> So it looks like guttata grade is not so good, cornea are a little
> thick, pressure is OK. So what does that really mean?

> "ray" <spammers[at]do.not.reply.com> wrote
> > unless I can compare normal to what I have at present. So I have a
> > hard time judging morning haze or other subtle symptoms, but no
> > problem recognizing two images.
> I think you would have no trouble noticing AM haze. It's like looking
> through dirty cellophane, hard to miss.
> > I have read that Fuch's can cause blisters on the cornea. This would
> > seem to be consistent with what I am seeing, but I am not sure that
> > completely explains it happening in both eyes at the same time.
> Except not many Fuch's patients get to the blister stage, and you couldn't
> miss it because it's _painful_ and it's usually preceded by a decade of
> other problems.
> I don't think you have erosions either. They hurt. They hurt enough to drive
> people to the doctor. You haven't described corneal erosions or bullous
> keratopathy.
> > I was not prepared for the diagnoses so I did not have a list of
> > questions to ask. The doctor's description was the cells on the
> > endothelial layer were dying and therefore the layer is thinner than
> > normal and can't pump out excess water from the cornea.
> That's what creates morning haze. Closing the eyes overnight reduces the
> oxygen and the endothelial pump slows down.
> > He also said
> > there were "divots", might that be the same as erosion?
> Erosions might look like "divots" but they HURT. You aren't hurting. So your
> divots probably aren't erosions.
> Normal endo looks like a carpet of hexagonal tiles. "Missing tiles" are the
> only finding you've described and I think that's what he meant by divots.
> > The doctor
> > said he sees about one case a month like mine, but it is usually after
> > cataract surgery. The treatment is supposed to slow the progress of
> > the condition. It will not cure, reverse or stop it.
> I didn't know it would slow the progress. I'll find someone soon to ask.
> > I go back in 2 months so I will be better prepared to ask questions.
> > The corneal thickness will be measured again and compared. What are
> > the downsides to using the salt solutions?
> None. Just cost. Don't try to make your own.
> -MT

> unless I can compare normal to what I have at present. So I have a
> hard time judging morning haze or other subtle symptoms, but no
> problem recognizing two images.

> I have read that Fuch's can cause blisters on the cornea. This would
> seem to be consistent with what I am seeing, but I am not sure that
> completely explains it happening in both eyes at the same time.

> I was not prepared for the diagnoses so I did not have a list of
> questions to ask. The doctor's description was the cells on the
> endothelial layer were dying and therefore the layer is thinner than
> normal and can't pump out excess water from the cornea.

> He also said
> there were "divots", might that be the same as erosion?

> The doctor
> said he sees about one case a month like mine, but it is usually after
> cataract surgery. The treatment is supposed to slow the progress of
> the condition. It will not cure, reverse or stop it.

> I go back in 2 months so I will be better prepared to ask questions.
> The corneal thickness will be measured again and compared. What are
> the downsides to using the salt solutions?

> "ray" <spammers[at]do.not.reply.com> wrote
> > Thank you for your informative response. As you might guess I am
> > confused and frustrated.
> > > My symptoms are not really those of Fuch's and mostly not cataracts.
> > Question, if it were the cataracts would the polyopia come and go in
> > both eyes at the same time?
> Depends. Lenticular diplopia, if present in both eyes, could easily vary
> with external conditions (background illumination, target
> brightness/contrast) but it would be the same each time you reproduce the
> conditions.
> If there is diurnal variation, like it's worst in the morning, then
> lenticular problems don't do that. A cycle of corneal edema could make
> diplopia appear to wax and wane but there'd also be haze.

> > If just an optical problem how does one
> > eyeball know what the other is doing?
> Pupils normally change the same in each eye, and accommodation likewise is
> lockstep left/right. Both eyes inhabit the same environment, optically but
> both eyes also swell at night.
> > The doctor said to use a 5% salt solution eye drops 4 times a day and
> > a ointment at night. He says this will slow down the progression of
> > the process.
> I didn't know it was standard to treat asymptomatic Fuch's so aggressively.
> You've had no erosions and no morning haze, right? I'll have to check on
> that.
I tend to only notice changes. I didn't realize how bad my shoulder

> > He said come back in 2 months. Other than the
> > outrageous price of an ounce of salt water ($20) it seems to be a
> > reasonable course of action if I really do have Fuch's? The doctor
> > diagnosed based on microscopic inspection of the cornea and a device
> > that measures corneal thickness. Is this a definitive diagnose, or is
> > it very much subject to interpretation?
> It's hard to miss Fuch's in the microscope, so you can be sure you have some
> endothelial changes. But that doesn't guarantee you'll have symptoms.
> I'm no expert but it seems you'd have to measure corneal thickness at least
> twice to demonstrate edema in Fuch's.
> I've always held off using salt solutions and ointments until there was
> observable swelling or morning erosions, but I could be a few years behind.
I go back in 2 months so I will be better prepared to ask questions.

> -MT

> Thank you for your informative response. As you might guess I am
> confused and frustrated.
> My symptoms are not really those of Fuch's and mostly not cataracts.
> Question, if it were the cataracts would the polyopia come and go in
> both eyes at the same time?

> If just an optical problem how does one
> eyeball know what the other is doing?

> The doctor said to use a 5% salt solution eye drops 4 times a day and
> a ointment at night. He says this will slow down the progression of
> the process.

> He said come back in 2 months. Other than the
> outrageous price of an ounce of salt water ($20) it seems to be a
> reasonable course of action if I really do have Fuch's? The doctor
> diagnosed based on microscopic inspection of the cornea and a device
> that measures corneal thickness. Is this a definitive diagnose, or is
> it very much subject to interpretation?

> "ray" <spammers[at]do.not.reply.com> wrote
> > > I went to the eye surgeon. He said my cataracts were very small and
> > not the cause of my problem.
> It's the "small" or "early" cataracts that cause monocular diplopia.
> > He said that I had Fuch's Endothelial
> > Corneal dystrophy. This was based on see divots in the cornea and
> I'm very familiar with Fuch's and it's very common. The optical effects are
> negligible in early Fuch's.
> You haven't described essential Fuch's symptoms - morning erosions, diurnal
> haze - so presumably you're "pre-symptomatic". You might never have optical
> problems resulting from Fuch's. Many don't. The important thing is, if you
> do, it'll be fog, not diplopia.
> Not saying your surgeon was wrong, just I have trouble explaining static
> polyopia on the basis of asymptomatic fuch's. He prolly would too, if he
> slowed down to think about it.
> Don't change your treatment on my advice. But he didn't recommend any
> treatment, right?
> So just re the physics of monocular diplopia, I still think yours is
> lenticular.
> > symptoms. I don't seem to have the symptoms attributed to the
> > condition. Any insight would be appreciated.
> Fuch's is usually detectable in the microscope long before there are
> symptoms. Sometimes it never causes symptoms. It's a 10-20 year disease, but
> even at 20 years they aren't all "bullous", and keratoplasty is a safe and
> effective treatment if it ever went that far.
> You still _could_ have corneal irregularities that produce diplopia, but
> FWIW, it's still likely your diplopia is just loss of uniformity in the
> crystalline lens.
> -MT

> I went to the eye surgeon. He said my cataracts were very small and
> not the cause of my problem.

> He said that I had Fuch's Endothelial
> Corneal dystrophy. This was based on see divots in the cornea and

> symptoms. I don't seem to have the symptoms attributed to the
> condition. Any insight would be appreciated.

> Monocular dioplopia would come-and-go very readily with changes in the size
> of your pupil and the qualities of the scene.
> High-contrast, bright targets against dark backgrounds are classically best
> for eliciting monocular diplopia.
> Large pupils make it much more noticeable.
> Holding a pinhole close to your cornea would eliminate double images
> immediately.
> The only other reasonable cause for monocular diplopia would be corneal
> irregularities. These would vanish with pinholes too, but they are MUCH less
> likely to develop suddenly, if you're over 50 with no history of corneal
> trauma, surgery or degeneration.

> Have the surgery on one eye first, the eye with more noticeable diplopia.
> Surgical implants have their own phenomena, like flare and reflections. To
> some degree you're trading one for the other.
> -MT, OD
> "ray" <spammers[at]do.not.reply.com> wrote in message
> news:cif704tt58rjg3gesrqrgldb457h18kgn3[at]4ax.com...
> > I have monocular double vision in both eyes. It comes and goes fairly
> > quickly. It lasts between a few hours and a couple days. It occurs
> > in both eyes at the same time, but not to the same degree. Sometimes
> > I see two images quite clearly focused, other times it can be multiple
> > images. The double vision goes away completely if I look through a
> > pin hole. I went to an MD ophthalmologist who recommended new
> > glasses. I tried them and it makes little difference. I went to an
> > OD who thinks it is probably cataracts and referred me to a cataract
> > surgeon. I have an appointment at the end of the month.
> > > From my reading double vision can be a symptom of cataracts. I don't
> > think I have other symptoms. With cataracts does the double vision
> > come and go quickly? Any ideas of what else it might be that I
> > should have checked?

> The condition seems to get worse after reading. My eyes focus at a
> comfortable distance for reading, so I read without glasses. Maybe I
> should get brighter lights for reading?

> I assume this is a progressive condition. If so how fast does it
> normally progress?

> Monocular dioplopia would come-and-go very readily with changes in the size
> of your pupil and the qualities of the scene.
> High-contrast, bright targets against dark backgrounds are classically best
> for eliciting monocular diplopia.
> Large pupils make it much more noticeable.
> Holding a pinhole close to your cornea would eliminate double images
> immediately.
> The only other reasonable cause for monocular diplopia would be corneal
> irregularities. These would vanish with pinholes too, but they are MUCH less
> likely to develop suddenly, if you're over 50 with no history of corneal
> trauma, surgery or degeneration.
> Have the surgery on one eye first, the eye with more noticeable diplopia.
> Surgical implants have their own phenomena, like flare and reflections. To
> some degree you're trading one for the other.
> -MT, OD
> "ray" <spammers[at]do.not.reply.com> wrote in message
> news:cif704tt58rjg3gesrqrgldb457h18kgn3[at]4ax.com...
> > I have monocular double vision in both eyes. It comes and goes fairly
> > quickly. It lasts between a few hours and a couple days. It occurs
> > in both eyes at the same time, but not to the same degree. Sometimes
> > I see two images quite clearly focused, other times it can be multiple
> > images. The double vision goes away completely if I look through a
> > pin hole. I went to an MD ophthalmologist who recommended new
> > glasses. I tried them and it makes little difference. I went to an
> > OD who thinks it is probably cataracts and referred me to a cataract
> > surgeon. I have an appointment at the end of the month.
> > > From my reading double vision can be a symptom of cataracts. I don't
> > think I have other symptoms. With cataracts does the double vision
> > come and go quickly? Any ideas of what else it might be that I
> > should have checked?