Sunday, August 21, 2011

Prism lens, Meniere’s disease and juggling

Our balance depends on a few things; vision, the inner ear and sensory input, which is contact from your arms, hands and feet among other things. As most of you with meniere’s know the inner ear stuff is a big problem for me and lots of other folks.  The vision, I believe, is also very important. I have had vision problems since I was a kid and in the past few years I had cataract surgery plus glaucoma. After the surgery the meniere’s seemed to be worse. A coincidence, maybe but I don’t think so.  I am not saying that I shouldn’t have had the surgery because it certainly has helped my vision, but it definitely had an effect on my meniere’s.
A recent comment came from FP who lives in Belgium who described their situation. FP was put on medications such as Betaserc and given treatment to help put the “crystals” back in place, which is a treatment that some doctors use for vertigo.  FP also started to juggle balls to improve hand eye coordination which helped. It is really interesting to see how innovative some folks can get when they are stuck with this disorder.
Then FP was introduced to prism lens
“The consultation lasted two hours: I did tests I had never encountered before and was prescribed prism lenses. Not fully understanding how they work, please bear with this certainly unscientific explanation: apparently research has shown that by changing the light refraction using prisms in glasses, this can alleviate motion sickness and the sense of instability experienced by people with vestibular asymmetry. There’s nothing odd-looking about these glasses - they don’t look ‘different’. When I put on these new lenses for the first time, it felt as if an invisible wire above my head was pulled tight and forced my head to the upright position. It was rather bizarre - and quite uncomfortable for the first six weeks with these new lenses. But after this - I threw the medicine away, and suddenly I came out of the fog: my concentration was back, my sense of spatial awareness returned. I no longer felt as if I would fall if I did not take extreme care walking down stairs nor did I waver when rising to make presentations nor did I feel disoriented after long flights. In short, I felt human.”

FP goes on to say that prism lenses don’t cure meniere’s disease but it does seem to help.
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  1. The prism lens thing baffles me. My ENT recommended that I see an ophthalmologist, because she was sure the prism lenses would help me with my nystagmus. Well, the eye doctor disagreed, and I have no idea why. I wonder if I should see another eye doctor about this, because my vision is still totally screwed up, 10 months after the labyrinthectomy surgery. I would have hoped my body would have done a better job adjusting by now.

    If anyone else has thoughts about prism lenses, I'd love to know about it.

  2. Peggy~
    Go to a different eye Dr.
    They are worth trying. For me they sharpened vision, and things didn't seem to be shifting around as much, plus my headaches were less.
    I had no short or long range vision with them...but the in-between really helped around the house or watching TV.

  3. I have worn prism lens most of my life (age 65) and have had MD about 10 years. I therefore can't say if they help or not since they were there first. Earlier this year I had surgery on the muscles of my eye as the prism was no longer keeping the left one straight. Iam still having to wear prism (4 out), which is what it was for several years prior. My ENT agrees that my genetic eye condition is a contributing factor. Has a lot to do with they way they each communicate with the brain. I am fortunate that my opthalmologist and ENT know each other (which I did not know for a while) and the communication between them is extremely helpful. My eye dr. is quite familiar with MD, did his residency under my ENT, and has other patients with it.

  4. OK, I think I need a new eye consult. That could be interesting, since the first guy was the recommendation by my ENT. Guess I'll launch some independent research to find another ophthalmologist.


  5. WELL. I saw my ENT today, had a new ENG test and a new caloric test, and the results showed I still have a low level of nystagmus that never goes away. This leaves me dizzy 24/7. My ENT wants me to go back to the same ophthalmologist, but she will call him first and talk to him about my case and insist that we try the prism lenses. This should be interesting.

    We are insisting on this because there are only two other things she can think of: a nerve section in the ear that was previously unaffected but seems to be causing some trouble now; and Botox injections straight into my eyes to stop the nystagmus cold. That freaks me out completely. Injections into my eyeballs is freaky enough, but the idea of injecting a toxin into my eyes is simply unacceptable. It even makes my doctor shudder to think about it.

    So, onward and upward, right?

    But I could use a few more details from people who have tried the prism lenses. Do they look like regular glasses? How long did it take you to adjust, and how did you feel while you were getting used to them?

  6. Injections into the eyeballs makes me cringe, it was bad enough to get them in the ear. I wouldn't do it either.

  7. I found it really funny that my doctor, who is a neurosurgeon, was so freaked out at the idea of needles in eyeballs that she had her shoulders pulled all the way up around her ears and was shuddering with horror. Way to sell the procedure, Doc. :)

  8. I have an appointment with the ophthalmologist this coming Monday to discuss prism lenses. I'm very curious about this now, although a little apprehensive. I can't even imagine what they will look like, and I'm wondering whether they'll be covered by my health insurance. I guess I'll find out.

  9. hello peggy
    good luck i hope its a piece of your puzzle that gets you closer to getting better and living a half normal life.
    one day you really should try Propranolol, within a week of taking this stuff i saw a huge difference, try it for a month you never know.

  10. Hi, Ali.

    Thanks for the good intentions, but propranolol is a prescription-only beta blocker that works on hypertension and slows your heart rate. That's pretty serious stuff. It also is contra-indicated for people with asthma, which includes me. So although I'm glad it helped you, I don't think it's on my list of options.

  11. hello peggy
    i would say valium is much more serious then propranolol (everyone on here seems to be on it), but you right it aint asprin thats for sure. many drugs have many different things they do, i.e. diuretics is also used for blood pressure, but we all take it for water retention. i take propranolol for migraines and head pressure. which is secondary to my menieres, but menieres drugs like serc and diuretics by themselves are of no use for me.

  12. You're right... valium is nothing to take lightly. I have a bottle of it in the house, but I use it very sparingly, because of its possible implications. When my symptoms become more dramatic, I use it, but very, very carefully.

    I tend to keep all prescription drugs at arm's length, if I can.

  13. Hi I am a internal Medicine Physican and also have Meniere's but nowhere as severe as what I am reading. I will try to explain the possible benefits for the prism lenses. All balance is processed through the Brain Stem at the Vestibular Nuclei ( Think of this center like the major crossway for 3 major and 4 minor highways. Or even a major airplane hub. The big input for your balance is the 8th nerves (vestibular complex) but your vision is the second largest input probably up to 20%. Then there are the motor/sensory inputs after processed through the cerebellum. For someone who has persistent nystagmus (tilting and movement of the eyes) secondary to your meniere's or even 8th nerve dysfunction, the Prism glasses may be a way of OFFSETTING the deficit and help with the symptoms. Think of it this way: Lets say your car gets into an accident and the whole central structure alignment get pushed 5 degrees to the left. The car will always tilt and move to the left despite trying to drive straight. You buy new tires and rebalance them to veer to the right and have them reset the individual tire mounts so they veer right (actually able to do this). What happens is the 5 degree pull to the Left is OFFSET by the adjustments you made to the new tire mount and the off center rebalancing to the right. This will eventually cause severe wear on the tires, but the car will drive straight. Same theory is behind the prism glasses OFFSETTING the vestibular nystagmus.

    PROPRANOLOL is a beta blocker antihypertensive, but it really has some great side effects for certain nervous conditions. We use it all the time for patients with essential and fine motor tremors. Does NOT remove the tremor but helps with symptoms. VALIUM is a controlled substance and is a Benzodiazapine like ATIVAN. It works wonders to actually calm down and decrease the electrical potentials of the brain. Therefore, these BENZOS do work well for the symptoms of Meneires. BUT there is NOTHING more potent about one medicine over another except there is some addictive and abuse potential with VALIUM. If prescribed and used appropriately, there is NOTHING WRONG with someone taking VALIUM regularly.

  14. Dr. Cheung, thank you so much for your input and explanations. I'm more hopeful now that the prism lenses might be of some use to me. I wish the ophthalmologist had given it more consideration a year ago when I first saw him, but he seems open to it now. So I'll keep my fingers crossed, and perhaps be less fearful of using Valium when I need to.

  15. Peggy~
    Try the lenses.
    I adjusted in about 2 weeks with only some eye and head aches (which we have anyway :))
    I had some dizziness when I removed them and switched to readers, and vice versa.
    My lenses looked normal, and I was able to choose my frame.
    NO eye injections!
    Lord only knows what side effects you could be left with.

    I've been unable to post for quite awhile.
    I finally had to unblock ALL blogger cookies to get through. ( It worked fine unchanged previously)
    Am I safe to do that? Techno I am not.
    Has anything changed on your end?
    I've missed everyone!

  16. hello lauri
    for me it all depends on the web browser i use, on internet explorer i can not send messages or even sign in, whereas when i use firefox web broswer all seems to work.

  17. Hi Lauri,
    I don't know what happened unfortunately this sometimes happens with blogger. I'm glad your back

  18. DR. CHEUNG~
    If you happen to catch this post, I wanted to thank you for your information. Sorry to hear you also suffer from Menieres.
    I have a question, should you happen to know...For someone who has quite frequent (or like Peggy, constant)Nystagmus, what damage is that doing to the eye muscles/eyes?
    Would the damage be permanent?
    Thank you.

    Ali & David~
    Thanks for the help! I may have to change browsers.

  19. Hi, Lauri, and thanks for the recommendation. I think I concur. Fingers crossed!

    Regarding not being able to post, I noticed that there appeared to be no new posts for about three or four days. Strange... But, like Ali, I use Firefox and have no problems with that, except that the Top Comments disappear from time to time. When that happens, I just keep reloading the page until it fixes itself. Quirky, but functional. Sort of.

  20. Erk. It never dawned on me the damage might be permanent.

    I went to the ophthalmologist today, and now I have a new prescription for lenses with a little prism in them. I'll take it in tomorrow to be worked up, and then we'll see how it goes.

  21. Peggy~
    I found a Nystagmus support site today.
    From what they had experienced, it seems that the prism glasses (or surgery on the eye muscle if it works for that persons Nystagmus) was about it for helping. Many of them had seen Neurologists and still came away with the prisms or surgery. I've been having Nystagmus a lot lately (not just during attacks) and I do find the glasses help some...but you have to keep wearing them.
    Luck to you!

  22. Peggy~
    Forgot to mention..the first prism lense prescript. he gave me was for only one eye, and too weak.
    Did not work at all, so I went right back.
    The 2nd one was stronger and for both eyes.
    That one worked.
    Don't hesitate to have your prescript. tweaked if the first isn't right. :)

  23. I will remember that... thanks for the tip.

    I'm grinding my teeth, though, because my blasted insurance company has stopped paying for refraction exams. That's the test they do to find out if your prescription is still working or if you need new or different lenses. Basically, the test everyone is going to need to do every year.

    What is WRONG with insurance companies????

  24. Peggy~
    Call them and fight that one.
    This is a medical condition requiring you wear these lenses. It may fall under a different category that they cover. Your ENT could back you up with a letter.
    Worth a try.

  25. Got my new glasses today. Holy cow. Progressive lenses AND a mild prism in one lens. This should be an interesting adjustment. But so far I love them. Everything is sharp as crystal at a distance, so all I have to do is adapt for the other fields.

    Fingers crossed that this helps...

  26. Congrats Peggy!
    I'm glad you decided to try them.
    Isn't the sudden sharpness in vision a trip!
    Makes you realize how bad your focus had become.
    You are right about the other vision fields, but even to have new clarity in just one is helpful.
    I found that wearing the prism's as often as possible also helped with the headaches.
    Hope you have continued great results!

  27. Thanks, Lauri! So far, the best thing about the new glasses is being able to sit and watch TV while knitting, because now both fields are in focus! That's pretty amazing. Still working on getting the focus right while using the computer or reading a book, though. I'm giving myself some breaks, because the constant use is making me queasy. But I'll build up to using them during all my waking hours soon.

  28. Peggy~
    Yes..just take it slow or it can cause U to feel dizzy, and actually increase headaches until U adjust. Actually at first I wore them too much, and later..not enough. I eventually found my balance, and then adjusted w/in 2 weeks.
    I have to switch to regular readers for computer or reading..but the prism's work great for tv or around the stores, etc. I do still have a little trouble wearing them and walking around outside though. Not quite sure where the feet are at.

  29. At the end of a day of wearing them, my peripheral vision is very blurred. I don't know if that's from the prism effect or the fact that the lenses are progressive. Early days yet, but I'm finding the experiment very interesting.

    I know what you mean about not knowing where your feet are. I'm having the same difficulty with stairs. I have to be careful with that to make sure I'm looking through the top of the lenses or under the bottom of them. But that's definitely the bi-focal effect.

  30. Peggy~
    I had completely forgotten about this.
    They did try the bifocal lense on me originally, but I couldn't wear them at all.
    Now it's just the regular prism lense.
    Even that one was readjusted to prisms both sides.
    Geez...sorry I forgot to tell U that!

  31. That's OK, Lauri... I thought about what the progressive lenses might do, combined with the prism. The prism is very, very mild, so I'm hoping it won't really be a great difference in the adjustment.

    The optometrist told me to call her in a week or two, after I give the glasses a fair shot, and she will change them as needed, with no additional charge for tweaking the lenses.

    Today is what, day four? And it's been kind of rough. I had a dizzy spell while throwing out some leftover food this morning, and ended up breaking a bowl because I couldn't recover fast enough.

    We also are in the area that got hammered by the SNOW yesterday, so maybe that's affecting me. All I know is I don't feel at all well today. :(