vision & dry eye

[alittlemotel]

I didn't get any answers on the other board about this and I'm desperate for answers.
I went to the optometrist because I was seeing halos and starbursts around lights to the point where I was not comfortable driving at night, even with glasses. (My prescription is very low, I think it's -0.75 and -1.00.) She gave me the standard vision exam and she also checked my cornea, or is it retina for damage. At this point, I never even considered dry eye because I have allergies so my eyes are constantly irritated, even with meds. She said my blurry vision was caused by dry eye. When she did the glasses exam, she was able to improve my vision a little, but I still had smeary looking vision with the best corrected vision she could give me. She said this was caused by dry eye. I've been using Refresh Optive eyedrops and it seems a little bit better, but I really need to be able to see correctly. Can dry eye cause vision problems like this? I've only read about it causing minor vision problems. I'm worried she thought I was crazy.

[Rebecca Petris]

Hi alittlemotel,

Caveat: Not a dr, not an expert of any kind, just sharing some thoughts FWIW.

From what I've observed over the years... For dryness alone to cause enough consistent interference with vision that it reduces you to 20/30 (I'm going to assume your 'norm' is at least 20/20 - please say so if not - but going from average 20/20 to 20/30 means loss of two lines of best-corrected vision and that's a really big deal!), the dryness would probably have to be quite severe. In fact in those situations one would rather expect you'd be even more concerned with pain than vision. Can you elaborate a little on any non-visual symptoms of dryness you have if any? My impression is the only reason you even found out you had dry eye is because of vision problems, is that correct?

I think you're fully justified in pursuing a more detailed diagnosis of what's going on with your vision and why, exploring possible NON dry eye reasons. I would also find out from your optometrist's office any specific dry eye test results they did and how severe they consider the dryness.

Find out if they did any vision tests other than a simple refraction (that's what produced out the 20/30 number). Find out what your best-corrected acuity is in EACH eye, not just both together. Ask about possibility of getting corneal topography and/or wavefront aberrometry done.

The kind of symptoms you described in one post, all the starbursting etc, and even the loss of BCVA would be consistent with a significant rise in what's called higher-order aberrations. Can that be caused by dry eye, yes, but again, you've every reason to seek a better explanation. Corneal edema? Something else? I don't know what the other possibilities are, I just think you deserve more detailed diagnosis. Maybe referral to a good corneal specialist ophthalmologist.

[alittlemotel]

Thanks Rebecca. Although you are not an expert, you do know more than me about eyes. I don't have a lot of pain but my eyes are constantly irritated. I've had very bad allergies since I was a child so I assumed the irritation was due to that. This is more burning though, where it used to be itching when I was a kid. It's mild though. The only reason I did find out I had dry eyes was because the optometrist said it's why I couldn't see well even with glasses. I am just skeptical that dry eyes can cause this much variation from normal. She did drop some dye in my eye and looked very carefully at my retina. I was also dilated. I will give the drops some time and see if they help. If they don't, then I'll persue further diagnosis. I just needed to know if that was normal or not.

Hi alittlemotel,

Caveat: Not a dr, not an expert of any kind, just sharing some thoughts FWIW.

From what I've observed over the years... For dryness alone to cause enough consistent interference with vision that it reduces you to 20/30 (I'm going to assume your 'norm' is at least 20/20 - please say so if not - but going from average 20/20 to 20/30 means loss of two lines of best-corrected vision and that's a really big deal!), the dryness would probably have to be quite severe. In fact in those situations one would rather expect you'd be even more concerned with pain than vision. Can you elaborate a little on any non-visual symptoms of dryness you have if any? My impression is the only reason you even found out you had dry eye is because of vision problems, is that correct?

I think you're fully justified in pursuing a more detailed diagnosis of what's going on with your vision and why, exploring possible NON dry eye reasons. I would also find out from your optometrist's office any specific dry eye test results they did and how severe they consider the dryness.

Find out if they did any vision tests other than a simple refraction (that's what produced out the 20/30 number). Find out what your best-corrected acuity is in EACH eye, not just both together. Ask about possibility of getting corneal topography and/or wavefront aberrometry done.

The kind of symptoms you described in one post, all the starbursting etc, and even the loss of BCVA would be consistent with a significant rise in what's called higher-order aberrations. Can that be caused by dry eye, yes, but again, you've every reason to seek a better explanation. Corneal edema? Something else? I don't know what the other possibilities are, I just think you deserve more detailed diagnosis. Maybe referral to a good corneal specialist ophthalmologist.

[zuzu70]

A former coworker of mine headed to the optometrist one day because her vision had deteriorated so much she thought she was going blind. Turned out it was due to dry eye. Coworker told me that the optometrist wouldn't let her drive home because her vision was so bad. In our state you're allowed to drive with 20/40, so she must have been worse than that. (Granted, dried-out-contacts+dry eye probably gives poorer vision than glasses+dry eye.)

My coworker was put on a couple prescriptions (she did not tell me which ones) and now takes only restasis, permanently. Her vision is much improved, and she is even able to wear her contacts again (although she couldn't for a few months while her dry eye was being treated).

I know one of the big Dry Eye books (Latkany's, maybe?) talks about, if you're not sure if you have dry eye, put eye drops in and if your vision improve even for a second or two, you probably have dry eye. I can attest that this works for me, but it has to be really thin drops (refresh plus maybe) and I have to put them in and not blink at all. My vision in my dry eye is then crystal clear...until I blink.

Rebecca knows a LOT about dry eye, so I'm not trying to contradict anything she says, but I wanted to chime in with my coworker's story to give you some hope.