Double Vision After Retinal Detachment Surgery

Double Vision Can Follow Retinal Detachment

Decreased vision and double vision (aka diplopia) after retinal detachment surgery may occur, yet is not common.  The perception of “double” is more common than actually seeing two of everything.  There are several causes for really seeing two images following retinal detachment surgery.

Scleral Buckle May Cause Diplopia

A common method to fix a retinal detachment involves the use of a “scleral buckle.” This involves placing an element, usually silicone rubber, on the outside of the eye and underneath the eye muscles.  The visual effect of a scleral buckle is an increase in myopia (nearsightedness) and/or astigmatism.

Scleral Buckle for Repair of Retinal Detachment

At times, manipulation of the eye muscles can cause true double vision.  The muscles may get injured or impaired such that the eye does not move in coordinated fashion with the other eye.  Diplopia can occur with this muscle imbalance.

The prescription for glasses will change after scleral buckle surgery.  Large differences between the two eyes leads to a condition called anisometropia.  Basically, this occurs when the prescription change between the two eyes is so large the brain actually does see double.

Why?  Inherent to large changes in prescription is a change in the actual size of the image that we see.  Thus, with large changes, the brain actually sees two images of different sizes.

With anisometropic double vision, one see double because the images are too different for the brain to make into one (this is, in part, why we get depth perception, the two eyes gives us slightly different views of the same image).

This is probably the most common cause of “double vision” after retinal detachment surgery.

Cataracts Can Cause Diplopia

Gas is commonly used to repair a retinal detachment.  A common side effect of intraocular gas is the hastened formation of a cataract.  This, too, can change the prescription of the eye pretty dramatically.  “Double vision ” can result from cataract formation by causing a strong shift in the prescription and by physically altering the light as it comes into the eye.

What Does This Mean? True double vision, where the eyes are misaligned after surgery is quite uncommon after retinal detachment surgery.  There are many causes of decreased vision following retinal detachment surgery and many are described as “double vision.”

Many cases are actually caused by changes in the prescription, either due to physical changes of the due to the scleral buckle, or, due to advancing cataract.

Happily, most cases can be fixed.  If the retina is functioning well enough for the double vision to be “seen,” then it’s likely corrective measures can be taken.

Specifically, eye muscle surgery can help if there are true muscle problems, whereas cataract surgery or correction with a stronger contact lens may be helpful, too.

Enhanced by Zemanta


Randall V. Wong, M.D.

Ophthalmologist, Retina Specialist
Fairfax, Virginia

Google
***This post is for information purposes only. This posting does not offer legal or medical advice, so nothing in it should be construed as legal or medical advice. The information on this blog/post is only offered for informational purposes. You shouldn’t act or rely on anything in this blog or posting or use it as a substitute for legal/medical advice from a licensed professional. The content of this posting may quickly become outdated, especially due to the nature of the topics covered, which are constantly evolving. The materials and information on this posting/blog are not guaranteed to be correct, complete, or timely. Nothing in this posting/blog and nothing you or I do creates a doctor-patient relationship between you and the blog; between you and me; or between you and Randall Wong, M.D. or RetinaEyeDoctor.com. Even if you try to contact me through the blog or post a comment on the blog you are still not creating a doctor-patient relationship. Although, I am a doctor, I’m not YOUR doctor until and unless there is a written agreement specifically providing for a doctor-patient relationship.***

Comments

  1. Dear Gopal,

    Most likely due to bubble. Best is to keep in touch with your doctor. I can’t tell if you’d redetach just from the symptoms you describe.

    Randy

  2. Dear Jonah Javier,

    In general, ROP is NOT a surgically correctable disease, that is, do what ever you can to ensure your kid grows up with some vision. I wouldn’t worry about the buckle. Without it, you might risk complete detachment.

    Most of the time, the buckle is intended to be permanent.

    Randy

  3. Dear Paula,

    I’d have to agree with the advice given so far…which also explains why you can’t find any answers online.

    Randy

  4. Robert Gilchrist Huenemann says:

    Dear Dr. Wong;

    I have a detached retina in my left eye, with a scleral buckle. I had mild astigmatism before the RD, and my optometrists attempted to improve my vision in my left eye by treating the RD like it was astigmatism. This meant I wound up with a very large amount of cylinder in the left lens. It took me years to figure out that this was causing eye strain. As you know, differences in spherical correction can cause strain due to different image sizes. Cylinder can do the same thing by causing different image aspect ratios, if you will.

    I am no doctor, but I have two degrees in electrical engineering with a physics minor. So I have studied a bit of optics. It seems obvious that after RD, it becomes extremely difficult to measure astigmatism with simple refractions. My optometrist has removed the cylinder from my left lens and optimized the spherical correction only, at my request. As a result, the eye strain is gone and my overall vision is better than it has been for years. My depth perception is much improved.

    I would caution optometrists to be extremely cautious about trying to correct astigmatism in an eye that has suffered RD. In this case, what looks better on an eye chart bears little relation to images of real world objects.

  5. Gopal Gupts says:

    Dr Randall

    After retina detachment surgery using C3H8 gas
    After seven weeks the gas bubble is still there
    Please tell me when bubble will get dissolved
    My doctor has told that every thing is fine recovery is good
    That I can also see

    Please tell me when bubble will get dissolved and I ma be free from its shadow

    Gopal Gupta

  6. Dear Robert,

    I am glad you’ve found some relief. In retrospect, I wonder if you just were given too much cylinder. I don’t refract anymore, but high amounts of cylinder are never adequately neutralized by spectacle correction. I think we are in agreement.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, Virginia
    http://www.RetinaEyeDoctor.com

  7. Dear Gopal,

    C3F8 can take several weeks, but 7 sounds extreme. You’ll have to consult your doctor.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, Virginia
    http://www.RetinaEyeDoctor.com

  8. How long after surgery for retinal detachment with a 180 degree giant tear can cataract surgery be performed?

  9. Dear T J Van,

    I don’t think cataract surgery really affects the outcome of giant retinal tear surgery….6 weeks is probably a decent amount of time.

    Randy

  10. joseph vigliaturo says:

    its been almost a year since the scleral buckle Vetrictomy surgeruy was done for my Detached retina.
    1 Dr did the surgery and another doctor replaced the lens. I have noticed a difference everyday in the surgery I but I am scene double vision. I read something about that 1 Eye prescription is very different from the other that can cause double visionI have had seven different prescriptions for glasses the last 2 include prisims still seeing that double vision unless i tilt the glasses one way or another to make them come together.
    Any ideas, the surgery eye also has kind if a distorted wiggle when i look at straight lines ,but crystal clear. Any eye exercies i can do to maybe get this fixed, ? Can anyone refer me to someone. I am thankfull for regaining myy sight ,just would. Like to be independent enough to drive again i am 57

  11. Joseph,

    I would seek the opinion of another retina specialist, but would also consider seeing a pediatric ophthalmologist. These are specialists who deal in double vision (often seen in children and adults).

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, Virginia 22031
    http://www.TotalRetina.com

  12. Thank you very much for all these necessary information, I also had an eye surgery followed by Retina Detachment and currently I am facing cataract which is confirmed by doctor. My vision is so much blur and cloudy from that eye.

    Is my vision is blur only due to Cataract? or surgical part may take more time to recover?

    I had retina detachment surgery on 25 July 2013

  13. Riaz,

    Really hard to know. If your doctor is recommending cataract surgery, it may be worthwhile to consider having the cataract removed and then you can figure how much vision is lost from the retinal detachment…if any.

    All the best.

    Randy

  14. I had a 45% tear in the left eye and 25% tear in the right eye repaired. At about the 6 week point after the gas bubbles were small, I started noticing that I was seeing double for any distance further than about 15 feet. I did have Scleral buckles put in both eyes, but my vision only changed from 20/30 to 20/60 in one eye and 20/70 in the other. I obtained glasses from my optometrist, but this did not help the double vision. Now, a week later, it seems the double vision is a bit worse. Going into the doctor this Thursday. How long will this double vision last and should I be concerned? Worried.

  15. Randy,

    Several reasons why you could have double vision; change in your refraction, cataract or mis-alignment.

    Make sure to express your concerns with your retina doc. I can’t tell from here without examining you.

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  16. Dear Dr Wong,
    A year ago I developed ARN following an attack of shingles. Acyclovir via picc line, oral prednisone, and intravitreal injections, prevented bilateral involvement, but the retina in the affected eye eventually detached. I had scleral buckle surgery to reattach it. Silicone oil removal followed 3 months later, and cataract surgery 2 months after that. I suffered muscle damage during the buckle surgery, to an extent that is not correctable through PT or optometry. The neurophtalmologist consulted, told me that surgery was my only option and would have to be performed in both eyes. Having recently lost functional vision in one of my 20/20 eyes, I am reluctant to have the other potentially compromised. On the other hand, living with loss of peripheral vision as well as pretty disruptive diplopia is at time overwhelming. There is also the lingering issue of macular edema which followed cataract surgery, and is showing little response to usual local treatment (injection and drops). I am otherwise healthy and active, but at a loss as to how to proceed from here. I see an acupuncturist to help with inflammatory response. Have I reached biomedicine”s limits?

  17. Dear Marie,

    I am assuming that surgery to the muscles is recommended to help with the diplopia?

    Seek the opinion of a pediatric ophthalmologist regarding the double vision. It is the pediatric ophthalmologist who deals with adult strabismus and double vision. Sometimes operating on both eyes is indeed the best fix.

    Thanks and Happy Holidays!

    Randy
    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, VA 22030

    http://www.TotalRetina.com

  18. Dear Mr Wong,
    I had a retina detachment in my left eye nearly 3 years ago. The retina was successfully reattached but the sight in the eye became very short sighted due to the buckle. Before the detachment I was short sighted and wore glasses. After the operation because my left eye was much more short sighted than the right eye I was told that I couldn’t wear glasses if I wanted binocular vision. Eventually I got contact lenses and my vision is nearly perfect which is great and I’m delighted with. The only problem is that I used to play golf and my golf game has deteriorated significantly from what it was before the operation. From what I can tell my depth perception is as good as it was before. My vision in my left eye is nearly 20/20. I have tried everything to figure out what the problem is. I have some theories about what could be the problem but I don’t know enough about vision and hand/eye coordination to be sure. The problem isn’t with putting or near the greens. It’s with my full swing. I have a feeling that at impact with the ball my right eye is now where my left eye used to be. I have found out that golfers with dominant right eyes can’t turn their heads as much on the backswing as golfers with dominant left eyes (due to their nose causing them to lose sight of the ball). All in all my sight is nearly perfect but something has happened to cause my golf swing to change dramatically. Before the operation my handicap was 5 and the way I hit the ball now it would probably be over 20 even though my vision is nearly perfect. I’m 99% certain that something has changed in my hand eye coordination due to the operation. If you could maybe enlighten my as to what could be the problem I would greatly appreciate it.

  19. J Kelly,

    I think you are right. The refractive powers (the amount of glasses you need) are pretty different between the two eyes and by turning your head, you force yourself to use one eye then the other.

    Read this article on anisometropia. It might help explain better.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

    http://www.vitrectomyforfloaters.com

  20. deborhonestly ah says:

    Hi I had a pneumatic rex something or other with vitrectomy. Gas bubble lasted fifteen days (left eye). Never considered my eyesight that bad just short sightedness and glasses for tv driving etc (to see better). Anyhow retinal detachment macula off (yes the worst) but it actually detached over a matter of hours waiting at hospital a and e. Previously it presented as two tears. However it was seen to asap.

    I had suffered a pvd apparently a year earlier and had thought it was the same eye but no it was the good eye that suffered the pvd. Anyhow now I am worried as have a floater that is annoying me from the pvd eye but I think it is because I am anxious and notice it more!!! No flashing lights though and sight is as clear as ever. I find if I keep busy I don’t notice it. Bright and lightened rooms, screens etc, are worst for this to occur though. However was told at hospital that pvd did leave a wrinke and hole!!!! Help! They don’t seem particularly worried about this! They said sight is good in that eye and I think I heard doctor say no vitreous left now?

  21. Dear deborhonestly ah,

    Pneumatic retinopexy is a method of repairing a retinal detachment with gas.

    Sorry to hear about the macula off.

    Your story is just a bit confusing. How is the vision?

    Make sure your doctor gives you a better explanation of what’s going on, or, get a second opinion.

    Sorry, but confused.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

    http://www.vitrectomyforfloaters.com

  22. craig thomas says:

    I had retinal reattachment surgery in October of 2013. a scalera buckle was used as well as a gas bubble. after the sgas bubble disappeared and the eye had a little time to heal I had cataract surgery in the same eye. after the cataract surgery there was some tissue behind the new lens and that has been recently removed via laser surgery. I have some double or ghost vision as well has seeing wavy lines instead of straight lines. I have to close my eye in order to read or use this computer due to the double vision using my other eye. will this heal on its own or is more surgery required?.

  23. Craig,

    No way for me to know without examining you.
    Distortion may be caused by many things such as an epiretinal membrane, macular hole or could be residual from the retinal detachment if the macula was involved.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

    http://www.vitrectomyforfloaters.com

  24. Fred Samuels says:

    Dr. Wong,

    Thanks for providing this resource, extremely helpful to read others conditions and what you recommend.

    My family has a history of retinal detachments and I’m a +5 or on the myopia chart so I took preventative action and had a ophthalmologist do regular exams for this condition. Unfortunately, I never fully understood what a detached retina was until after I had pneumatic retinopexy for a central detachment with some macular tear about five weeks ago in the specialist’s office on an emergency basis. Hind sight indeed is 20/20 and I wish I took some time to understand the condition before hand and had not waited to make my appointment, for the now obvious symptoms I had. Even after I had the curtain come down on the lower left quadrant I did not want to think it was an emergency. When the doctors office asked me what my symptoms were I did not know to say it was an emergency. Two or three days past, from the time I noticed the curtain, to the time I sat in the specialist’s chair getting it fixed. Another costly case of old too soon, smart too late.

    Now that my gas bubble is almost gone I’m wondering how long there may be improvement happening in my eye? There still is significant change in my ability to see what I’m writing and reading. My thought is to wait until the bubble is gone and then wait for things to quiet down in the affected eye, only then getting a new prescription. How long do you suggest waiting before getting new lenses to address the up close distortion?

    On a different note, do you think there is any way that limiting head/body movements could help prevent detached retina for persons with a higher probability of occurrence, such as PVD, or previous detachments? Would trampoline use, slackline activity, or jumpy jump fun, increase the likelihood of a detachment? Could sleeping positions or yoga positions use gravity to somehow help prevent the problem? Lastly, with PVD the vitreous moves away from the retina, what then goes into that open space?

    I enjoyed your welcome video and had no idea it took 50 some takes to do, seemed natural.

    Sincerely,

    Fred Samuels

  25. Fred Samuels says:

    RW,

    Wanted to add a few more details and corrections. My vision was -3 to -4 or somewhere in that range not the +5 I put in the previous comment. My one year younger sister, at 55 or so, had two tears corrected and another tear fixed a year or so later. Her eyes are in the -11 to -12 range. The right eye is the one with tears, and it also has some tricky floaters. Would she be a FOV ready patient? My 49 year old brother whose vision is about the same, had a cataract removed and suffered a subsequent retina detachment missed by the cataract surgeon in his right eye. He complained of detachment symptoms but after looking at the eye the surgeon said it was ok. He later got a retina guy to look at it and had the correct diagnosis made then.

    One of my cousins who also has poor vision, had a retina detached while on a carnival ride at the tender age of 17. Could the forces exerted during jogging, trampoline, and gymnastics induce a weak retina to tear and/or detach? When I slackline, by that I mean just walking across the line without doing tricks, my sense of balance and equilibrium go into the alarm mode. Sort of a post-bounce slackline sickness, like what I imagine seasickness would be like. I can make a comparison between walking across a 2 inch diameter 10 foot black iron pole only six inches off the ground and a ten foot slackline, 12 inches off the ground. The unyielding black pipe has less after effects than the slackrack.

    Again thanks for your site and I hope I did not over do it here.

    Fred

  26. Dear Dr. Randy,

    First of all I want to thank you for the excellent service u have been providing to all eye patients.

    I am 47 yrs los male and had cataract surgery in my right eye about 1.5 yrs back, my visión was excellent after cataract, 20/20. I was doing mini mono visión with using contact in left eye.

    I had RD in my eye 7 days back with scleral Buckle in my right eye, as per surgeon, my surgery went as best it can go. Have few questions for you and would appericiate if u can answer those:

    1. I was on cyclopentalote for a week , 4 times a Day, which was stopped a Day back, is this my double visión because of That?

    2. Since I had IOL in my right eye, with distance and with astigmatism, with RD it is Still possible that my visión will be changed in my right eye ?

    3. What would be the healing time, when will I be able to see better again, I am Very much anxious and frustated ?

    Hoping for your reply.

    Thx again for the great service you been providing to all eye parients.

    Regards,

    Nilesh

  27. Dear Fred,

    Thanks for you comments.

    Sorry about your retinal detachment. As long as your retina remains attached, wait and ask your doc about getting new glasses. I usually wait a few months in patients with a macula off detachment. You’ll also want to ask about cataract.

    Head positioning and body movements have no effect on retinal tears or retinal detachments. Think of REM sleep – your eyes beat back and forth so hard and fast that it is unlikely you can reproduce these forces while awake – short of getting sucker punched. Even with that, I’ve only had a handful of patients with retinal detachment who’ve had a history of boxing.

    Randy

    Randall Wong, M.D.
    Retina Specialist
    Fairfax, Virginia 22030

    http://www.VitrectomyForFloaters.com

  28. Dear Fred,

    Very interesting history about your family.

    I think your sister would be an excellent candidate for FOV based upon your statement. Sorry to hear about your brother.

    Forces exerted during jogging, trampoline, etc. are probably negligible with regard to causing retinal detachment.

    Not sure if your slackline comments are related.

    Thanks for the kind remarks about the site….it’s a lot of work, but rewarding.

    Randy

  29. Nilesh,

    1. Doubtful
    2. Not sure I understand about your using the term “vision” – do you mean presciption? do you mean permanent loss of vision?

    3. I can’t tell you because I can NOT examine you and I don’t know the details of your case before and during surgery.

    Sorry I can’t be more helful.

    All the best,

    Randy

  30. Hello Dr. Rand,

    Thx for the reply.

    I meant prescription.

    Due to IOL, i had 20/20 distance vision, will
    I get That visión back ?

    How Long does it take to wear off the effects of cyclopentolate on pupil, which was 4 times for a week, as pupil Still seems
    Dilated.

    Regards,

    Nilesh

  31. nilesh,

    Cyclopentolate is relatively short acting and should wear off in a matter of days.

    Pupil dilation may be due to something other than the drops.

    Randy

  32. Hello Dr. Randy,

    Thx for the reply. Have 2 more question:

    1. My visión Still seems blurry after 4 weeks, from operated eye, as though looking from Transperent film, is this
    Due to Vitrous Gel or something else ? When will it go away ?

    2. Eye Still feels glare from light, when should I expect to get better.

    Regards,

    Nilesh

  33. Nilesh,

    Sorry, but I can’t answer you because I can’t examine you.

    sorry.

    Randy

  34. Hello Dr. Randy,

    It has been six weeks Since my Retina Detachment surgery, I have following questions about my on going recovery.

    1.when I blink my eye, My visión looks better when looking at any object or reading text, why ? When this will get better ?

    2. I can see better in more lighted área than low light area, why ?when it will getbetter.

    Regards,

    Nilesh

  35. Dear nilesh,

    I wonder if blinking causes you to use more of your peripheral vision? Don’t know. Blinking could also cause your cornea to get moist which, if dried, could clear.

    Too many possibilities re: light, cataract?

    Most often, people see better in lighted areas than low light.

    Randy

  36. Andrew Showering says:

    Hi Dr Randy

    I have had a retina reatachment, with gas.
    I have been told that I have a very dense cateract forming.
    Q. I have double vision out of the one repaired eye but if I look through my galasses, the wrong way, out of the other eyes lense the double vision disapears and the sight is very good, so do I just need a new lens or is something else happening?
    Regards
    Andrew

  37. Dear Dr. Wong

    I had vitrectomy and scleral buckle surgeries to fix retinal detachment in the left eye eighteen months ago. These surgeries have been successful and the retina remains flat and attached with excellent vision in the left eye. Both eyes are pseudo-phakic with IOLs of same strength. The left eye needs refractive correction after the surgery due to myopic shift and astigmatism. So, I wear glasses with left lens Sph -1.25 ,Cyl -1.75×071, and right lens plain.
    I have two lingering problems:

    1. Residual drops of heavy liquid (PFCL) have been left in the left eye. I can see them by looking up. When I look straight down the left eye vision is blocked by a fog. This is causing significant visual problem. The left eye is perfect for close vision without glasses. But, most close work requires looking down. I can raise reading material to the eye level but cannot raise to eye level writing material, desktop, kitchen counters, dinner plate, work-bench etc. Is there an effective way of removing/reducing the residual heavy liquid from the eye? Will the presence of residual drops harm any part of the eye in the long run?

    2. Still struggling with double imaging. Started with severe diplopia after the surgery, which has gradually improved until recent three or four months. Does not seem to be improving much lately. It changes from time to time, sometimes better, sometimes worse. I lose binocular vision looking sideways or down. There is a narrow cone of binocular vision around the axis lop-sided toward upper right quadrant (worst double imaging toward lower left quadrant). Within the cone I am fine shifting my gaze from point to point gently. But if I need to quickly scan my field of vision, keeping a single image requires effort and strains the eyes. Should I continue to wait longer for further spontaneous improvement? What can be done to correct this problem? Will switching to a contact lens in the left I help?

  38. Andrew,

    Cant’ really say for sure. The prescription of the edge of the lens is different than looking through the center. I’ like to believe that cataract surgery may be very helpful; it may improve your vision and may reduce/eliminate the double vision.

    r

  39. Zafar,

    1. I’d investigate the possibility of removing the PFO. It can usually be done quite simply. Residual PFO can cause some inflammation which will vary from patient to patient.

    2. I have no idea without trying a contact lens. I’d ask your doctor about this.

    r

Trackbacks

  1. [...] This post was mentioned on Twitter by Bright Eyes Tampa, Randall Wong, MD. Randall Wong, MD said: Double Vision After Retinal Detachment Surgery http://goo.gl/fb/pBKy5 [...]

  2. [...] 3.Causes of Double Vision Following Retinal Detachment Surgery Jan 21, 2011 … Scleral Buckle for Repair of Retinal Detachment. At times, manipulation of the eye muscles can cause true double vision. The muscles may get … http://www.retinaeyedoctor.com/2011/01/double-vision-after-retinal-detachment-surgery/ [...]

  3. […] Anisometropia is an imbalance in the prescription needed between your two eyes.  There are several causes of anisometropia, but the most common for a retinal surgeon is a result of a scleral buckle used to repair a retinal detachment. […]

Speak Your Mind

*


Privacy Policy · Terms of Use

Search Engine Optimization by Medical Marketing Enterprises, L.L.C.