Dear Dr. SerVaas: Three years ago, I had a cataract removed from my right eye and a lens replaced. Afterwards, I could see better with that eye than I had since childhood. However, the image I saw with that eye was about one-third bigger than with the left eye. Glasses had no effect.To correct the disparity in size, the same clinic removed a minor cataract in my left eye and replaced that lens. To my great disappointment, instead of equalizing the image sizes, the difference became about 50 percent--and has remained unchanged in the ensuing three years. No one can explain the bad results nor give me hope for remedy.
Most of the time since the surgeries, I had been able to read only by closing one eye or other. But about three months ago, I began to realize that I could read without closing one eye. What I am seeing, however, is only the left eye image. Occasionally the double vision will suddenly reappear and I have to blink and look away to eliminate it. The double vision is more apparent at close-up distances.
We greatly appreciate your column and hope you can shed some light on my problem.
Marvin Cobb
Dear Reader: Dr. Stephen Massicotte, who trained in Iowa City and was mentored by Dr, Hayreh, says that a question like yours might appear on their ophthalmology board exams. He offered the following comments:
"The situation described does not happen often, but it sometimes can become symptomatic. We read about this in our textbooks.
"In this case, optical therapy might help. What happened is the amount of magnification changed. Interestingly, this was a more common problem before we began placing the lens implant immediately after cataract removal.
"Twenty, 30.40 years ago, the way to correct the problem was to use thick spectacles--the 'Coke-bottle' glasses--after surgery. Besides being very heavy, the lenses would magnify 25 percent. As a result, patients could not have one eye done and wait to have the other eye treated. Actually, a person could opt to wait, but with the glasses one eye would be 25 percent magnified and the other eye actually would be minified because a cataract induces myopia, or near-sightedness. The glasses made the disparity between the two eyes even more apparent.
"Today, instead of those spectacles for aphakic eyes (eyes without their natural lens), doctors can prescribe a contact lens to eliminate many magnification problems. You just wonder if a contact lens in one eye might help relieve your problem."
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We also asked Dr. Francis Price, a nationally recognized ophthalmic surgeon, to study your inquiry. He responds to you as follows:
"You certainly have an interesting problem with the image size difference between your two eyes. There are a few things that can cause this. One would be that the actual size of your eyeballs might be different so that the way the image is magnified within each eye causes the resulting images to be different sizes. That could be checked by measuring the length of each eye with ultrasound.
"Another explanation, perhaps in conjunction with a different size of the two eyes, is that one of your eyes is more near-sighted than the other. If your left eye is more nearsighted, that essentially gives you more magnification and will make things look larger. That would allow you to read up close without reading glasses.
"If your right eye does see distance clearly without glasses and your left eye sees near objects clearly, this is called monovision--each of your eyes sees a different distance clearly. Usually people suppress one eye or the other, depending on if they are looking at near or distant objects; however, especially up close, if you continue to use both eyes to view the near object, you could see double.
"There are ways to minimize this difference in image size between the two eyes, but in doing so you would most likely lose the ability to see up close in your left eye. If most of the time you are functioning adequately, you may not want to change this situation, as it does allow you to see both near and distant objects without glasses. However, if the situation is too bothersome, then laser refractive surgery could correct your left eye for distance and minimize the image disparity between the two eyes."
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