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Vision Deterioration
virtual_patient_009 posted:
I'm very frustrated over the way my vision has deteriorated over the years. Until early teenage, I had great vision: 20/15 on both eyes, no need for glasses. I'm 26 and I'm no longer able to see beyond 20/30, even with glasses. I fear that if this trend continues, I will start having daily life handicaps, including not being allowed to drive ( 20/40 is the legal limit in my state).

Examples of my vision problems

(1) Mild case of diplopia: Letters or signs appear doubled at the edges, especially when they are in high contrast with the background.
See this link , as an example
(2) Inability to read small road signs until driving almost passing by them. For example Interstate Highway signs have the word "Interstate" written in white font on a red background. Anytime I approach an Interstate sign while driving, I have to almost pass by it before I can read the word "Interstate".
(3) Need to sit in the front of a classroom to see clearly when the professor writes on the board. Shouldn't people with normal vision be able to read an average hand-writing regardless of where they seat?
(4) Inability to read smallest letters on the McDonalds Drive through Menu. Aren't Mcdonalds Menus designed so that a person with normal vision can read them in their entirety from the driver seat?
(5) Have to bend over to read small fonts on books à not very good for the back.
(6) Have trouble reading small fonts on the labels of groceries or items; for example some packages I have to bring them very close to my eyes in order to see them. I work with small electronic components and some have very small labels that I cannot see clearly.
(7) More difficulty seeing in the dark
Short story:
I have gone from seeing 20/15 in both eyes without glasses to seen at best 20/30 with the glasses. I have had many prescription changes since 2003. I'm currently trying rigid contact lenses, which are supposedly better for correcting astigmatism. But the contacts I'm wearing don't help me any better than the frame glasses. I know I have astigmatism and myopia, but I'm suspicious I have other eye diseases/ conditions as well.
Note: I don't have my most current eye prescriptions with me but I know for a fact that it is not more than 4 diopters (sphere or cylinder) on neither eye.


1. Aside from physical trauma or a chemical spill, is it possible for a person's eyesight to deteriorate overnight?
2. Do the Snellen Eye Charts tell you the whole story about eyesight acuity? In other words, can you have imperfect far vision, even if able to read the 20/15 line?
3. I understand that myopia has to do with the size of the cornea, while astigmatism has to do with the shape of the cornea. Assuming all I have is astigmatism and myopia, why are the opticians no longer able to prescribe a pair of glasses that could correct my vision to the 20/20 level?
4. According to my previous eye exam, which was done 9 months ago, I don't have keratoconus. Are there any conditions or diseases that could cause my cornea or other part of the visual system to be so fragile?
Alan M Kozarsky, MD responded:
I am so sorry that you are having visual problems.

There is almost always a discoverable reason why a person has a loss of best vision with glasses. It may be a corneal condition (change in curvature or clarity), change in the natural internal lens of the eye (cataract), retina, or a problem with the optic nerve. Your ophthalmologist should be able to tell you which structure in your visual system is causing your problem In most cases, the specific condition causing your blurred vision should be easily diagnosed.

While I cannot make a diagnosis without examining you, the exploration of rigid gas permeable contact lens as a means to optimize your vision is suggestive of a loss of normal spherical corneal shape as a cause of your vision problem. Rigid contact lenses can often neutralize the negative effect of irregular corneal shape on your vision. keratoconus is the most common cause of irregular corneal astigmatism. Even though your doctor says you don't have this condition, I am suspicious of this diagnosis. Without a diagnosis, I cannot give you a prediction of your visual future. Keratoconus patients, with the aid of contact lenses or corneal surgery almost always can have sufficient vision for driving and almost all other visual tasks.

If your ophthalmologist cannot give you a specific diagnosis for your condition, you may want to seek a second opinion.

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