Ophthalmology & Optometry/Vision correction dilemma

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Question
Hello,

I'm 57 years old, in good health, and have worn soft contacts for decades.  I have never had a problem getting clear and crisp vision in both eyes, although my prescription is different in each one (-5.50 in the left; -4.00 in the right).  After my most recent vision exams (at 2 different optometrists), I am still not getting crisp vision in my right eye after correction.  A slight astigmatism was eventually detected in my right eye for the first time, but even with a toric lens, the vision is still noticeably blurred in that eye (albeit it mildly) compared to the left.  I also noticed that my vision is much brighter in the left than the right eye when I compare them, and one of the doctors said this could be the early signs of a cataract in my right eye, although none can be seen on exam.  This "uneven" vision is driving me crazy, especially with distance vision, even though it's not severe.  The latest exam has me at 20/20 in both eyes, so why am I noticing that details are sharper in my left than right, and why do I feel as though there is a slight fog or haze blurring my right eye vision overall?  The doctors are frustrated with me, and I am frustrated with them.  There must be a reason that I am not seeing clearly from this eye and I'm hoping there is a way it can be identified and corrected.  There are no ophthalmologists in my area, so I am stuck with what I have locally for now.

Your professional opinion and advice would be much appreciated.

Answer
Summer,
It sounds very frustrating, I'm sorry.  
Nothing beats a physical exam, so it's hard to say without seeing you myself, but I suspect early cataracts may be the culprit.  At 57, it would be completely expected to have the beginnings of cataracts - most people start to show signs in their 50s.  As the crystalline lens inside the eye stiffens and the proteins change, the clear lens can get different kinds of 'haze' to it.  Some of these have little to no impact on vision and function, and other times the smallest amount can have a large and dramatic impact.
A dilated eye exam from any optometrist or ophthalmologist would be able to evaluate the lens to check for this and see if it's the culprit.
I would also suggest a visual field - which helps test the conduction of the optic nerve - how good is the signal from the eye to the brain.  It's a quick, simple test that 99% of eye doctors would have in their office.
Another pertinent exam would be corneal topography - a map of the front surface of the cornea.  With age, contact lens wear, and sometimes pathology, the surface of the eye can change - flatten or steepen in certain areas.  This can change your contrast sensitivity, increase blur, etc, but without a topography done it would be nearly impossible to detect.
If your problems persist or worsen, I would consider talking to your doctor about further testing including the above, or seek another opinion.
Good Luck!
Dr.D

Ophthalmology & Optometry

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John M. Dovie, OD, FAAO

Expertise

As a residency-trained Fellow of the American Academy of Optometry I am able to answer most questions regarding eye and vision health. Anything is welcome, ranging from dry or allergy eyes, bifocal contact lenses, or thoughts on LASIK surgery. As I am not a surgeon, detail-oriented surgical-related questions may be better answered by an ophthalmologist.

Experience

Selected to participate in the PCO residency program in Philadelphia at The Eye Institute, where I worked OD and MD specialists gaining invaluable experience in various clinics including glaucoma, cornea and cataract, oculo-plastics, retinal disease, neuro-ophthalmic disease, primary care, emergency medicine, and special populations. Have practiced and trained in numerous settings including hospital, academic, retail and private practice. I earned my Fellowship in the American Academy of Optometry (FAAO). There are currently only about 3000 active fellows worldwide, and there are only about 70 Fellows in the state of Virginia. I currently own and operate my own optometric practice/clinic.

Organizations
American Academy of Optometry, American Optometric Association (Contact Lens/Cornea Section member since 2001), Southwest Virginia Optometric Association, Virginia Tech Alumni Association

Publications
Seminars/Presentations:
“Nyctalopia as the Presenting Sign of Vitamin A Deficiency: A Late Complication of Gastric Bypass Surgery.” Clinical Case Study Poster presented at The American Academy of Optometry Denver, Colorado, December 2006, co-authored with Bradley Lane, OD.
“The Importance of Considering Paranasal Sinus Mucocele as a Differential Diagnosis in Diplopia.” Clinical Case Study Poster presented at The American Academy of Optometry San Diego, California, December 2005, co-authored with Kelly Malloy, OD, FAAO and Cherie Farkash, OD.
“Acute Onset of Halos and Glare: Bilateral Keratitis—An Atypical Presentation of Amiodarone Keratopathy.” Clinical Case Study Poster presented at The American Academy of Optometry Tampa, Florida December 2004. Also Presented to New Jersey Academy of Optometry, Neptune, New Jersey March 2005.
“The Opportunity for an Optometrist to Save a Life.” Clinical Case Study and Grand Rounds Presentation presented at The Pennsylvania College of Optometry, Philadelphia, Pennsylvania, September 2004.
Publications:
“Corneal whorls cause wonder.” Clinical Challenges Quiz, co-authored with Andrew Gurwood, OD, FAAO, Review of Optometry. Published 10/15/2006.
“Acute onset of halos and glare: bilateral corneal epithelial edema with cystic eruptions--atypical presentation of amiodarone keratopathy.” Co-authored with Andrew Gurwood, OD, FAAO. Published February, 2006, Optometry.
“Pondering the posterior polka-dots.” Clinical Challenges Quiz, co-authored with Andrew Gurwood, OD, FAAO, Review of Optometry. Published 5/15/2005.
Professional Involvement:
“AION: Amiodarone-Induced or Anterior Ischemic Optic Neuropathy?” Participated as a peer-review referee for Expert Review of Ophthalmology (London, UK); refereed 10/2006.

Education/Credentials
Bachelor of Science, Cum Laude, Virginia Tech. Bachelor of Science, Pennsylvania College of Optometry. Doctorate (OD), Pennsylvania College of Optometry Residency, Pennsylvania College of Optometry Fellow of the American Academy of Optometry

Awards and Honors
Winner, First Place, "Best Beside Manner" by Our Health Magazine: 2012, 2013, 2014 Winner, First Place, "Best Eye Doctor" by The Roanoke Times: 2013, 2014 Recognized as a Fellow of the American Academy of Optometry, December, 2006 Recipient of the Onofrey G. Rybachok Memorial Scholarship, 2000-2001 Member: The Golden Key International Honor Society Member: The National Biological Honor Society Member: The National Honor Society Eagle Scout awarded 1994

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