Debbie:
I am a pwp and MD with an active practice in Neuro-ophthalmology and have
offered to answer this sort of question when it comes up. Unfortunately, from
your
description it is difficult to make a diagnosis. I gather your mother, who
has PD,
has a cataract in her right eye and has had a cataract-extraction with
intraocular lens implant in her left eye. Now she is complaining of
"diagonally distorted" vision and "muscular pulling."
It is possible that the diagonal distortion reflects a post-operative
astigmatism, but that sort of thing is usually well managed by her
ophthalmologist who might cut a too-tight suture in the cataract incision, or
more likely do a careful refraction and prescribe new glasses. If she has
already received her post-op glasses, the chances are that something else is
going on and if covering either eye and viewing monocularly [with one eye at
a time] improves or resolves the distortion, it is most likely that she is
experiencing DIPLOPIA or DOUBLE vision. PD results from a lesion in the
midbrain [part of the brainstem] and damage to neighboring midbrain
structures can produce a variety of abnormalities of eye movements.
Dont overlook non-preserved tears for her dry eyes and low blink rate.
To make a specific diagnosis I would need to know if the double images are
separated up and down or side by side, is her sense of distortion worse at
near or in the distance, does she have a head tilt, is she hypertensive, etc.
[To be technical, if the distortion is worst in the distance, she is likely
to have divergence insufficiency or relative in-turning of the eyes. If she
is having more trouble reading or looking close up, she may have a convergence
insufficiency, or a breakdown of the ability to fuse an old or long-standing
4th nerve palsy.] If she had cataracts for a while before undergoing
surgery, her eyes may have gotten out of the habit of fusing to make one
image, and PD makes it hard to regain this ability.
Check out all these possibilities with her ophthalmologist, who should
be able to pursue the differential diagnosis or refer her to someone who can
give her prismatic correction. I practice on Long Island and in New York
City but perhaps can help with referral in your area. In the meanwhile, if
the problem is really double vision and not refraction, she might have some
comfort and less pulling if you put an ordinary piece of scotch tape over the
inside of the right spectacle lens [the eye that aleady has blurred vision].
Let me know more specifics.
Jacquie Winterkorn, PhD, MD
