Double Vision

What is it? Double vision is exactly what is sounds like: a person sees two images when there is only one. There are two types, and the names give a hint as to what they are: monocular and binocular.

Monocular is double vision when one eye is closed. 

Binocular is standard vision with each eye separately, but double vision when both eyes are working together. If you close your left eye, you’ll see one image. And if you close your right eye, you’ll see one image that is in a slightly different location. When viewed together with both eyes, our brain merges the two images into one. But sometimes the eyes don’t work together quite right, so the separate images from each eye don’t exactly align. Things might simply look blurry if the images are only offset slightly, but if there’s enough offset people can actually notice two images instead of one.

It’s important to note that most double vision (aka diplopia) is temporary. That doesn’t mean that you should ignore it and wait for it to go away, because it can be indicative of something serious that needs to be treated.

Cause: There are myriad potential causes of double vision. Partly, the cause depends on the type.

Monocular double vision can be caused by cataracts, astigmatism, dry eyes, and even glasses or contacts that don’t fit properly. Obviously treating the cause will alleviate the problem.

Binocular double vision can be caused by something as simple as misaligned eyes (strabismus), or by something more serious such as neurologic disease like MS or myasthenia gravis; by problems like stroke, aneurysm, giant cell arteritis, or brain tumor; or by complications of diabetes/thyroid/Lyme diseases.

Tests: Obviously, given the possible seriousness of causes, it’s important to identify and treat the underlying cause of double vision. In addition to discovering the cause, tests will determine type and extent of the problem.

MRI can look for signs of thyroid eye disease or MS or tumor. Blood tests can check for thyroid disease, Lyme, and diabetes. Neurologic exam will test for nerve damage that might affect the eyes. The eye doctor can use a Hirschberg Red Lens test to check the eyes’ alignment. There are others, but these are at the top of the list.

Treatment for double vision is to first treat the underlying cause if they can determine one. Some double vision can be corrected with surgery – cataract removal or nerve repair. Sometimes they can add prism via a sticker on your glasses prescription to see if the prism will correct your problem. Long-term, prisms can be ground into your glasses prescription. Those bend the light before it ever hits your retina and trick your eyes into seeing just one image.

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Long long ago I visited the eye doctor to change from glasses to contact lenses. Since I was teaching swimming lessons, it seemed prudent to be able to see all my students no matter where in the pool they were. The exam went well, the doctor fitted me with a pair of trial lenses, and I was very happy as I got up to leave.

But then things deteriorated as I kept running into the wall on my way down the hall to leave. Things looked quite disorienting.

Back to the exam room I went so they could figure out what was going on. After a number of additional tests, the doctor determined that I had double vision. You might wonder (as he did) why I didn’t notice. Well, first off, it was more noticeable at a distance than up close. And second, the view from my window was beautiful and didn’t really make it noticeable that things were overlapping. Who counts trees?

But the main reason I hadn’t really noticed is that over time I had bent the frames of my wire-rimmed glasses to create my own correction. The doctor was quite puzzled why I hadn’t noticed until he asked to see my old glasses and discovered how askew they were.

Fast forward fifteen years and my eye doctor couldn’t fit our family in. I don’t expect a same-day appointment, but if we call in October to be seen over Christmas break, I would hope to get in sometime in December or early January. They didn’t have any openings until mid-February and that wasn’t the first time that appointments had to be booked three to four months in advance. For me, I don’t care. I can schedule ahead. But a college student who realizes a need for stronger prescription while away at school and wants to be seen while home on break should be squeezed in if they want to help their patients. I really felt like they didn’t care about my son so we called around and found someone who was able to schedule my kid – and since I was driving him, we scheduled me, too.

Even though I had been so happy, for years, that the eye doctor had figured out how to correct my vision, it turns out that he was negligent. As noted earlier, double vision is a huge cause for concern. When somebody has double vision, optometrists are not supposed to just throw prisms in glasses like he did. Standard of care is testing to figure out what’s going on. My new eye doctors were appalled that no testing had been done and insisted on those tests before writing a new prescription.

Eventually tests ruled out a few things, but didn’t find a cause. Sadly, things have gotten worse. I can blink and shake my head to get the images to merge, but they split again unless I’m really concentrating. Weirdly enough, people rarely split into two images – I suspect the movement keeps me concentrating enough to focus. Anyhow, I’m back to not driving because it looks like cars ahead of me in my lane are flying up into the air over oncoming traffic while oncoming traffic is veering into my lane headed straight at me.

Nobody wants me on the roads until I get new glasses.

We’re in Texas now and I’ve found a great eye doctor. She’s highly recommended. She listens to me. She explains well. And now I’m waiting because apparently they don’t like to write for more than 4 (somethings – she didn’t state any units so I don’t know what those are four of), and I’m measuring 8 and 12. She wants my old records before writing a new prescription. Meanwhile, I sit at home – still working on the unpacking process because we own too much stuff – wishing I felt safe to drive cuz even though we have really nice walls, but sometimes I get tired of staring at them and would like to go elsewhere.

Hope you are doing well.

Comparing Health Systems

Wow, do I ever like Texas! Aside from it being hot enough to fry an egg on the sidewalk, it’s great.

As we’re in the process of moving into our new house, I managed to break the toes on my right foot. OUCH!!!! In my old house, the stairs have a 6″ rise, but the new house has standard 8″-rise steps. My legs seem to think that they don’t have to lift those extra two inches.

And I know that there is usually no point in seeing a doctor for broken toes because they don’t do anything other than sell you an expensive boot. But after a couple days, the swelling went down enough that I could see this might be a problem that needed to be addressed. At home, I’d call my doctor’s office. They’d see me and send me across the street to an independent imaging place, then my doctor would look at the x-rays and decide if he could treat it or if he needed to send me to an orthopedist. Straightforward, easy, relatively affordable.

But that doctor is in Washington and I don’t have one yet in Texas. And timing just didn’t work out, so off we went to urgent care, who told us that emergency would be more appropriate for broken bones..

It was incredible to have people tend to the medical issues first, and later worry about money.

In Washington, you walk in and security makes sure you’re okay to be there and enforces the governor’s mask mandate. Then triage takes your identification and insurance card, after which they write down the chief complaint and take vitals; then they get your medical history and meds list. If they send you out to the waiting room, they’ll call you back up to collect the copay. Eventually you’re taken back and put into a room until the doctor can get to you. It takes a while. If you skip the waiting room and go straight back, they will interrupt the doctor to collect your copay. An hour or two after the doctor orders x-rays, they’ll get around to taking them. Who knows how long it will be until they read the images and return to explain the treatment plan. It’s very impersonal and they act like your injury or illness is a huge imposition. A trip to emergency takes 6-12 hours in Washington so you definitely don’t want to go. Even when my mom was admitted, she was in the ED for 12 hours before being taken upstairs.

In Texas it was very different. We walked in and went straight to triage where they put my name and chief complaint into the computer then did a quick check of my toes. Security was available, but off to the side and not in your face pushing masks on everyone who walks through the door. When I was taken back to be seen, the nurse and PA promptly descended on me as a team and the PA did the exam and ordered x-rays while the nurse took vitals (this makes the bp reading highly inaccurate). The nurse came back later for a meds list, and then later for medical history. Not one time did anyone ever harass me about the stupid pain scale. “You think your broken toe has a bone displaced? Let’s get some x-rays and take a look.” Eventually someone came and asked for ID and insurance info; there was a problem verifying insurance, but eventually she said not to worry about it and we could deal with it on Monday when the insurance company is open. They never did collect a copay. We walked in the door at 9:30 and were home before 1:00.

Every part of the experience was better in Texas. Plus everyone was really nice, chatted a bit, and treated us like real people. I’ve been dreading having to find a new medical team, but gotta say that my first experience with the medical system in Texas far exceeded my hopes or expectations.

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Thankfully there’s no displacement needing surgery. I chipped the bone and that little fragment is what I feel, but the breaks will heal fine without intervention.

What a Year!

It’s been over a year since I last posted. Partly, I’ve had nothing to say about RA because disease activity was mostly under control, and partly because I decided to pretend like I’m perfectly healthy. Living like an ostrich was fun – until it wasn’t.

Effects of Nutrition on RA

I continue to be fascinated by all the RA symptoms that could easily be attributed to vitamin deficiency – someday I’ll make a list. After merging a few different eating theories that seem to be well-supported by science, I created an eating plan and stuck to it. I felt better than I had in years, lost weight, and was in remission enough that I was able to stop all my meds. It worked!

Unfortunately, it took a lot of effort, and once I reached my goal, I stupidly went back to eating the way I used to – and after a year, I went back to weighing and feeling like I used to 😦 Now I’m back to eating carefully again and someday will share the tips I’m learning.

I’ve also found a Master’s in Nutrition program that I can do online, so am considering actually earning some credentials to back up and augment my informal reading.

I’m Moving to Texas!!!

Now that the kids are mostly through college, my husband has retired and we’ve been working on sorting through all the junk we’ve accumulated over the past couple decades, deciding what to move, what to donate to charity, and what to haul to the garbage dump. The movers should be here in a few weeks, and we hope to be fully moved by the end of September.

Finding a New Doctor

This needs to be its own post once I have some clue what I’m talking about. All I know at this point is that I need new doctors.

The situation is complex. My family physician of over 25 years retired in the middle of covid. I’d really hoped that he’d hang on a few more years but completely understand. So I need a new primary care doctor at a time that are are fewer than ever.

BUT we’re moving and I don’t want to do this twice. We have planned for a decade that once my husband retired, we would be relocating. Who would want to put the effort into establishing a new doctor-patient relationship when they’re moving in a year or two? Not me. So I’ve not seen a primary care doctor in a few years.

AND I also will need a new rheumatologist when we move. We’ve all heard horror stories about going to a new doctor who insists on doing completely new testing instead of trusting the previous doctor, and then claims that you don’t have RA – labs are normal, exams are normal because the meds are working! So I’m a bit apprehensive about 1) being able to get in to see a new doctor, and 2) getting appropriate care once I am able to get an appointment. Time will tell.

Sometimes Life Sucks

My computer died. Completely. So I lost a ton of stuff including access to my blog and two email accounts – thus I no longer get updates from all the blogs I follow. Everything else has been so complicated that it took forever to try to fix things. Today I finally got back into my blog. It will take a while to reconnect with people.

Last fall my niece’s one-year-old baby was murdered by the babysitter. This tragedy has been hard on everyone. The wheels of justice turn slowly. It certainly makes me think differently about serving on jury duty – which I got called for in the middle of covid. Tip: don’t eat onions for breakfast if you’ll have to wear a mask all day. I’m not trying to be flip or diminish what happened, but you just have to keep going because the thought that anyone could beat an innocent baby to death is too horrible to dwell on.

We also lost my mother-in-law this spring, and a month later my brother-in-law had a stroke. Apparently we’re getting old and will be facing things like this. It did serve as a wake-up call to my husband that there are lifestyle choices he should make while he still can. So he’s finally willing to eat more fish, and we also make time to go for walks together.

And not wanting to end with such a depressing section…

Bragging on My Kids

When I first was diagnosed and started this blog, my kids were still young. I managed to homeschool them despite all the ups and downs of learning to live with a chronic disease that nobody understands. The kids all grew up. Skip the next bit if you don’t want to hear me brag about my kids 🙂 But if you want reassurance that homeschoolers can grow up and go to college and live normal adult lives:

• The oldest graduated from college with an engineering degree and works as an engineer. He married a nurse (who was also homeschooled) and they now have three children. How am I old enough to be a grandmother?
• The second graduated from college with a nursing degree and psychology minor, and works as a psych nurse in a busy hospital. It’s an incredibly demanding job helping people who are really hurting.
• The third (the one with JIA who once told me that I could make her go to the doctor because she was a kid, but once she turned 18 she was never going again) sees our rheumy regularly, graduated from college, and works in a PT clinic while saving money for DPT school.
• The fourth graduated with two undergrad degrees: 1) accounting, and 2) kinesiology with a sports management emphasis. He then earned his MBA and is working as an accountant while taking the CPA exam series (one more test to go). He also played on the national champion Ultimate Frisbee team two years running. Last summer he got married to a brilliant biomedical engineering major who is now in grad school to be a prosthetist.
• The youngest is just beginning his senior year in college, majoring in business management. He’s spent two summers interning at a non-profit, and hopes to work with non-profits after graduation. He’s also planning to earn his MBA.

Back to Blogging

Once we get moved, I will try to get back to blogging. Our new house has a pool, so I’m looking forward to that nice, low-impact exercise that’s supposed to help my joints.

Hope you are well!