-drive these clip-ons?
Do you think it's gonna be OK to use my old glasses when outside (i.e. looking mostly at far distances) while using prismatic glasses at home on my PC? I mean, won't that "confuse" my eyes leading to increased pain?
Do you think I should ask for the full-strength prism correction, or would it be better to go with the medium-strength one?

AGI

logixoul Assuming it is not just a naming issue, perhaps you could see an orthoptist rather than an optometrist?

How bad is your esophoria? I am not a specialist, but if the condition is not too bad there is a chance that you can improve significantly by just doing exercises with loose prisms, similar to the ones I posted about here. This is actually two prisms on a single post, one for convergence and one for divergence. If it is your first time exercising and again, depending on your condition, you may have to start from single prisms of suitable power, one for divergence and one for convergence. I bought the double prism object recently to "maintain" what I had learnt last year. However, when I began the treatment from scratch, my orthoptist lent me single prisms of power suitable for my condition. I kept changing prisms (higher and higher power), until I was able to successfully use the high end of the prism power range. The progress was very quick. My orthoptist was super-nice and allowed me to pass by every week or 10 days to swap prisms, without paying a penny. What we learnt is that, after 9 months without exercising, my vergence ability dropped. Reason why I struggled a bit when I restarted exercising with the double prism object of given convergence and divergence power.

ryans

logixoul Do you think 3-4 days will really be enough to test-drive these clip-ons?

My optometrist said it can take 2+ weeks to adapt to prisms.

logixoul Do you think I should ask for the full-strength prism correction,

I have been reading books that optometrists who specialize in BVDs train from. They almost never correct the full phoria. Because your eyes have been compensating for it for so long, they are not able to handle the full correction. The advised approach is to prescribe as little as possible prism to relieve symptoms.

For exophoria, I guess you have base in prism? It is common to be more exophoric at near, e.g. require more BI prism at near than at distance.

Hoping the glasses help you.

logixoul

Thanks guys.

AGI Assuming it is not just a naming issue, perhaps you could see an orthoptist rather than an optometrist?

I did see an orthoptist ("strabologist" in my language) some months ago; she found no BVD in me. I'll think about trying another one (this one was clearly not very good at her job). Considering that my optometrist hadn't even heard of a brock string, let alone any other exercise tools.

Btw, I have eXophoria, not eSophoria (just clarifying). My exophoria is not very bad, I think. For example, I have no binocular double vision, and no ophthalmologist never even thought I might have BVD issues, until I read about it on LedStrain and found an optometrist who confirmed it.

Those loose prisms and stuff look awesome, I hope I can find them in my country (Bulgaria).

ryans My optometrist said it can take 2+ weeks to adapt to prisms.

👍

ryans For exophoria, I guess you have base in prism?

Honestly I don't know; the optometrist won't print me a recipe until I buy his glasses.

AGI

logixoul Those loose prisms and stuff look awesome, I hope I can find them in my country (Bulgaria).

Mine arrived from India, the orthoptist said. I'm sure you can buy loose prisms online. I once saw the whole kit. But it's best if you find someone who checks on the prism power you need.