The first thing I want to say is that I certainly understand your desperation and your needs. I can not feel them, I don’t share your visual problems, but I am empathetic to your cause.

Without appropriate clinical findings, it is difficult to establish a specific treatment plan for you or to make any particular recommendation. However, some resources are probably present around you. For example, you can consult at University of Waterloo School of Optometry to see how they can help you. The cost for treatments is usually lower in schools compared to private clinics even if the professors there are highly competent in their own respective field. Email or phone to vision therapy specialists over there and they will be able to provide you answers to your questions. In ophthalmology, make sure to consult with someone specialized in strabismus surgery. A general ophthalmologist will not know how to deal with you. It is unfortunate that there is a very few doctors who are specializing in strabismus care for adults in general. Make sure to consult the appropriate people.

Good luck !

Dr Langis Michaud, OD M.Sc. FAAO (Dipl)

Associate Professor – Université de Montréal

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There are definitely some binocular vision problems that can be treated very successfully with vision therapy. Without knowing your specific problem I cannot determine if vision training would be helpful in your case. In general binocular vision therapy is more common with children as their eyes are still developing and they are more likely to have binocular vision problems. Adults have usually adapted to most binocular vision problems, although this is not always the case. Binocular vision problems do not usually develop as an adult, although there are many situations where there could be an underlying problem that may not show itself until the eyes are under stress with a lot of visual demands. If you feel uncomfortable with what was proposed you may want to contact the optometrist to gain more information, or get a second opinion from another optometrist. In my experience it is difficult to definitively diagnose the cause of headaches. Ocular-related headaches tend to be milder than other causes and tend to occur during visual tasks. For example if someone worked on a computer all day at work, they would likely find the headaches worse at the end of the day and on days that they are working, but that the headaches would improve on the weekends when there is less demand on the vision system. You may also want to visit your family physician to rule out another cause of the headaches. Good luck!

Dr. Doman

You may have already explored this, but have you been either to your optometrist or to the CNIB to inquire about low vision aids and other devices that may be helpful to you? There are a number of new high tech devices that are able to aid people with low vision to better navigate the world around us. Many optometrists provide low vision services in their offices. I don’t know where you live, but if you are in southwestern Ontario the School of Optometry at the University of Waterloo has a great low vision clinic (Centre for Sight Enhancement). Here is their phone number: (519) 888-4708 and this is the link to their website: optometry.uwaterloo.ca/clinics/centre-for-sight-enhancement.

Dr. Doman

Dr. Doman

The symptoms you describe can be caused by an incorrect PD measurement, an incorrect prescription, a change in lens design (density and curvature) or poorly fitted eye wear. However, these symptoms can occur even when the PD measurement, the prescription and the eye wear fitting etc. is completely accurate. A significant change in prescription can affect the binocular coordination of the eyes because the functions of convergence (turning the eyes inward) and accommodation (focusing the eyes on a close up object) are intricately linked. A significant change in prescription most often alters the amount of accommodation required to see up close, and this temporarily upsets the person’s accommodation/convergence balance until the visual system adjusts to the change.

In my experience, patients can present with a wide range of maladaptive symptoms when adjusting to new eye wear. The identical change in prescription might not induce any negative symptoms in one patient, but cause another patient to go into a bit of a tailspin. I am encouraged by the fact that your symptoms appear to be lessening as you wear the glasses. So long as you continue to experience improvement, I would give it a little more time. You might want to return to where you purchased your eye wear to ensure that your glasses are fitted optimally. However, if after a couple of weeks you are still unable to use the glasses comfortably, I would return to your optometrist to have your prescription rechecked to ensure that it is adequate for your current needs. There are certain health conditions, such as diabetes, that can cause your prescription to fluctuate, even on a day to day basis. If a reassessment of your prescription yields a different result from the original, there may be underlying health issues that need to be addressed. If the prescription determined on retest is consistent with the original result, sometimes your optometrist will be able to prescribe an alternate lens design to which you might adjust more easily.

Best of luck,
Dr. Smit

What you are describing is a typical appearance of what are commonly known as “floaters”. Floaters are located inside the eye in the tissue called the vitreous humor and they cannot be removed by flushing the exterior of the eyes with an eye wash solution.

The vitreous humor is a clear gel that occupies most of the space inside of your eye between the iris (the coloured circle that controls the size of the pupil near the front of the eye) and the retina which lines the inside back of the eye. Normally at birth the vitreous humor is a fairly firm and perfectly clear gel like tissue. As a person matures, the vitreous begins to deteriorate as a normal part of the aging process. The gel becomes somewhat liquified and tends to break up into strands that can drift in front of your vision where they become visible as “floaters”. In most cases, seeing a few floaters is normal as we get older.

However, a sudden onset of new floater(s) (as in your case), especially if they are accompanied by faint flashes of light in the vision, can be an indication that the vitreous humor is shrinking and pulling away from the retina at the back of the eye. This is also a normal part of the aging process and is referred to as a posterior vitreous detachment. If you experience these symptoms (flashes and/or floaters of sudden onset), you should see an optometrist or ophthalmologist promptly because as the vitreous humor pulls away from the retina, it may cause the retina to tear. A retinal tear, if detected and treated early on, can usually be successfully repaired without any significant loss of vision. If a retinal tear is left untreated, it may lead to a retinal detachment. Treatment of a retinal detachment is a complicated and delicate procedure, and even if the treatment is successful, many patients are left with some permanent loss of vision.

I would advise you to see your optometrist to determine if your symptoms are just the result of the normal aging process or if they are an indication of more potentially serious changes inside your eye.

Sincerely,
Dr. Smit

The Canadian Association of Optometrists does not have general policy statement specific to the use of photochromatic lenses (lenses that change colour in response to different levels of available light). “Transitions” lenses are a trademarked variety of photochromatic lenses.

In my experience, patients may benefit from wearing photochromatic lenses, as they serve as effective sun protection for outdoor activities, and they lighten adequately to provide good vision for indoor activities. It is now known that exposure to direct sunlight can contribute to the development of cataracts, so wearing a lens that provides “on demand” sun protection when outdoors is probably a good idea. However, for daytime driving I feel most patients are better served with a pair of good quality sunglasses (also available in prescription form) because most photochromatic lenses do not darken as effectively when worn inside a vehicle. This is because most of the particular wavelengths of the sun’s radiation that trigger the darkening process in the lenses are filtered out by the vehicle’s windshield.

It is true that photochromatic lenses had earned a (somewhat justifiable) negative reputation in the past. I believe this stemmed from the fact that some glass photochromatic lenses gradually lost their ability to lighten up in low light levels. As a result, patients who wore an older pair of photochromatic lenses when driving at night often were wearing the equivalent of a pair of prescription sunglasses. Wearing sunglasses of any type for night driving presents a safety hazard and is not recommended. For night driving the best vision is provided with clear lenses with an anti-reflection coating. Today’s photochromatic lenses maintain their ability to lighten in low light conditions more effectively than the designs that were available in the past and most can be worn safely for driving at night.

You may want to reference a blog I posted on November 29, 2011 entitled “Sunglasses for Driving”, posted under the category “Sunglasses”. It provides a few more comments about the suitability of photochromatic lenses for driving.

In the meantime, if you are a person who likes to spend time outdoors and you are aware of the limitations of photochromatic lenses for daytime driving, the benefits of photochromatic lenses may well outweigh their potential shortcomings in your case.

Hope this is helpful.
Dr. Smit