Double Vision: A Personal History

I am lying in a hospital bed inside the staging area of a busy surgery center in Scottsdale, Arizona. It is early in the morning, and yet there is a thrum of activity all around us. I watch comfortable-looking sneakers stream by under the privacy curtain at the foot of the bed. Lisa holds my left hand, the one without the IV. I am no stranger to hospitals, but until now, I’ve been the one in the visitor’s chair. I take deep breaths, but my heart thumps like a piston in my chest. Fight or flight.

A nurse comes in to check my vitals.

“Oh, you’re nervous, aren’t you?” She asks as she removes the blood pressure cuff from my arm. I’m still thinking about that two-page surgery consent form I signed.

An anesthesiologist joins the nurse, and they chat about the heavy traffic this morning. I wonder what I can say to stop all this, to get back in the car and get the hell out of here, but before I can think of a good enough reason, Lisa is kissing me and wishing me luck, and I am wheeled away into surgery.

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But I’ve gotten ahead of myself. Let me start at the beginning.

Eleven years ago, just after my fiftieth birthday, I started having trouble reading late in the day. This is common for people of a certain age, but the reason I was struggling wasn’t normal. Instead of a single row of data on a spreadsheet, I saw two, one below the other. If I closed one eye, everything was fine.

I went to an optometrist who prescribed reading glasses with prism to correct this double vision.

“Is this serious?” I asked. Before I made the appointment, I diagnosed myself online. Never do that.

“I doubt it,” he said. “You’ve probably been fighting this your whole life, but as you got older, your eye muscles weakened and finally gave up.” He said this kindly, as if he had seen how it would play out.

Fast forward eighteen months. The double vision had worsened. Aided by the prism in my glasses, my eye muscles relaxed and weakened further. Now I was seeing double while driving. Taking my glasses off after using them for a while felt like entering a house of mirrors.

Concerned that there might be something seriously wrong with me, I went to see a highly regarded neuro-ophthalmologist at the University of Washington. The visit revealed a cause but no cure. I suffered from a cranial IV nerve palsy, stemming perhaps from too many thudding left hooks to my temple during my teenage boxing career. But because my double vision was relatively minor, there was no alternative to wearing glasses.

Two years later, I needed two pairs of glasses to function: a weaker prism for morning and a stronger prism as my eyes tired. If I used the stronger glasses too early in the day, I was left with uncorrectable double vision by evening. By the start of this year, I was using eight different pairs of glasses. An outing often meant packing three or four pairs as my vision changed.

Over time, my double vision got worse and worse. I was examined by seven different optometrists and ophthalmologists over a ten-year stretch. All were sympathetic to my situation, but none offered anything but glasses with stronger and stronger prism lenses. “Surgery,” they all said, “was too risky for someone like me with so little correction. You wouldn’t want to make it worse, would you?”

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Fused vision is something most take for granted. Losing it affects many parts of life. Simple things become difficult: driving, reading, writing, cooking, shaving, and even making eye contact. When my eyes are tired, I see four eyes looking back at me. Which pair should I look at? Instinctively, I turn away.

An inherent weakness in using prism glasses to correct double vision involves simple geometry. The prism works to fuse objects at near working distance. Further away, the geometry changes so dramatically that the same fixed-prism correction is no longer sufficient. This means that things like highway signs, birds in flight, and boats on the horizon are always doubled, even with glasses.

I’m a private person, so I didn’t often talk about this condition with others. What could I say? I have a vision disorder that makes it a challenge to do basic things, and it’s only getting worse year by year.

At least part of my decision to retire early stemmed from the fatigue and frustration of this persistent double vision. In my last year of boating, I struggled to make out the navigational beacons marking tricky passages. Being a trawler captain was one of the great joys of my life, but piloting a 60,000-pound vessel isn’t something you can safely do with sketchy eyesight.

The medical term for double vision is Diplopia, which comes from the Greek words Diplous (“double”) and Ops (“eye” or “vision”). Many have experienced short-lived double vision from drinking too much or receiving a blow to the head. Chronic diplopia is much less common. There are no reliable estimates of how many people suffer from it. Eye specialists I’ve asked said they see one or two patients with diplopia a week. I would guess there might be millions of adults here in the U.S. dealing with chronic double vision. These people, like me, have been forced to adjust to a diminished life with little hope of a cure. It is believed that Socrates endured double vision from an early age, which might explain why this consummate debater so readily drank the hemlock at his trial.

Earlier this year, I saw a new ophthalmologist who specialized in double vision. I learned that my prism needs had increased once again. What started as a single prism diopter in 2015 had grown sevenfold. I could no longer function without these thick, eye-distorting glasses, which is ironic since my vision is otherwise pretty good. If it weren’t for diplopia, I wouldn’t need glasses at all.

I also learned that surgery still wasn’t an option. My condition stemmed from an eye muscle that was notoriously difficult to correct surgically. “I wouldn’t risk it until you can no longer tolerate prism glasses,” the ophthalmologist told me. “If you did pursue surgery, your best bet would be to seek out a pediatric ophthalmologist. They do these kinds of surgeries all the time for children, and some operate on adults.”

Later that day, I reflected on what I had learned. My double vision will continue to worsen to the point that I will eventually need surgery. And that surgery will most likely be performed by a pediatric ophthalmologist, not the optometrists and general ophthalmologists I had seen. Maybe, I mused, I’ve been asking the wrong person about the possibility of a surgical remedy.

Around this time, I had been experimenting with AI agents. I told Claude about the cause of my double vision and asked whether surgery might be an option. Claude was refreshingly optimistic and forthright about my chances. It suggested I consult with James Plotnik, a pediatric ophthalmologist at Phoenix Children’s Hospital. Dr. Plotnik wasn’t in my insurance network, and he required a referral from another ophthalmologist to book an appointment, but he treated adults and could give me an informed answer on the prospects of surgery.

I got in to see Dr. Plotnik three months ago. I detected a faint Northeastern accent alongside his gruff, no-bullshit manner. I related my vision history as succinctly as I could. He performed his own assessment, having me watch his upheld finger as he shifted his hand over first one eye, then the other. He measured my visual imbalance using a scale of prism diopters on what looked like a plastic ruler.

After a few minutes of this, he shared his prognosis. My condition wasn’t severe enough to mandate surgery. I could continue to wear glasses with up to a 10-diopter prism before the lenses became too thick and heavy. Or, I could have the surgery now, though the chance of a successful outcome was only 50%, and the surgery could possibly make things worse.

I asked about the difficulty of the surgery, telling him I was told that my particular condition was the most complicated of all eye muscles to surgically correct.

“You’ve got a weak Superior Oblique. It’s one of the more forgiving muscles in response to surgery,” he said. He explained that optometrists and ophthalmologists have little experience with eye muscle surgery. “I’ve done five surgeries like yours every Friday for the past twenty years. It’s actually a pretty simple operation.”

A fifty/fifty chance felt bleak. No better odds than a coin flip. My gut reaction was no, no, no. Too risky. I fretted about the possibility that the surgery could make things even worse; that I would lose what meager vision I possessed.

But I also knew that as humans, we have an irrational aversion to losses. We hate to lose. Behavioral studies suggest a loss feels twice as bad to us as the same level of gain feels good.¹ You might have experienced this if you held on to a job you hated or stayed in a relationship that didn’t serve you. In my case, I was clinging to an untenable health condition.

Based on the trend of my worsening double vision, I knew it was just a matter of time before surgery became imperative. Even if the chance of success were only 50%, the upside was enormous. I would get my life back. Now.

Plus, Dr. Plotnik has had 5,000 patients undergo this surgery before me. Surely that improved the odds. I would roll the dice.

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I wake from surgery. My right eye is bandaged. I am groggy but learn the procedure went well. The anesthetic wears off, and my eye itches and aches, but not unbearably so. Once home, I sleep most of the day.

The next morning, I brace myself and remove the bandages taped around my eye. The room spins. My vision is fuzzy but fused as I look forward, but looking around produces disorienting double vision that is much worse than anything I’ve ever experienced. The eye itself looks better than I expected, though I catch my breath when I pull down the eyelid to examine the surgical site.

On the third day, my vision is considerably better. I take a walk to the park with only a pair of cheap sunglasses to shield my eyes from the Arizona sun. The worst of the peripheral double vision has subsided, though my neck aches from turning my head in the precise direction I want to look. Street signs are doubled, but any object in my direct line of sight has a clarity that astonishes me.

On the sixth day, I take the golf cart for a spin around the neighborhood. I haven’t driven without glasses in a decade. Quick looks in the mirror feel like someone is poking me in the eye with a needle, but otherwise my vision is fine. Road signs are fused. I hear the unmistakable sound of a fighter jet practicing maneuvers from the nearby air base. I crane to look and smile when I see just one jet silhouetted in the deep blue sky.

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Three weeks have now passed since my surgery. I am writing this with no glasses, no pirate patch across one eye. Earlier, I looked over a personal finance spreadsheet with dozens of columns that consumed the full width of my 27” monitor. My eyes tracked the figures effortlessly. If you knew me from my working days, you would sense how good this feels.

I still see double when I look straight up or straight down or far to the left. Each week of recovery has brought gradual improvements as my eye heals and my brain adjusts to its new visual mechanics. It may take months for this lingering double vision to fade, or it might be something I live with. It’s a small price to pay.

I smile as I think about the small things I enjoyed yesterday: watching a mourning dove alight on our fountain in the backyard; reading highway signs; making easy eye contact with a friend; pausing to gaze at the moon on a nighttime walk with the dog; writing this essay on my computer without the constant strain of willing the lines of text to converge.

It’s clear now that the surgery was a success. I’ve come out on the lucky side of a coin toss. I can’t imagine how discouraged I would feel if it had failed. But it didn’t. I am counting my blessings, but also thinking about what-ifs. What if I hadn’t decided to have the surgery? And more wistfully: what if I had found Dr. Plotnik sooner?

This improvement in my vision has literally changed my outlook on life. I feel so much more optimistic. I am writing again. I am hatching plans for the future that would have felt absurd to think about just a month ago. I am opening those boxes of dreams I had long ago locked away inside my mind. At the bottom of one box, I carefully unwrap a calm evening at anchor on a trawler yacht. The smell of salt water, the feel of the sea undulating beneath my feet, the clink of the anchor chain as the boat swings on the tide, and a red buoy marking a shoal off to port, so clear in that perfect light just before dusk, all of this rolls over me in one clarifying instant.

1. See Decision Lab’s Why do we value items more if they belong to us? ↩