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Read this if you don't see sharp stars...Map-dot-fingerprint dystrophy

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#1 Eddgie

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Posted 07 January 2017 - 10:53 AM

Consider this a public service announcement and not at all a "Pity Party."

 

Often we attribute our vision problems to things like cataracts or astigmatism of the eye lens but I have just had a major revelation about a condition that could affect up to 40% of the population (but no one knows for sure because it may be going undetected or unreported).

 

The condition is called Map-dot-fingerprint dystrophy.

 

I recently went in for cataract surgery and as part of the evaluation I was told (by two different ophthalmologist in the last year) that I have this condition.   Now neither really elaborated on it, so I thought little about it.

 

I had my cataract removed about a week ago.  The web tells us what to expect and of course my expectation was that I would see far more clearly withing even hours of the surgery, though a couple of days is more typical.

 

Four days into recovery and I was frightened that something had gone horribly wrong.  My vision especially at night was little batter than it was before the cataract was removed! 

A call to the doctor did not make me feel a lot better, but he said to give it a few more days until my followup.

 

During the follow-up, he studied me and said that the Map-dot-fingerprint dystrophy was likely aggravated by the surgery and that it would probably smooth out a bit given time, but that he thought that the condition would have to be treated by polishing the cornea or some other means (the good news here is that he believes that my vision can be improved).

 

Now this is the most important point.  Because my mom has glaucoma, I go to the optometrist annually and in all the decades of going not one of them has mentioned that I have Map-dot-fingerprint dystrophy.  Both ophthalmologist though mentioned this to me (though neither of them at the time really explained how this could be a major part of my vision problems but that is because these guys are pragmatist that just work though it one step at a time).

 

So, why am I posting this:

 

My belief is that amateur astronomers put more demands on eye site than almost anyone else.   A point source like a bright star is an incredibly revealing target.   Any flaw in the vision at all will turn it into something less than a perfect point.

 

I hear this all the time and especially for people using big exit pupils..  We (and I am guilty of this as well) often suggest that this is just the astigmatism in the eye, but I now know, and I am now sharing with all of you another highly likely cause of spikey stars, and one that might be possible to fix! 

 

If your optometrist has given you glasses with astigmatism correction but you still see stars or spikes or small halos around bright stars, you could have this condition.  Maybe your optometrist is better than mine have been (I have seen two in the last 3 years) then you may want to consider seeing an eye MD to have them check you for this condition and treat you for it if you do!

 

I am currently wearing a Bandage contact provide by my doctor and the difference was immediately obvious but he says that I can expect some improvement over about two weeks of wearing the contact, at which point he will determine the next course of treatment but he has given me some meaningful amount of hope that there are still major improvements that can be made to my vision.

 

The funny thing is that the estimates for the number of people that have this condition range from as low as 2% to has high as 40%.  My bet is that the number is closer to 40% and that most people do not apply their vision to the kind of use that we do and that often it goes undetected, or un-reported (by the optometrist) and is only really diagnosed when an MD doing pre-cataract surgery sees it and tells people about it.

 

So this is a public service announcement to CN readers.   Even if you wear glasses, if you have any spiking around headlights or when viewing bright stars at low power, rather than go to an optometrist on your next eye exam, consider going to an ophthalmologist instead on a one time basis to have the look for Map-dot-fingerprint dystrophy and if you have it, see about getting it treated.  This is a medical condition and it is likely that your insurance will pay for it. The doctor says that it is in-office (no need to go to a surgical center where prices are highly inflated and a broken toenail costs $5000). 

 

This concludes the public service announcement.

 

Stay tuned to this channel for a followup on the end result.   I will report in time how much improvement was achieved but I now know that the Map-dot-fingerprint dystrophy was perhaps degrading my vision as much as the cataract was and I am disappointed that the optometrist never identified this condition to me.  Any you may be experiencing the same thing. 

 

Again, this is NOT a pity party.   I was shocked to find that this condition exists and since I had never heard of it, my thinking was that most CN readers never have either, and being armed with the knowledge that the condition exists and knowing the symptoms, the readers of this post can be aware that it does, but more importantly that treatments exist that may improve your vision.  


Edited by Eddgie, 07 January 2017 - 11:19 AM.

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#2 nevy

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Posted 07 January 2017 - 11:35 AM

My optician tells me I don't have astigmatism but with naked eye viewing I sometimes se a spike or two , the next time I see him I'll test his knowledge & ask him about this , chances are he will either not have a clue what I'm talking about or he will just dismiss it , we'll see. 



#3 opticsguy

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Posted 07 January 2017 - 12:00 PM

WOW!! Thanks for this valuable information and thanks for sharing your personal experiences!!  A recent problem (vitreous detachment) already has degraded vision in one eye and I worry about my future as an observational astronomer. Eyes are much more important than telescopes and eyepieces. Maybe we need a separate vision forum??



#4 SeaBee1

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Posted 07 January 2017 - 12:23 PM

Thank you for this Eddgie! Your description perfectly matches my visual experience. My eye doctor has never mentioned this to me either, and has only treated me for my astigmatism. I still get spikes surrounding stars and assumed that this was normal. It has worsened in recent months, but that may be due to my increased awareness since taking up the hobby.

 

I will certainly bring this up on my next visit!

 

Thank you Sir!

 

CB



#5 Kent10

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Posted 07 January 2017 - 12:38 PM

I also see spikes in stars when viewing with my glasses even though they are corrected for astigmatism.  I always assumed my astigmatism was uneven and a lot worse when my pupils are dilated at night.  The curvature in my eye might be uneven.  Hard to know but I have always been curious about this because it seems the doctor can never get my astigmatism correction done right.


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#6 Eddgie

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Posted 07 January 2017 - 01:36 PM

I did not describe the cause of this condition because you can google it, but what happens is that the membrane below the outer layer of the cornea gets uneven due to some kind of lumping in that layer and this causes waves in the surface of the cornea.

 

And this was my caution.  My own optometrist (two different ones) both told me I had  cataracts year ago, but neither mentioned the Map-dot-fingerprint dystrophy.

 

That is why unless whoever is doing your eye exam is an MD, I would encourage you to make your next visit to an eye surgeon's office.

 

I was shocked at how much of my own aberration was apparently coming not from the cataract but from the dystrophy.   So many people reported seeing things with great clarity a day after surgery that I was in panic mode that the doctor botched it!!!!

 

So my main point is to inform readers of the condition and if they recognize the symptoms go to a real MD for your next visit rather than an optical shop examiner.  I do not know if they are not trained for this or what, but two out of two optometrist failed to tell me about this condition and two out of two MDs caught it and told me I had it. (thought again, neither told me how seriously it could affect my vision and my thinking is that their standard procedure is to do the cataract first and the deal with any other issue after).

 



#7 Eddgie

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Posted 07 January 2017 - 01:40 PM

And it might be good to bookmark this thread and if you don't mind sharing, report back on any positive tests, so that we build more awareness in the community.

Again, I have even told people that spikes on stars was caused by astigmatism and clearly that was gross ignorance of this condition.

 

If we get a few more people that report getting this diagnosis, it will help others with understanding the condition and help them be more aware of it.

 

It is thought to be hereditary, and it normally progresses as we age.   



#8 Eddgie

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Posted 07 January 2017 - 01:44 PM

And here is an excellent web page that gives a comprehensive description and treatment of the problem. 

 

If you have spikes in your vision I recommend reading this...

 

http://emedicine.med...945-overview#a4

 

Use the links at the bottom to progress though the material. 


Edited by Eddgie, 07 January 2017 - 02:03 PM.


#9 Eddgie

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Posted 07 January 2017 - 02:07 PM

Oh and when viewing the above, click the pictures to enlarge and you can clearly see the defects.



#10 Kent10

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Posted 07 January 2017 - 02:16 PM

I recall now that several years ago my doctor prescribed special prescription drops and they were very expensive.  I could have had cheaper ones but then it would take longer.  He described my problem as dry cells on my cornea from wearing contacts so long.  I assume after the drops that all cleared and now I don't wear my contacts as long in a day.  Our eyes don't have as much lubrication as we get older.



#11 Eddgie

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Posted 07 January 2017 - 03:41 PM

I recall now that several years ago my doctor prescribed special prescription drops and they were very expensive.  I could have had cheaper ones but then it would take longer.  He described my problem as dry cells on my cornea from wearing contacts so long.  I assume after the drops that all cleared and now I don't wear my contacts as long in a day.  Our eyes don't have as much lubrication as we get older.

Did you read the link above?

One of the treatments for this conditions:

 

Nonhypertonic lubricating drops or ointment may be used; the only prospective study to date detected no difference in the results of bland versus hypertonic lubricating treatment.

 

The next level of treatment involves bascially taking a spatula to the cornea and "Polishing" it. 

This is I think the proceedure my doctor is going to perform.  Basically it sounds like they rub it smooth. 

 

 

Place a lid speculum, then debride (with a rather blunt Kimura spatula) the entire extent of any loosely adherent epithelium or basement membrane level opacities. With sweeping and pushing motions, using the trailing or leading edges of the instrument, keeping nearly parallel to the corneal plane, redundant basement membrane level material can be massaged away, while maintaining the integrity of the Bowman layer.

There are other proceedures as well, but the really important point to this is that there are surgical methods (though rubbing with a spatula seems to be short of surgery in my book) that can actually reduce or eliminate the effects!

 

And since it is considered a surgery, my guess is that health insurance will pay at least part of it.

 

Also because it can be done in the doctor's office with numbing eyedrops, the cost should not be in the multiple thousand dollar range that you enter when you step into a surgical center. 

 

Man, I am jumping up and down with glee.. I thought I was broke bad and could not be fixed.  

 

I have probably had this condition for 10 or 15 years or more.  I remember changing from my dominant right eye to my left eye about 10 years ago because I just thought I could see more sharply with my left eye.  At this time, the problem was probably not at all severe, but in time it grew much worse and I attributed 100% of it to the cataract.    Imagine my surprise when they put in an IOL and my vision was still terrible!

 

And now I know way.

 

Even wearing the Bandage contact lens has made a huge improvement in my vision after only 24 hours, and when I saw how giant the improvement was, it made me think to start this thread because I have heard people complain about stars with spikes around them for more than a decade and no one ever mentioned this to me.

In addition to the bandage contact he gave me some over the counter eye drops and said to keep the eye lubricated.


Edited by Eddgie, 07 January 2017 - 03:44 PM.


#12 Kent10

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Posted 07 January 2017 - 04:34 PM

Yes, thanks Ed.  And good luck to you.  It all sounds very promising. 



#13 Eddgie

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Posted 07 January 2017 - 05:07 PM

Yes, thanks Ed.  And good luck to you.  It all sounds very promising. 

Thank you so much!

 

I hope this thread helps others.  



#14 SeaBee1

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Posted 07 January 2017 - 10:07 PM

Eddgie, my eye doctor is actually an MD, and he has never mentioned this condition. He has always treated me for astigmatism, and I always thought spikey stars were normal. I have never complanined to him of the spikes... but I will now!

 

Thank you Sir for posting this!

 

CB



#15 WadeH237

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Posted 07 January 2017 - 10:17 PM

My wife had Lasik about two years ago.

 

She has noticed since the procedure that one eye does not focus as well as the other.  She also had trouble getting her vision fully corrected with glasses prior to Lasik.

 

Given the description of this condition, I am wondering if one of her eyes has this problem.  She has annual check-ups with the surgeon and I will have her ask about this.

 

Thanks for bringing it up.

 

-Wade



#16 csrlice12

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Posted 07 January 2017 - 11:09 PM

For as long as I remember, from needing glasses from the get go to lasik surgery and the resulting floaters, my eyes just flat out suck.  Probably why I prefer mid and low power viewing...except maybe for globulars



#17 leonard

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Posted 08 January 2017 - 02:09 AM

Eddgie , First off let me say I wish you a full and satisfying recovery . 

I also never heard of this condition , big thanks for bring it up for the rest of us .

There seems to be some question about just what is normal when looking at stars with the eye alone and 

the image through the eyepiece . It appears to each of us what we see and have seen most of are lives

is the collective normal . I have no idea what a normal looking star should be . With my corrective glasses on and looking at a 2nd mag. star I see a point with very short radial spiking evenly spaced around the point . I see the same thing

with low power in the eyepiece . On very bright stars and planets I see the effect of astigmatism as spiking that is not 

even around the center but may enlongate to one side or both sides of the object . I have no idea if this is normal or just the way I see stars . If the readers that are interested could make a drawing and up load a pic of what they see with eyepiece and eye , we may get some idea of normal.



#18 samovu

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Posted 08 January 2017 - 02:50 AM

Eddgie, thanks so much for the public service info for something so important and dear to us that love viewing stars. And I hope that your vision improves  very quickly and completely due to your condition being properly identified and treated. 

 

By the way, and maybe I'm splitting hairs, but ophthalmologists are more than 'just' MD's. Well, they are medical doctors but they have had additional training after becoming doctors. So there is a HUGE difference in the amount of training that an ophthalmologists gets and what optometrists get. To become the former takes 11 or 12 years, the latter takes 4.

 

That's not to say that optometrists can't give good services. I'm sure most all do. But when it comes to identifying and treating diseases of the eyes, I'd much rather get the advice of an ophthalmologist. 

 

Clear views,

John

 

 



#19 spongebob@55

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Posted 13 January 2017 - 04:59 PM

Eddgie,

Thanks for this and I hope you're progressing nicely.

I just happened to have an ophthalmologist's appointment today and along with hand drawn pictures of what I see I had this information with me.  Sure enough, I have it in both eyes.  She explained exactly your description of it above.  I started talking operation, but she wants me to try the new prescription first; she says it might be able to correct the astig.  I also got the impression that even in an operation, they want to see if it'll aggravate the condition, and only then, treat it.  

Can you describe what you mean by a 'bandage contact lens'?   I never could wear contacts......

Regards,

SBob



#20 swsantos

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Posted 14 January 2017 - 01:02 AM

Map dot fingerprint dystrophy is not difficult at all to detect says this optometrist. I would bet that most optometrists who spend all day looking at contact lenses and corneas probably look more closely at corneas than most cataract surgery specialized ophthalmologists unless they are actually cornea and LASIK specialists as well. 

 

Just sayin'



#21 Eddgie

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Posted 14 January 2017 - 07:30 AM

Eddgie,

Thanks for this and I hope you're progressing nicely.

I just happened to have an ophthalmologist's appointment today and along with hand drawn pictures of what I see I had this information with me.  Sure enough, I have it in both eyes.  She explained exactly your description of it above.  I started talking operation, but she wants me to try the new prescription first; she says it might be able to correct the astig.  I also got the impression that even in an operation, they want to see if it'll aggravate the condition, and only then, treat it.  

Can you describe what you mean by a 'bandage contact lens'?   I never could wear contacts......

Regards,

SBob

The Bandage contact is apparently an extended wear contact that has no visual correction on its own and I think that the purpose is simply to help put pressure and tension on the cornea to flatten it.  It is temporary only. 

 

This made a huge improvement to my vision but I think it is temporary and after over a week while the cloudiness in my eye had abated, I see a very faint double image like fringe on lights.  It is like I am seeing a very slightly offset edge to things.

 

I suspect that he will have to do the polishing or perhaps more aggressive treatment to correct this.  Again, while the vision in the right eye is stupendously better than before the contact this is still a pretty bothersome condition.  A star will show a very bright spike at about 7:00 and a minor one at about 9.30.   Can't be focused out.

 

My ability to drive at night was hugely improved.

 

I have high confidence that he will at minimum  make meaningful improvement to my vision but I am of course keeping fingers crossed  that he will restore my eye to full visual acuity.

 

I am very pleased that my post was useful to you.   As I mentioned I have seen two optometrist in the last three years and neither of them mentioned this issue to me but both of the eye surgeons mentioned it almost as soon as the exam started so my guess is that because they are examining the area around the cataract to be removed, they see it quickly. 

 

If others are diagnosed and don't mind sharing, I feel that in a few months we will be able to have more conclusive proof that this may be the major contributor to reports of people seeing spiky stars at low power.

I am absolutely convinced that this is perhaps the major cause and not classic astigmatism as we often tell people when they report seeing spiky stars..

 

I am eager to hear your progress with the drops.  My own I think was perhaps to severe for drops because he started talking polishing pretty quickly..  


Edited by Eddgie, 14 January 2017 - 07:38 AM.


#22 Eddgie

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Posted 14 January 2017 - 07:37 AM

Map dot fingerprint dystrophy is not difficult at all to detect says this optometrist. I would bet that most optometrists who spend all day looking at contact lenses and corneas probably look more closely at corneas than most cataract surgery specialized ophthalmologists unless they are actually cornea and LASIK specialists as well. 

 

Just sayin'

It may not be difficult, but my guess is that it still goes undetected and unreported.

 

I have been on CN for 15 years and to the best of my knowledge, in all that time, no one has ever posted about this condition on these forums.

 

One would think that people were getting this diagonsis on a regular bases everyone on CN would know about it. 

 

My guess is that many of these people simply do not deal with people that routinely look at point sources and because they don't realize the impact it would have to astronomers they simply don't mention it because if they can correct the persons vision to 20/20 they just consider it to be a non-issue.

 

And that makes sense.  So while this is just a guess (a theory if you will) a theory gains validity as empirical results are collected and now within 10 days of my posting we have a second astronomer that has the same symptom and same diagonsis.

 

Theory is looking good so far and I expect that this is the tip of the iceberg.   My bet is that some substantial percentage of the older astronomers on CN have this condition and we have been telling each other to ignore it for as long as I can remember. 


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#23 Eddgie

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Posted 14 January 2017 - 07:47 AM

And without sounding mean spirited about it, on every visit to every optometrist in the last 40 years, I have be very clear to say that astronomy was a big passion in my life and that I valued the ability to resolve point sources and distant objects (pilot) and that I considered myself to be much more concerned than is typical because my activities made the highest possible demands that can be made on human vision which is looking at a point source of light. 

 

 As it turned out, the dystrophy was probably affecting my vision more than the contact was so if they saw it and did not tell me about it, even knowing that I was staring at point sources for hours at a time, and because of this, I think they failed me.

 

My girl friend goes to the same shop and she has started to wonder if she may not have the same issue because they never seem to get her vision as sharp as when she was younger.  They have been all over some issue with her retina and may have been looking past the area in front of the lens. 

 

Just sayin.


Edited by Eddgie, 14 January 2017 - 07:47 AM.


#24 Starman1

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Posted 14 January 2017 - 05:28 PM

There are many sources of the issues you describe.

 

Whereas you have undoubtedly come upon the reason you have vision issues, for many people it is simply a lumpy wavefront due to an irregular cornea.

 

Wavefront analysis of many peoples' eyes for LASIK surgery shows that many people have multiple axes of astigmatism at different angles.

My glasses, for instance, correct the dominant angle and diopter of astigmatism in my eyes, but my left eye still sees drop shadows on all letters and

I can take a DioptRx and hold it in front of my glasses and eliminate the drop shadow with an astigmatism correction that is at right angles to the astigmatism correction in my glasses.

 

On the Moon, I see three moons--one major moon and two partially superimposed moons at roughly 8 o'clock and 4 o'clock.

My glasses make this into two moons, one major and one at 4 o'clock.  With the DioptRx, I can get it down to one well-focused moon.

If you looked at my cornea, it would have high spots at 12, 3, 6, and 9 o'clock, and low spots at 2, 4, 8, and 10 o'clock.

That cannot be corrected with glasses.  And the risk of correcting it with LASIK (because it could be done) is that, in a year or two, one of the cylinders of astigmatism might rotate

and the correction be for naught.

I'm a lot fussier than 99% of the people my optometrist sees, and he corrected only the cylinder of astigmatism that allowed me to read well.

I don't observe with that eye, so I don't bother to DioptRx that eye to correct it.

 

I only tell this story to illustrate that other issues other than Ed's can result in similar issues.

 

Some people develop wrinkles in the sac behind the new lens implant, too, resulting in wrinkles in their vision.  This has to be solved with a laser opening of the rear membrane.

When my wife gets cataract surgery, she will also have to have a vitrectomy because she had a vitreal detachment that puts curtains in her field of view.

The eye has a complex list of possible problems.


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#25 swsantos

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Posted 15 January 2017 - 01:30 AM

Eddgie take a step back and look at it this way. Your ophthalmologist operated on you despite the presence of the mild MDFD precisely because it rarely and only infrequently causes visual symptoms and when it does it's usually only after a corneal stress like cataract surgery and obviously he felt your visual symptoms were cataract related and the MDFD was mild or he wouldn't have operated on you in the first place. If your optometrist had mentioned it to you there would have been no difference in outcome because MDFD is typically not treated unless it's so severe it causes the surface of the eye to slough off (a corneal erosion) and if that were the case you would have had physical pain symptoms, not just blur, and the surgeon would have addressed it or at least advised you of the risks pre op. I know from your point of view it's hard to believe but the reality is we refer lots of people with mild MDFD for cataract surgery because cataracts are way way more visual symptom causing than MDFD and the MDFD is dealt with after cataract surgery in those infrequent cases where problems arise post op and those cases are often not predictable beforehand. The relative impact on vision from a cataract is much much more than the impact on vision from MDFD so in the face of visual complaints both optometrists and ophthalmologists will blame the cataract before the MDFD and the fact that the surgeon himself operated on the cataract before addressing the MDFD proves that. The time between your optometrist not telling you about the MDFD and the cataract surgery in no way created the post operative problems you are facing because it's not treated when mild.  The fact that your ophthalmologist did not treat you for it pre op is proof of that. if the MDFD had been a predictable problem pre op putting the cornea in danger the surgeon would have not proceeded with the cataract surgery. Cataract surgeons do not pragmatically as you say fix one problem then the other, rather cataract surgeons put off surgery as long as they can in the face of a truly sick cornea.




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