Odd vision issues
February 11, 2015 4:42 PM   Subscribe

Lately I've been noticing my vision just seems crappy; I notice my vision just seems "busy"/"shimmering"/slightly noisy. This is particularly noticeable when I'm looking at high contrast things, like computer monitors in a dimmer room. I also see "outlines"/a glow, around contrasting colours, as well as what feels like flickering in some portions of my vision towards the periphery.

First off, I'm a young man in his early twenties. I have a mild astigmatism that I have glasses for (this problem happens with and without them), that are pretty new. I have mild ADD for which I take Concerta (time release Ritalin), which I've taken on and off over the years. Aside from my father's bipolar (I have never demonstrated signs, even during periods of extreme stress such as a messy breakup), I don't have a family history of unusual neurological issues or out of the ordinary vision problems. I'm reasonably healthy, take a few vitamin supplements, eat reasonably well, etc. I've had semi-regular blood tests which have been pretty optimal (normal blood panel, thyroid panel, glucose, liver panel, creatinine, kidney panel, etc).

The best way to describe the issues I'm having, is it feels like my vision has suffered from crappy video compression. Text is still crisp, yet colours seem to smudge slightly (not severely as I was on acid or something, but there's a bit of bleeding). I can make out slightly flickering patches along the edges of my vision, as well as an overlaying portion of what feels like static. It's very subtle, but I feel like it may be the source of the "frenetic" quality things seem to have, particularly bright things. I also notice that I'm really susceptible to lights streaking/casting rays; at night it's constant (every light casts visible rays and has a hazy glow around it), while during the day every time I blink every light source casts rays.

I'm also very susceptible to afterimages; if I look at a bright portion of the screen and shift my image, I see a slight trail following my focus away from the bright portion.

All of this adds up to make my vision feel crappy, makes it difficult to work, particularly towards the end of the day as the sun goes down.

One thing to note is that my entire life (I can remember being 6 years old and seeing it, it looked the same as it does today), I've noticed that fairly regularly I experience what seems to be a "scintillating scotoma" that is visible when I'm looking at something very bright or reflective, like snow. It's not the alarming kind that migraine sufferers seem to have, as it doesn't block my vision in the area. It also is a bit different that the traditional description; more like in the center of each eye's vision, I see a gray shimmering that seems like tunnel vision. Once again, it's very subtle, but definitely there, and on occasion has been very clear (it seems to be worsened by dehydration/heat, it's hard to figure out which of the two common circumstances it is).

Anyone have any idea what could be going on? As I said, I had a recent eye workup, the only thing he didn't do was the dilated test, but apparently my retinas looked normal. I described some of the issues I'm having and he waved it away saying it's normal or could be related to my astigmatism. I can't afford to go back yet, so I can only leave it to speculation.
posted by Willz to Health & Fitness (13 answers total) 2 users marked this as a favorite
"Difficulties with accommodation and blurring of vision have been reported with stimulant treatment." From the FDA-mandated product insert. If you have questions about their intensity, character, or change over time, you need to document them now with your physician and track your experience between visits. This is a good thing to do, and an essential part of a physician's access to a complete medical history.
posted by late afternoon dreaming hotel at 5:02 PM on February 11, 2015

My dad has Fuch's Corneal Dystrophy, and one of the things that he first noticed was halos around lights. He'd also see distortion - like the green glow of the lights on the router in a dark room would be "doubled."

You are really young, though, and it is VERY rare for Fuch's to affect someone in their 20s.
posted by Ostara at 5:05 PM on February 11, 2015

Is it anything like visual snow?
posted by skye.dancer at 5:14 PM on February 11, 2015

Are your eyes dry? What happens if you use some lubricating drops? This sounds like my recovery from PRK surgery, which I know you didn't have, but it's always worse if my eyes are dry.
posted by J. Wilson at 6:19 PM on February 11, 2015

This would be something to talk to a neurologist IMO because I associate all of your symptoms with migraines and head issues. YMMV.
posted by Hermione Granger at 7:03 PM on February 11, 2015

The after images and the streaking of lights sounds like palinopsia, but when you have a hammer (I have palinopsia, visual snow and problems with accommodation) everything looks like a nail.

I agree with Hermione Granger, it would a good idea to see a neurologist next.
posted by squeak at 9:21 PM on February 11, 2015

New visual disturbances? You need to see a doctor, soon. You can probably get in to see your regular doctor or some other GP much much sooner than a neurologist -- and it's possible a neurologist won't be the specialist you need to see if it's serious. Some very serious medical conditions can cause visual disturbances as symptoms, and it's not unheard of for optometrists to wave away such symptoms because, well, your _eyes_ are fine.

Anyone have any idea what could be going on?

I know I'm not actually answering your question, but the things that are coming to mind aren't really conditions you want to be diagnosed with by strangers over the internet, and IANAD. You need to see a doctor, in person, who can examine you and will have a much better idea of what's going on.
posted by yohko at 11:25 PM on February 11, 2015 [3 favorites]

Get a dilation test. You can probably find somebody in your neighborhood who will do the whole exam for less than $100. If you're a Costco member, you can get it done there. You gotta do it, to really make sure there's nothing wrong with your eyes.
posted by Ursula Hitler at 12:44 AM on February 12, 2015 [2 favorites]

A neurologist might be a good place to start, but there are also specialists, neuro-opthalmologists, who specialize in sussing out what might be eye related vs. what might be nerve or brain related. What you're describing sounds like it could be neurological, so that may be the best place to start.
posted by goggie at 6:27 AM on February 12, 2015

It would be wise to make an appointment with an ophthalmologist, preferably a specialist as goggie suggested. New changes like these can happen for any number of reasons, some of which are not things you want to mess around with. I had some recent experience with this.

I'm visually impaired (underdeveloped optic nerves) and see a specialist once a year/as needed to ensure everything else is in order. A month or so ago, I went in for what I thought might be eyestrain. It was eyestrain, however, when he did the exam, the doctor noticed changes in my eyes since my last visit. The drainage angles were doing iffy things, and I was at risk for acute angle-closure glaucoma, (basically, your intraocular fluid would stop draining all of a sudden, causing a ton of pain and (very likely) vision loss). He lasered some tiny holes in my irises to provide extra drainage. I'm still visually impaired, but the risk of an additional issue has been reduced to near-nonexistence. The intraocular pressures were still normal, and no damage had been done yet. We caught it in time.

If I hadn't gone in for the eyestrain symptoms, I might not have known about this until the sudden onset. I could have lost the vision I do have.
posted by Flipping_Hades_Terwilliger at 9:35 AM on February 12, 2015 [1 favorite]

I may try taking a break from the Ritalin/cutting the dose in half to see if the vision issues could be related to it as "late afternoon dreaming hotel" pointed out; it makes given that the issues started fairly recently, and I've only been on the current dose for maybe 2 months or so.

It's worth pointing out that I've had the odd vision episodes (center of vision ripples slightly sort of like the shadow of heat waves you see cast on a wall beside an open window) my entire life. They haven't gotten worse except in cases linked to unusual circumstances (i.e really hot, moderately dehydrated; it never spontaneously gets worse on it's own).

As for the noisy vision (yes, it's a lot like mild visual snow, though it doesn't feel like noise over my entire field of vision, more like I see patches of subtle noise that seems to "dance" around the edges of contrasting colours), I've also had that for a long time when I think about it, but I've only noticed it infrequently, and it's only been on my mind consistently lately. It's hard to tell if it comes and goes or if I'm just obsessing about it the last few days, because it's not debilitating. I find if I get caught up in something I stop noticing it, so it's very mild.

I plan on going to a neurologist when I can, but I'm wondering what the possibilities are for the time being. I'm not a hypochondriac, so I won't read something and then decide I must have a brain tumor or something. I just want to be informed so I can ask a neurologist questions ("Do you think it could be X? It sounds similar").

Just to clarify some more details:

I never get migraines, and I wouldn't say I get regular headaches much more frequently than the average person (maybe once a month or less). My blood pressure is consistently optimal. I can't think of any transient neurological symptoms, just consistent difficulties (i.e I often will stumble midsentence and sort of garble my words, sigh, and restart, or I get stuck trying to find an easy word, etc) that I've had for as long as I can remember.
posted by Willz at 10:43 AM on February 12, 2015

On your followup, it sounds like these things have been happening as long as you can remember, and haven't increased in intensity or frequency, you are just paying attention to them now more than in the past.

Vision is weird, and everyone has weird stuff like floaters that they ignore a lot of the time. If you read the link you'll see that a sudden increase in floaters can be an emergency, but just having floaters is normal.

And yes, new neurological oddities can be a symptom of a brain tumor. Waiting around for a neurologist appointment isn't a good way to address that, you'd want to see your regular doctor who might do some imaging and refer to the appropriate specialist, which isn't going to be a neurologist. Sure, don't decide you must have a brain tumor, but don't decide you don't have one either, see a doctor and let them decide.

Try some eyedrops and see if that helps your vision.

consistent difficulties (i.e I often will stumble midsentence and sort of garble my words, sigh, and restart, or I get stuck trying to find an easy word, etc) that I've had for as long as I can remember

Everyone has this to some degree, but if you want to improve try Toastmasters, a speech therapist, or reading out loud to friends.
posted by yohko at 11:51 AM on February 12, 2015

I am fairly certain a brain tumor is unlikely, as it seems highly unusual for it to show up with only visual noise and trailing as the symptoms (I never have recurrent nausea, headaches, dizziness, mood swings, memory loss, odd sensations, etc), and they've been present at varying degrees my whole life. However they feel like they've intensified lately, but it's hard for me to tell if it just feels that way (I am admittedly very vigilant of changes in my body; I would not say like a hypochondriac, as it's within reason, but I have a tendency to notice even small changes) or if it's actually gotten worse.

I mean I'm open to the possibility, and will certainly get it checked thoroughly if I can confirm a worsening of symptoms or if new ones appear, but I'd rather not ask for a neurologist's referral prematurely, because I don't want my doctor to stop taking me seriously (we disagreed about getting my thyroid checked in the past, but he ended up ordering a panel at my request). So far I suspect it's either eye or optic nerve related, though unfortunately those are two areas that are not cataloged very well on places like Wikipedia. I've heard some interesting ones here so far that could be at play.

So my plan is as follows:

1. Get doc to prescribe 18 mg Concerta instead of my current 36. I'd rather not abruptly stop due to the withdrawal syndrome's effects on performance for the couple of weeks, as well as the fact that I do believe it benefits my concentration. I suspect if it's the cause, halving the dose will cause the visual symptoms to diminish.

2. If I notice no difference from that, I'll try to get a dilated eye test, and if it's not expensive, a glaucoma specific test too (though apparently glaucoma usually just causes loss of vision starting from the peripherals, and sometimes blurriness, but not noise or trailing).

3. If that comes back clean, and the problems remain or worsen, I'll get a referral to a neurologist who can conduct an MRI scan.

I'm still curious to hear ideas, as it's been really helpful so far.
posted by Willz at 5:08 PM on February 12, 2015

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