Any eye doctors in the house (questions)?

I don’t recall reading any posts from someone who is an eye doctor, but I’m hoping someone can speak to this problem. If it’s even a problem.

I had cataract surgery on both eyes. End result is 20/25 in both eyes because of a slight astigmatism. So I got some glasses from my regular optometrist to use for things like driving, movies, etc. Progressive lenses (which I’ve had before) for the clear, regular lenses for the tinted.

Here’s the problem. I noticed (and still notice), that there is what appears to be distortion. when I look at a flat surface, it looks tilted away from me instead of level. My computer screen looks like a rhombus, narrow at the bottom, wider at the top. When I go walking, I feel like a hobbit, as the ground appears closer than it should.

Now, I went back to the clinic (my eye doctor, not the surgeon) and one of the assistants made some adjustments to the glasses, but the problem is still there. She sort of brushed off my suggestion that perhaps the doctor could tell me if this is normal or not. I don’t remember having any of these issues with progressive lenses before surgery, so the problem (if it is indeed a problem) has to be either a result of the surgery or a problem with the glasses.

Any help?

Moderator Action

While parts of this can be answered factually, the overall post still basically falls under the umbrella of medical advice and is better suited to IMHO.

Moving thread from General Questions to In My Humble Opinion.

Does the distortion occur both while wearing glasses and while not wearing glasses or does it only occur when you are wearing say the progressive lenses? I personally refuse to get progressive lenses because of issues like this.

Only when wearing the glasses. As mentioned, I didn’t have problems like this with my previous glasses.

I am not an eye doctor, but this sounds to me as if it is just what you ought to expect from wearing progressive lenses. After all, they will have a different magnification toward the top of the lens from what they have toward the bottom. Perhaps the previous ones you had were weaker, or perhaps you just didn’t notice the effect before, but now you have noticed you can’t unsee it again. I certainly experienced unpleasant distortion effects when walking about in progressives after cataract surgery, and so stopped using them. (I now don’t use glasses at all when walking about, as my distance vision is adequate anyway, and use line bifocals for reading and the computer.) Many people say the distortion is easy to get used to, however.

Speculatively, it may be that the natural lenses of your eyes were able to compensate somewhat for the distorting effects of the progressives you had before, but the plastic lenses you now have in your eyes after the surgery will not be able to do this. (I never wore progressives before cataract surgery, so I can’t say this for sure.)

Are you wearing the glasses all the time, or switching back and forth? Do you have these issues with both pairs, or just the progressives?

Two possibilities are occurring to me. One is that you’re running around most of the time with no glasses, so your brain is compensating for the distortions caused by an astigmatism. When you put on the glasses, the astigmatism disappears, but your brain is still trying to compensate for it, which creates a distortion. I used to have that issue when I wore contacts about 70% of the time but also had a pair of rimless glasses. The glasses had a fairly strong prismatic effect outside my central vision that my brain compensated for just fine. I could put them on straight out of the shower, and everything looked perfectly normal. My brain could also not compensate for the prismatic effect just fine–I could put my contacts in straight out of the shower and everything looked perfectly normal. But if I wore one or the other for a few hours and then switched things were very swimmy and disorienting and my balance was all jacked up. I pretty much had to sit quietly and only use my central vision for about 30 minutes to let my brain switch gears, and then things looked just fine.

The other possibility is there was a mistake in the measuring, grinding, or fitting of your glasses. Some prismatic effect is normal for progressives, and some people adjust to that more easily than others. But it sounds like this is something beyond a normal amount of that, since you’ve previously had progressives and not had these issues.

Out of curiosity, have you tried closing one eye and seeing things still look skewed?

If you don’t get the effect without the glasses, your IOLs are probably fine. Most lens implants are very standard and the measurements used to come up with the right ones are very good.

You could try a new refraction (more optometry than ophthalmology) but the advice from here (assuming a competent initial refraction) is to give it a little time.

It’s amazing how the brain adjusts.

I’ve been using these since January and have pretty much gotten used to them. I don’t wear them when I walk, as the illusion of being closer to the ground is just too damn weird. I’ve gotten used to the distortion for the most part and mostly use the glasses when driving or at a movie or concert. Yesterday, though, I was starting to drill the dog holes in my workbench and was cursing the fact that the drill stand seemed to be canted off of 90 degrees. Then I realized I had my glasses on; when I lifted them up, everything looked just fine. I can live with this just fine, but it annoys me not to know the “why” of it.

Yeah, that’s probably a prismatic effect from your progressives. Prisms shift the path light takes to get to the eye, but the brain default operates on the assumption that the light took a straight line, so things look like they’re in a different place than they really are. Progressive lenses tend to have a very strong prismatic effect, but so do single vision lenses where the optical center isn’t properly aligned with the patient’s eye. For you to have so much prismatic effect that something as central as the stand on which you’re drilling something seems canted, I’m thinking you probably have both issues.

I would very much recommend taking the glasses back to wherever you had them made and asking them to recheck their IPD and add height measurements, both on you and on the glasses. If they balk, make sure you explain to them just how severe your problems are, that you can’t even look straight at something in your central vision without it looking slanted. There are a lot of places things can go wrong with making and fitting glasses, so most places are happy to recheck everything for a patient who’s having this much trouble.

I had the same issue whe I got my first prescription lenses. I am a bit nearsighted and wanted to be able to read road name signs before I was past them. The Dr. didn’t mention that I had an astigmatism that would be corrected for as well.

They worked fine in the car but, as you indicated, the ground seemed much closer than it used to! I walked like I was climbing stairs. When I got home I stopped just inside the door and exclaimed to my wife that the walls were out of plumb. They leaned out at the top. All of them. Every dad gum one! And the ceiling slants, too! And that telephone pole! With my glasses off everything was fine. I, too, went back to the doctor. He looked at my chart and saw the astigmatism correction and explained that my brain had been correcting for it forever and continued to do so with the corrective lenses, making right look wrong and vice versa. It took, IIRC, about a week of constant wear to train my brain that a straight line with the lenses is different than straight without. Now it compensats instantly either way.

All that to say, it sounds like the astigmatism adjustment. Perhaps they corrected for it differently this time?