Star Bursts and Ghosting without any eye surgery

Hello together,

I am 30 years old and never had any eye surgery. In October 2016, I have developed Ghosting and Star Bursts symptoms in low light conditions (traffic lights, car lights, modem LEDs, white text on black Screen, etc.). I went to 3 eye doctors to do a Pentacam and OCT examination to rule out Keratokonus. All doctors said that there is nothing particular wrong with my eyes and that I should try eye drops, which rather do not help.

There are good and bad days regarding my symptoms. I would like to shortly summarize my situation. I can cover one eye and will still experience the symptoms.

  • If my pupils are enlarged, the symptoms are worse and it feels like that my eye has a prism inside.
  • Updating my glasses to stronger ones did not eliminate my symptoms, but improved them a little.
  • Before developing those symptoms, I was wearing normal contact lenses all day long for the last 17 years without any problems. I rarely used my glasses. Maybe this is one potential reason?
  • Driving at (11pm vs 6pm) in the night usually makes a noticeable difference. The later I drive, the worse the symptoms. Is there any explanation for this? I suspect that being tired can mean that my pupils grow?
  • Covering the bottom part of my eye lets almost entirely disappear my symptoms.

    Would it be possible that I can send you my Pentacam/OCT results to get your opinion? I would be particularly interested in knowing whether it makes sense for me to try RGP contact lenses.

    I have also prepared image examples of how I see the world in certain situations.

    With best regards,
    Paul
Original Post
By all means, feel free to send us whatever findings you have, including examination results, prescriptions, acuities, etc.

You say you went to three eye doctors to rule out keratoconus. Why were you suspicious of having keratoconus? I assume that you have been wearing soft contact lenses for all these years. Whether or not it makes sense to try RGP lenses depends specifically on what is causing your vision problem, so I will reserve comment. Generally RGP lenses will only improve vision relative to glasses if the (anterior) corneal surface is irregular. The Pentacam should reveal any irregularities.

Based on your description your problem is obviously something optical (as opposed to neurological). That would bring three things into consideration. (1) tear film, (2) cornea and (3) the physiologic lens. Since the drops you were given (I assume they were lubricating drops, i.e., artificial tears) gave you no noticeable improvement, I don't think the tear film is the issue. The Pentacam should give a good indication if the problem is corneal. The third possibility is the natural (physiologic) lens. You are quite young to have changes in the lens but it's possible and somewhat consistent with your symptoms.

Are you taking any medications?
quote:
By all means, feel free to send us whatever findings you have, including examination results, prescriptions, acuities, etc.


Thank you very much. I have prepared a PDF file. Should I send it via an email to info@visionsurgeryrehab.org ? I would feel more comfortable to not upload my examination results in public.

quote:
You say you went to three eye doctors to rule out keratoconus. Why were you suspicious of having keratoconus?


In the beginning of October I suddenly started to have accommodation issues. During this period of time, I also started to see severe "double images" for approximately one week when looking, e.g., at a PC monitor. I had troubles to see sharp (subjectively 50% of my 100% vision accuracy) and switched from soft contact lenses to glasses. After two weeks my sharpness returned more or less (subjectively 80% of 100%) and my "double images" and focus problems slowly almost disappeared, which I now rather call ghosting. I noticed that I'm more sensitive to light and that I experience increased light strokes. When I visited my first eye doctor and when I was telling him about my symptoms, he told me that this could be due to keratoconus, but he didn't have appropriate equipment (no PENTACAM, no Orbscan, no OCT) to examine this. This is the reason why I wanted to rule out keratoconus. I updated my glasses from (L:-6.00 dioptrins, R:-5.75 dioptrins) to (L:-6.5 dioptrins, R:-6.5 dioptrins) and obtained back my entire sharpness. It should be noted that I experienced similar issues 4 years ago (sudden loss of sharpness coming entirely back after 2-3 days), but never experienced any post-incident symptoms, which is unfortunately now the case.

quote:
Based on your description your problem is obviously something optical (as opposed to neurological). That would bring three things into consideration. (1) tear film, (2) cornea and (3) the physiologic lens. Since the drops you were given (I assume they were lubricating drops, i.e., artificial tears) gave you no noticeable improvement, I don't think the tear film is the issue.


Yes, these were artificial drops. I could imagine that both, (1) and (2), may be the case. Some light strokes are more or less constant and vanish away when my pupils shrink, but are not affected by any eye drops. Then, I sometimes additionally experience "dynamic" light strokes, which do change its size with each eye blink. These are influenced by eye drops, but not necessarily in a positive way.

It is especially my left eye, which is the problematic one regarding my symptoms. My right eye performs much better (almost no ghosting, only little light strokes). Maybe it is important to mention that when I tested one-day soft contacts, I also started to experience stronger ghosting issues on the right eye similar to my left eye with glasses. Hence, I didn't use any contacts since some months now.

quote:
The Pentacam should give a good indication if the problem is corneal. The third possibility is the natural (physiologic) lens. You are quite young to have changes in the lens but it's possible and somewhat consistent with your symptoms.


My second doctor told me that I have very clear lenses, which was confirmed by my third doctor. Is there a chance that bad lenses are hard-to-detect at an early stage?

quote:
Are you taking any medications?


I don't take any.
dede,

You can either email info@visionsurgeryrehab.org or you can Private Message (PM) me directly through this bulletin board.

You said in the beginning of October you suddenly started having accommodation issues. Can you relate this timeframe to any other change, like job requirement, prolonged reading demands, etc.? Does your career, in general, require prolonged computer use? The fact that your needed stronger lenses (more myopic) at your age is somewhat telling as it may pertain to prolonged near work. Often this is in conjunction with some convergence issues. I don't know if there are vision specialists (like optometrists) as opposed to eye surgeons in your country, but seeing someone who can evaluate the relationship between focussing (accommodation) and convergence is indicated.

Do you notice any eyestrain and or headaches when you read or use the computer for extended periods? Do you tend to hold reading material close or lean into your computer screen to see better?
quote:
Originally posted by Dr. DavOD Hartzok:
dede,

You can either email info@visionsurgeryrehab.org or you can Private Message (PM) me directly through this bulletin board.


Thank you. I wrote you a PM with my examination results.

quote:

You said in the beginning of October you suddenly started having accommodation issues. Can you relate this timeframe to any other change, like job requirement, prolonged reading demands, etc.? Does your career, in general, require prolonged computer use? The fact that your needed stronger lenses (more myopic) at your age is somewhat telling as it may pertain to prolonged near work. Often this is in conjunction with some convergence issues.


You are right about my career. I'm a researcher and my job requires to sit 8h+ in front of the computer. Before my incident, I was writing a publication, where I worked a lot during this period of time:

  • 21-22.09.2016: 12 hours
  • 24.09.2016 (Saturday): 15 hours
  • 25.09.2016 (Sunday): 16 hours
  • 26.09.2016 (Monday): I did not work this day.
  • 27.09.2016 (Tuesday): 6h hours
  • 28.09.2016 (Wednesday): 12-13 hours.
  • 29.09.2016 (Thursday): I noticed for the first time *slight* focussing problems with my eye.
  • For the next two weeks, I experienced a lot of focussing, sharpness, and especially strong ghosting problems.

    quote:

    I don't know if there are vision specialists (like optometrists) as opposed to eye surgeons in your country, but seeing someone who can evaluate the relationship between focussing (accommodation) and convergence is indicated.

    Do you notice any eyestrain and or headaches when you read or use the computer for extended periods? Do you tend to hold reading material close or lean into your computer screen to see better?


    I did not have any eyestrain, but headaches. The headaches came when I switched to new glasses. I had them for 1 week, which seems to be normal for many people. They are entirely gone since 2 months. I think the closer my monitor, the more comfortable I feel with this. I'm not entirely sure, but from the observations I made in the past, the symptoms also seem worse after doing near-sighted things like reading etc.

    I have no accommodation problems, anymore.
  • dede,

    Prolonged near vision activities mean that your eyes spend a lot of time accommodating (focussing). Think of it as a near "posturing" of the eyes. It may not seem stressful, but if this near posturing is excessive and daily, that posturing becomes fixed, your vision becomes somewhat more blurred in the distance, so you visit an eye doctor. Because your eyes are so accustomed to near, you easily accept additional lens power for distance (more myopic). Upon getting new glasses your distance vision is improved but your eyes are under additional stress to focus even harder as you attempt to continue the near posturing. While all this is occurring, your eyes need to converge excessively, you move reading matter closer and you may lean into your computer.

    The new glasses gave you headaches for a while possibly because of the convergence adjustment you were making by looking through stronger lenses. When the convergence is not complete (i.e., when your two eyes are not exactly aligned with what you are reading), the overlapping images between the right and left eye can give you a ghosting effect.

    The harder you focus, the more your eyes posture for near, the more your eyes converge, the closer you sit ... the more eyestrain, etc. You may not notice it as much in the morning, when you are rested, but later in the day it can become more difficult to juggle the focussing demand with the convergence excess.

    The essence of what I am trying to explain is often misunderstood by eye doctors. This is why I wondered if you can find an eye doctor who investigates ACCOMMODATIVE and CONVERGENCE problems. Also ask if the practitioner can do a "fogged" refraction. You might have to call around.
    According to my latest Pentacam/Wavefront exams my cornea is irregular being "probably" the reason for my current symptoms.

    I'm a pretty worried about my cornea getting worse, because it seems to be rare (unless it is a keratoconus) to just get an irregular cornea out of nowhere?

    I will have an apointment for fitting RGPs in 2 weeks and will let you know.
    Of course. If I ever try them, I will let you know. Promised! At the moment, I'm too scared to try any contacts and decided to postpone trying them.

    To give an update to all of you and mostly because I never found any thread on the internet that indicated improvements once such symptoms appeared out of nowhere:

    It seems that the described symptoms do improve very slowly, but honestly I'm still a bit sceptical. Maybe, my brain simply learned to filter some information. Time will tell, I guess.

    On on hand there are some improvments, but on the other I have new issues. I now also experience floater that even do shortly light up/flash, once they "fly" in front of my field of view and when there is a light source such as the moon, an LED, or a lamp. I don't have any other kind of flashes so I don't think it's a retinal tear or something similar. And I'm pretty sure that I also experienced this one month after my incident when looking at the moon. But it seems worse now.

    I can only speculate that my symptoms are somehow related to my vitreous body. Due to the floater increase, there must be some changes going on. In case it's difficult to follow me, I could also prepare some examples what I mean with flashes or lightening up.

    The floater issue seems to be strange to me, since any source on the internet only indicates that a shadow of the floater is projected on the retina, but the flashing is never mentioned in this context, only when there is a retinal dettachment going on which I believe is not the case for me.
    How's your condition now? My brother is recently experiencing this star bursts as he described and somehow related on your situation. It got little bad when he had a slight incident when we are installing the Smittybilt parts on his jeep. He resigned on his computer job to ease the eyes and the new stronger glasses seem helping.
    Hey reker45,

    Sorry for my late reply, but I just saw your question right now. Well, some things improved and other ones got worse.

    What got worse:
    1) Chronic eye floaters: they increased. Many more cast floating shadows on my retina. Additionally, they fly into the center of my eyes and shortly reflect light sources in low-light conditions. Really annoying. I can show you examples if you like. There are treatments like YAG-laser or operations, but they do not seem to be effective/safe enough and only ask for side effects/troubles.

    2) Chronic dry eyes: In the last months, my eyes got slowly dry/drier resulting in constant eye burning, which really badly affects my life quality. My eye lids are often itchy and eye lashes fall out. I have a tear-break-up time of 4 seconds, which is a bad value. I have no clue what the cause is and tried many things without success. Eye doctors in Germany only prescribe useless eye drops. I speculate that overwearing contacts or overuse of computers are my primary cause. See yourself how my eyes have changed within half a year since my problems started: http://imgur.com/a/AlAja
    What I wanted to tell you: your brother may have a dry eye issue, but is not symptomatic so far (feeling of dry eyes, eye burning, blurriness, etc.) except the star bursts. The bad thing about dry eyes is that there is no cure and it is a chronic condition.

    3) Star bursts seem slightly worse, but I stopped to pay attention, so I'm not sure about this. Nevertheless from my earlier observations I can tell that some days are better than others.

    What got better:
    1) My ghosting issue improved. Today, my left eye (the more problematic one) only has slight ghosting when compared to October 2016.
    2) My vision was somehow "blurry/bended" (difficult to describe) for a few months when reading text. This is entirely gone and I have "clear" day vision (except the annoying eye floaters).

    I have no clue what still exactly causes my star burts problem (forme fruste keratoconus?, dry eye?, degenerated vitreous?). Seems to be a combination of these things.

    With best regards,
    dede
    Dear Dr. Hartzok,

    I would be really happy to get further advice.

    Due to my developed dry eyes, I decided to give RGPs a new try. Together with LipiFlow (oil dots can now be observed on my lid margins!) I obtained a lot of comfort back, but I encounter new problems that I do not understand.

    I went to an optician who is specialized in fitting RGPs and she also fits patients with Keratokonus, so she has lots of experience and took a lot of time while refracting. We did a tear film analysis and also used the Keratograph for a further topography of the front cornea. Luckily, it showed that my anterior cornea still does not show any irregularity or any sign of Keratokonus.

    So, we started to do a new refraction for the new RPGs 4 weeks, ago. With my feedback during refraction, we determined that I still need:

    Left: -6.5 without astigmatism correction
    Right: -6.5 with a cylinder of -0.25

    My current glasses have:

    Left: -6.5 without astigmatism correction
    Right: -6.5 without astigmatism correction

    I would like to repeat that my 3-year-old glasses (the ones I have used prior my issues started a year ago) had the following values:

    Left: -6.0
    Right: -5.75 (with this glasses my higher order aberr. were really strong and awful a year ago)

    So, we ordered RGPs with L:-6.5, R:-6.5,Cyl:-0.25 (of course she transformed the values to the corresponding RGP values).

    She said that both RPGs fit really really well (swimming on my abnormal tear film, fluroscin) and I indeed could tolerate them easily within a few hours (regarding the movement/fit on my eye).

    When arriving at home I now wanted to read something on my notebook and I noticed some blurriness, when trying to look at any text (near, mid range distances). So I started to cover my right eye with my hand and the image was clear. Again, I looked with both eyes and there was some blurriness. So I now started to cover my left eye with my hand. The image was COMPLETELY blurred, but after a while it would focus and become clear, which means that my right eye only refused to accommodate in binocular situations. Using the right eye alone with the RGP, I experienced VERY SIMILAR accommodation issues like a year, ago! My right eye had a hard time to focus, but it managed to obtain the sharpness of the image after 2-3 seconds with some problems (image on focus, image out of focus, image on focus again, image shifted, image shifted back and forth (bouncing), etc.).

    I suspected that my new right RPG must be too strong. I decided to borrow a +0.5 glass from my old optician to do some tests on my own. So, I was wearing my new RPGs and was looking through the +0.5 glass with the right eye. And I did not experience any blurriness in binocular situations, but I still did notice that my right eye would do a stronger image shift, once I would cover my left eye. In the first days it also bounced a lot like it could not decide what's the best position.

    The longer I was using the RPGs, the better the entire situation got, but I felt that my eyes would get used to too strong RGPs, which cannot be good. So, I decided to do a new consultation with my optician telling her my finding, and our latest refraction indeed showed that my right RPGs was too strong (-0.5). So, we ordered a weaker RGP for my right eye. We discussed that there could be a different optical effect (since the tear film now fills a gap between contact lense and cornea) or it was a combination of varying eye day-performance potentially explaining the wrong value.

    So, I obtained my new RPGs approx 10 days ago and we did a new refraction. Everything seemed to be fine this time. But, when I arrived at home, the first days were horrible. My eyes had a really hard time to focus (a lot of blurriness with both eyes) and it took me almost a week to get rid of most accommodation issues. I could literally feel muscle tension. When I would look at a person, it also felt like that the right part of my head is going to tear apart, which is gone to 90%. In the distance I see sharp and clearly.

    There are a few questions that I have:

    1) I have re-read your post about the too strong glasses and it seems to make a lot of sense. 3 months ago, I was refracted by a very experienced optician (45 years of exp), who determined: L: -6.5, R: -5.75 (!), Cyl:-0.25 telling me that I easily accept and compensate too strong glasses. He used some device from the distance that flashed me a lot (I think this is used for children as well to determine the vision accu., but I don't know the name, maybe I'm wrong as well...) Back then and a day later, I have also borrowed a +0.5 glass and tested them with my current glasses (L:-6.5,R:-6.5) to find out whether my right glass is indeed too strong. Since the image was really blurred way too much and since my eyes felt very dry during refraction (potentially altering the measurement), I decided to NOT get a weaker glass for my right eye. Did I conclude wrongly that the refraction must have been wrong?

    As time moved on and before even trying RPGs, I have started to experience a lot of dizziness in the last 2-3 months, particularly in the mornings. Could it be related to too strong glasses, which I'm potentially wearing since a year now (-0.5 too much on the left eye and -0.75 on the right one?) Or is this rather unlikely, because I had no dizziness issues for the first 9 months with the exception of the first week?

    2) The main reason why I'm writing is because I still have accom. problems with my new RGPs after 10 days of constantly wearing them. I still often notice that the text is blurred (due to accommodation!) in at least on eye and that my eyes needs too much time to obtain sharpness. I'm sure that this is not due to dry eyes or blinking, since my lenses are already on position when this occurs (means while staring). When I look at my smartphone or laptop (particularly near vision), it often feels like that I need to compensate on my own to keep up the sharpness. As soon as I try to relax my eyes, my entire vision becomes completely blurred and I then start to also see doubled/triple images (ghosted text) in ONE eye only, really very similar to my initial complaints of higher order aberrations on low-light conditions! Isn't this a strong indicator that my eye lenses are maybe damaged, for example from excessive computer work? I have read about some early-and-difficult-to-detect cataract versions that can cause such double/triple images. My RGPs DO NOT correct my higher-order aberrations if my pupil is large, but they fix them pretty much in case my pupil gets just a little smaller.

    Weirdly, the blurring (while doing near work and trying to relax my eyes) particularly happens a lot when I'm rested, which is in contradiction to what you wrote in your post: you wrote that I should have less accom. issues in the morning as my eyes are then rested. If I'm getting tired, i.e., it is getting very late under the same light conditions I have less troubles, but they are still there. A general observation of mine is that when I'm tired, my pupil is larger under the same light conditions and maybe this has something to do with that? Do you think that the small irregularities on my posterior cornea could be responsible for such accomod. issues?

    In an additional experiment, I took the +2.5 glass from my parents and looked through it while wearing my RGPs to shortly test my near-vision: I neither start to feel any particular tension (I maybe only notice a very slight bouncing) nor does the text gets blurry upon relaxing my eyes when looking at my smartphone or notebook and the text actually even looks better. Is THIS a sign that my RGPs are still too strong? I would also like to notice that when I tilt my head downwards, I start to see clearer and seem to have less accom. issues?

    Should I just give my eyes more times to get used to the new RGPs?
    quote:
    So, we started to do a new refraction for the new RPGs 4 weeks, ago. With my feedback during refraction, we determined that I still need:

    Left: -6.5 without astigmatism correction
    Right: -6.5 with a cylinder of -0.25

    My current glasses have:

    Left: -6.5 without astigmatism correction
    Right: -6.5 without astigmatism correction

    I would like to repeat that my 3-year-old glasses (the ones I have used prior my issues started a year ago) had the following values:

    Left: -6.0
    Right: -5.75 (with this glasses my higher order aberr. were really strong and awful a year ago)

    So, we ordered RGPs with L:-6.5, R:-6.5,Cyl:-0.25 (of course she transformed the values to the corresponding RGP values).


    dede,

    It's very hard to provide advice based on the numbers alone, but I will say this: If a patient's glasses Rx is -6.50, the RGP lens Rx should NOT be -6.50. That would indicate that your RGP lens is fitted steeply (too much curvature) or is simply overpowered or a combination of both.
    I returned to (slightly weaker) glasses as the symptoms are less (50%) as opposed to wearing RGPs. I have finally figured out that the bouncing of my right eye or the "my eyes often get out of focus on their own in near vision situations" problem is due to having stiff neck muscles (believe it or not...). I did not see/believe this relation, since my neck never hurted/hurts.

    EVERY TIME, I massage or do some sport practices to loosen my neck muscles/region, my dizziness/and the eye focussing problems (almost) entirely disappear + my Tinnitus gets from a 4/10 to a 0.5/10... Also, near vision (reading a book or being on the smartphone) becomes instantly much more relaxed.

    These statements (https://visionsurgeryrehab.evecommunity.com/eve/forums/a/tpc/f/2786055494/m/7847088516?r=7307098516#7307098516) were very true and from my personal experience I conclude that neck problems can cause eye problems and vice versa.
    Just wanted to inform other sufferers and Dr. Hartzok about some finding.

    After my new eye doctor inserted punctum plugs (lower lids), my text ghosting issues are almost gone and if they appear I can now blink them away in most situations. Before this, there was a "dynamic" and "fixed" ghosting effect. The fixed part seems to be mostly gone or is significantly reduced. Also, my other visual night symptoms are 60% better. Particularly, whenever I just closed my right eye, I would see a ghosting in my left eye in virtually EVERY situation. This is gone since 3 days (the point in time when I got punctum plugs inserted).

    My schirmer 1 was: R:17mm and L:15mm, while my schirmer 2 was R:10mm, L:8mm. According to slit lamp exam my left eye is much more worse regarding dry eyes and this was always my more problematic eye, as well. So this matches well with my symptoms.

    LipiFlow did not fix my visual night visions symptoms, but ONLY plunctum plugs did improve them noticably. Putting eye drops and wearing RPGs (the symptoms were just different) did only have had a tiny impact on my symptoms and I tested this a lot of times on my own.

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