Diplopia

Diplopia. Ever heard of this word before? Me neither – at least not until I ended up with it. It’s more commonly referred to as double vision. This is the latest of my MS relapses. It’s been a killer hot, dry summer here. And like most people with MS, I have heat intolerance (also called Uhthoff’s Phenomena – there’s another fun new name to learn!). What that means is that my body doesn’t regulate its own temperature properly. So when it gets hot, my system becomes overly stressed, causing nausea, weakness, “pseudo-exacerbation” (which is a fancy term that just means existing symptoms feel worse for a while), and sometimes even new relapses.

Suddenly, about seven weeks ago, we were on our way to church when I noticed that everything looked very strange. Every item in my view outside of the car was slightly out of focus, similar to viewing a 3-D graphic, but without the 3-D glasses. And it all felt like it was frantically swirling around me because we were moving.

At first I didn’t think it was a big deal. With the constant fatigue, my eyes often just refuse to focus properly unless I put in tremendous effort. So in those cases, I just let everything be blurry until I can rest my eyes for a bit. But after several days, it still wasn’t going away. I could see things within a few feet of me just fine. But anything farther away was, well, trippy!

The only vision issue I knew of that MS can cause is Optic Neuritis. And that one is a scary one because it can be quite painful and can leave you blind. But being familiar with the symptoms, I was pretty sure that’s not what I had. In fact, I wasn’t really worried about it all because it didn’t hurt. It just seemed like an annoyance that would resolve quickly and I’d never know what it was. Well, that’s not quite how it went.

So began the online research that, let’s face it, we all use to diagnose ourselves. It took a while to figure out exactly what this symptom even was. “Everything is blurry and moving” doesn’t exactly bring up obvious results. But eventually I figured out that what I was seeing was a pretty classic case of horizontal double vision, or diplopia. This is the most common kind of double vision. It can be triggered by a number of things, and usually resolves on its own in time. Essentially, my eyes are not focusing in unison. Each eye is interpreting objects slightly out of sync with the other, creating two images. So I can see clearly out of each eye if I close the other. But when they’re both open the images don’t quite work together. The reason everything feels like it’s moving is that my eyes are working overtime trying to readjust to make the image uniform. Most often diplopia is caused by a nerve miscommunication to the eye muscles. So it makes sense that it’s most likely an MS symptom, since that’s basically what MS does.

Diplopia doesn’t hurt, but does put a tiring “pressure” feeling on the eyes. In the morning it starts off less pronounced because my eyes have been resting all night. But as the day wears on, and especially if my fatigue is really bad that day, it gets worse. And of course the heat isn’t helping either.

How the moon looks to me

The weirdest thing was looking up at the moon one night. When I let my eyes relax and blur, the moon went from one fuzzy light in the sky to two distinct moons, which started off close to each other, but quickly moved farther away from each other and then settled into two distinct side by side images. Like I said, trippy.

In my research I found conflicting recommendations to deal with the issue. Some articles recommended wearing an eye patch over one eye. Others said an eye patch is not recommended because your eyes need to keep trying to figure out how to focus properly. But for the sake of basic functionality, it seemed like something I should at least try. Well, what a miserable thing! The elastic pulled so tight around my head that it flattened the patch out onto my eye, which was horribly uncomfortable. So, I resorted to wrapping the elastic around my glasses arm to try and hold it in place. That didn’t work well either because I had to constantly adjust it back into place. And boy, do you get funny looks wearing the stupid thing (well, at least, I do…)! As an added bonus, wearing a patch means you lose your depth perception. So in addition to having slightly off balance, I also had to really watch where I stepped so I wouldn’t trip! Not a great solution, but better than nothing in a real pinch.

My stick-on prism. It attaches on the inside of my glasses on one side and is barely visible.

In the meantime I went to an optometrist for the official diagnosis. (Never trust Google for your diagnosis!). And yes, Google got this one right. A good optometrist can diagnose and determine the level of diplopia very quickly and easily by using the eye chart and a variety of glass prisms for testing. Though if you do have MS, it’s important that your optometrist also check your optic nerve closely to see if there is any obvious inflammation. A temporary stick-on prism was ordered to put on my glasses. A prism helps to focus one eye into the direction of the other eye’s line of vision. It can be hard to determine whether both eyes are focusing incorrectly or just one. The prism can go on either side of the glasses and have the same effect, at least in my case. It was a long wait for the prism, but when it finally arrived, it worked quite well. It does create a slight blur because it’s soft plastic with little lines cut in it (creating the prism effect). But it did finally allow my eyes to focus.

BUT then a few days after I was fitted for it, my eyes improved a bit! Not completely, but just enough that the prism wasn’t helpful anymore. Ugh! So then began an even longer wait (more than two weeks, if you can believe it!) for them to order a new lower strength one in for me. Sure enough, it did the trick.

Hopefully this means that I’m on my way to getting better. For some people this condition is permanent. If that’s true for me, I will have to get a special permanent prism lens for my glasses. But hopefully the fact that it’s changing means it’s on its way to remitting. I sure hope so because those temporary lenses are expensive, especially when you need different strengths.  I don’t want to even think about what a permanent lens costs! We’ve still got another six or more weeks of summer ahead, so I will likely have to wait for at least that long before I have complete improvement.

So, short story long (as always with me!), that’s my latest relapse. Supposedly it’s quite common for MS patients, though I haven’t found many articles or testimonials about it online. So I’m adding my story to the bunch. I hope it helps bring some comfort to other patients to know they are not alone in this and it will be OK. Again I am blessed with a relapse that (while  annoying and frustrating) is extremely mild compared to so many other potential symptoms this condition can cause. I thank the Lord again for His provision and pray that he will use this to sanctify and teach me, for His glory. If you have diplopia and have any questions or comments, please comment below or send me a message anytime.