The Neuro Visual Center of New York

Specializing in the Optometric Treatment of Headaches and Dizziness

What are “Ghost” Images and What Causes Them?

February 1, 2018

When I see a patient who needs a lot of prismatic correct to align the eyes, I like to demonstrate to my staff how the patient sees without it. Putting prism in front of a person whose eyes are not misaligned gives them the same symptoms of the patient. One time, I gave a clip to my optician with prism on it for her to look out of. She put it on and said, “Wow! This is great! I see so clear!”

Ghost Images

This optician had always complained to me of not seeing clear enough. Of course, she didn’t: she had a ghost image. She described it as things always appearing “smeary” when trying to focus. Interestingly, she did not complain of headache or dizziness at all, but she did have vertical heterophoria (VH), a type of binocular vision disorder caused by a misalignment of the eyes. With the prism glasses, her world is so much easier. Aligning her eyes gave her the binocular vision and depth perception that she was missing!

Now, anytime a patient uses the word “smeary” or just isn’t seeing sharp enough, I immediately pull out my instruments and screen for VH. Sometimes a little prism is all you need.

Double Vision and BVD

Ghost images are a type of double vision that is a sign of a binocular vision dysfunction.

There are two different types of double vision (diplopia): monocular and binocular. While monocular double vision can be caused by corneal disease or cataracts, binocular double vision can be caused by serious neurologic conditions.

If you’ve recently started experiencing symptoms of double vision, there’s a quick way to determine which type you have. If you’re experiencing double vision, try closing one eye. If you see images as double out of one eye with the other eye closed, you have monocular double vision. If you have binocular double vision, the double vision will go away when you close either eye.

How Monocular Double Vision Causes Ghost Images

Monocular double vision in one eye often presents as a “ghost” image, a shadow that overlaps with the primary image. It can affect the left eye, the right eye or both eyes at once. Monocular double vision can be caused by dry eye syndrome. When your eyes dry out, the surface of your eye becomes rough and irregular as the tear film along the surface of your eyes dries out. People with dry eye syndrome often suffer from itching, scratching, and burning sensations in their eyes, or they may feel like something has become lodged in their eye. These symptoms can get markedly worse if the patient does a lot of reading or computer work, as we unconsciously blink less while focusing on reading. The first step of treatment for dry eye syndrome is typically the use of artificial tears.

Like VH, binocular double vision is caused by eyes that are misaligned. This condition can be caused by a variety of serious factors, so it’s very important to contact a neurovisual professional as soon as possible to determine the type and cause of your double vision, and to get treatment started right away. If you are being plagued by ghost images or other double vision symptoms , give the Neuro Visual Center of New York a call today at (516) 224-4888 to schedule your evaluation.

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About Dr. Cheryl Berger Israeloff

Dr. Cheryl specializes in the optometric treatment of dizziness and headaches utilizing the Feinberg method. She is the only practitioner in the state of New York trained by Dr. Debby Feinberg of Vision Specialists of Michigan. Dr. Cheryl is a graduate of Cornell University and SUNY College of Optometry.

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June 28, 2019 at 9:10 pm

About 10 years ago I began having “ghosting”, which was a partial double image would appear rising above a line of print on a page. This began the day afer a chiropractor did a severe pop to my neck. I talked to him about this later, and he swore the pop could not have caused the ghosting. I later went to a neurologist, who said he had encountered this thing before, and said the neck pop had caused a mini sroke in my brain, which affected the vision. The probem has never gone away, but the brain is usually able to ignore it, except in especially stressful times. So never let anyone pop your neck!

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August 24, 2019 at 3:23 pm

So my neck popped and I have something double vision in both eyes and when a car goes by it’s like and tracing image. Did he say the brain can heal From it?

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August 28, 2019 at 4:39 pm

Please see you eye doctor.

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January 25, 2020 at 10:41 pm

This happen to me too did it go away yet

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October 24, 2023 at 7:25 pm

Hey! I have had a very slight double vision in both of my eyes and it is a slight shadow ontop of it and also my left eye is much blurrier than my right eye but just so you know my left eye has always been much blurrier than my right eye for years now so I doubt it’s anything very sudden and I don’t see my vision progressing getting worse but the double vision thing kind of goes up or down depending on how far or close I am and this never really bothered me but I can kind of curious on what’s going on.

October 30, 2023 at 12:57 pm

Hi Ethan This can be coming from a number of problems. Please schedule a routine eye exam with your doctor to start. All the best, The Neuro Visual Center

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November 19, 2020 at 11:59 pm

Hello I started to see ghost images recently Letters with shadow When I use optical glasses it comes to normal What us the reason for that And what are the treatment for it

November 30, 2020 at 11:21 am

You can see ghost images with uncorrected refractive error. We you put your glasses on the refractive error is corrected.

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December 22, 2020 at 2:04 am

when i see an image or try to focus on a text , i see a shadow image , the shadow isn’t too much , just along the curvature of the image , its a bit uncomfortable to focus on the image /text . I am also using glasses to correct my farsightedness. With the glasses the shadow gets reduced but it does not completely goes away . Am having trouble in having a sharp image , i can read and see but its a bit uncomfortable with the shadow , also am having frontal , temporal and pain around and behind the eyes

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March 1, 2021 at 3:04 pm

Hi I have monocular diplopia, ghost images in both eyes (clear overlapping images with glasses), example of what I see:

One doctor mentioned it could be the thining retina membrane of my right eye, my right eye has myopic degeneration, for which I had shots of avastin.

My left eye has the same symptoms because my brain is trying to make my left eye see the same as my right.

Other possibilities mentioned were neurological or dry eyes.

March 8, 2021 at 4:52 pm

We are sorry Jack. Prismatic correction does not work for monocular diplopia.

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March 10, 2021 at 7:25 pm

I just got new glasses on Friday and see ghost images with white words on a tv and stuff that lights up. I went to the dr yesterday they said to wait two weeks but didn’t check the physical glasses. I now have a headache and if I make a tiny hole with my thumb and pointer finger and bring it to my one eye with other closed while wearing glasses I don’t see the ghosting

March 16, 2021 at 9:37 am

Please return to your eye doctor.

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September 19, 2021 at 1:59 am

Lauren I just went to the eye Dr had my eyes checked she made glasses for me when I got them I seen double she checked eyes again and said I need cataract surgery I then went to a eye specialist he said eyes were okay need surgery in 2 years I went back to the eye Dr she checked my eyes again and changed the left lense now I see shadows can you please tell what you did to get rid of the ghosts. Thank you

September 20, 2021 at 12:28 pm

Please return to your doctor. This can be caused by many factors.

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April 29, 2021 at 6:34 pm

How common is it to develop ghosting after cataract surgery? Does getting a multi focal IOL greatly increase one’s chances of developing ghosting?

May 3, 2021 at 9:53 am

First it needs to be determined if your problem is monocular or binocular. Monocular means it is coming from one eye only. Prismatic correction only works for binocular ghosting.

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August 22, 2021 at 5:47 am

I am not sure what kind of diplopia do I have. I have them in both eyes, which when I close one of the eyes, the other eye will still see the ghost image. I only see ghost images in low-light places. The ghost images will only appear when I open my eye wider. Is there a cure for this? D:

August 22, 2021 at 5:50 am

The ghost images are more blur than the actual object. And also whenever during the process i open my eyes from closed (like blinking), I sometimes see the ghost images rising like layers by layers D:

August 23, 2021 at 1:38 pm

This could be many things. Please visit your eye doctor. All the best.

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January 18, 2022 at 1:34 pm

Hi Hung, i have the exact same issue. Have you got it checked out ? If so, what did they tell you? Thanks

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July 19, 2022 at 9:06 am

Is your problem cured now and how

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November 9, 2021 at 7:31 am

When my eyes don’t focus, the image separates into 3 copies slightly offset, 2 slightly distorted. Both eyes in turn, monocular. It’s like having astigmatism but in 3 axises. My accommodation range (lens in each eye) is reduced. So glasses correct the myopia but the astigmatism corrections are a compromise that never quite work. I pass the snellen chart in the room but clarity breaks up past about 8m. My visual span for detail like reading is 1char in focus, then the 2 on either side are half clear. So I read with a window of 3 or 4 characters scanning across the whole line. If I deliberately defocus my eyes I can see circles blur into 3 rings. It’s probably worse with dry eyes. Most Optometrists don’t seem to understand the extent for me or other rarer cases. They get frustrated when trying to work out the astigmatism corrections but I keep saying the difs are equally blurry & can’t find the right one per eye. It always takes a lot longer than scheduled but I think results are still not ideal. I don’t have Keratoconus, no major damage to surface of eyes so it must be more to do with the crystalline lense inside each eye. Which you can’t see (only specialist ophthalmologists have the equipment for full mapping of surface & optics, and I’m in Australia not USA). I did go through atleast 4yrs of school (11yo to 15yo) needing glasses after they tested me wrongly.

November 9, 2021 at 10:25 am

We are so sorry that you are still having difficulty. Please contact Dr. Andrew Taylor in Albany, Australia, he may be able to help you.

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December 6, 2021 at 4:44 am

I had the new catarac surgery with adjustable lenses. I see great but after close work or just “whenever” I see shadows above and below letters, musical notes road signs, etc etc. This comes and goes a a whim and it’s very disturbing because I am a pianist. My eye surgeon and eye doctor who did the adjustments have done every test on my eyes to determine if there are serious problems and said it’s got to be dry eye so recommended Ristasis the RX. My regular doctor and daughter-in-law, Doctor suggested not taking it because it is a Steroid. I’ve used Teradrops and Soothe and other off the counter drops but they don’t seem to do the trick for very long in the day. Eye Surgeon claims Ristasis is NOT a steroid..also it’s VERY expensive and I’ve already spent $7000 on these special lenses. Glasses do NOT help….HELP PLEASE

December 6, 2021 at 11:37 am

Restasis is not a steroid, your eye doctor is correct. I am sorry that you are having such problems. If your ghost images go away with one eye covered, then you have a binocular problem that we could help. If the symptoms do not go away when one eye is covered, then you have monocular diplopia. Prismatic correction will not help monocular diplopia. All the best. The Neuro Visual Center

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January 14, 2023 at 3:22 pm

I had high myopia(left eye power was -15 at the time of surgery) since childhood and decided to go for surgery. Surgeon performed phaco and put alcon iol.. after surgery my vision got really better but the problem is i started seeing larger image in one eye which causes ghost images and sometimes i feel burning sensations and pain around my eyes.. Please help.

January 16, 2023 at 10:26 am

This can happen after cataract surgery with a patient who had a high refractive error. Please visit the Vision Specialist of Michigan website to find a doctor closest to you for an evaluation. All the best.

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December 29, 2021 at 10:33 pm

I had a concussion two weeks ago. Ever since then I have been having burred images mainly when I look at screens. It looks like the letters are popping of the screen sometimes and everything looks fake. Is it something I should get checked out or just ride it out?

January 3, 2022 at 11:37 am

Hi Allan, You should contact your eye doctor. All the best, The Neuro Visual Center

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March 8, 2022 at 3:46 pm

I see ghost images on things that light up, in the left eye , when wearing glasses but not when wearing contact lenses or with the naked eye. My optician can’t tell me why.

March 15, 2022 at 10:44 am

There maybe something wrong with your prescription or the material yours lenses are made from.

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April 27, 2022 at 1:44 am

Can this cause damage to cornea or lens i wore glassess with such error for 4 months from that time ghost image is still present but lesser degree i want to know what happened and the secondaly lasik would still be an option for me or should i take any consideration

May 2, 2022 at 2:26 pm

We cannot comment on individual cases. Please call your doctor. All the best.

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April 26, 2022 at 3:55 pm

Thank you for this article! I have always had this ghosting, and not a single optometrist has asked me whether I have it when getting glasses for nearsightedness.

When they ask “which is better A or B?” the ghost images sometimes rotate, but never pull in to a single image. When I report that the images are the same just rotated, they have never said anything. Once I asked what the shadow images come from and was told that’s my astigmatism.

I will bring it up next time. It’s extremely annoying when working on the computer.

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July 29, 2023 at 6:23 pm

Have you checked for nerve palsies?

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September 1, 2022 at 8:11 am

I am an hour north of Pittsburgh. PA. I went to 4 eye specialist for this and finally googled my symptoms. Ghost vision. The fifth dr fitted me with glasses that helped. I am concerned that it can be a serious condition. Where are you located please?

September 1, 2022 at 8:38 am

We are located outside of New York City in Garden City, New York. Please call the office at 516-244-4888 for more information.

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November 8, 2022 at 12:46 pm

I cannot find much of anything on my issue. I see double/ghosting both monocular and binocular, with glasses and without. In other words, I see it with both eyes, when I cover just my right eye, and when I cover just my left eye. I watched a video from an neuro-opthalmologist out of Houston who explained it as “bilateral monocular cerebral polyopia,” but I can’t find very much information on this.

I have seen an Optometrist twice who expressed confusion by my vision and an Opthalmologist who said my eyes are healthy and it’s my brain. He referred me to a Neurologist. I am waiting for my appointment, but it’s far out.

I have ghosting/double vision of illuminated objects like the moon, lights, reflecting street signs at night, and subtitles on the tv, to name a few examples. The second image appears hazy, overlapping below the true object. It is constant, not transient. It’s more obvious at night. Some signs have multiple images. Like while most street signs appear as described above, these little vertical yellow rectangular signs reflect and create three images not touching the true object in the center. The ghosted images appear one below, one to the right, and one to the left of it.

What could this be? Is it really neurological? Could astigmatism do this? And if so, could the opthalmologist really have missed that? Why is he so certain it’s my brain?

In addition, I failed the field of vision test three times since February. I cannot complete the test because my vision immediately goes black from the outside in, to a pinpoint, to whatever object is in the very middle of the screen.

Also, I have episodes of transient vision disturbances lasting in 1 second bursts over and over again for up to a couple of hours, maybe more.

No headaches.

And last, but not least, two weeks ago I had an episode where I lost the entire left field of vision in both eyes. I was unable to read words because the left side of each word was missing. It was extremely bizarre. It lasted 45 minutes.

My eyes also have trouble reading or focusing in on text or on a lot of visual stimuli, such as many cereals in the cereal aisle at the grocery store or words on a page of many words or one store aisle in a sea of store aisles.

November 9, 2022 at 1:48 pm

Please visit the Vision Specialist of Michigan website to find a doctor near you. There are a few doctors in Texas who may be able to help you. The Neuro Visual Center

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June 13, 2023 at 8:54 pm

I have double vision and droopy eyelid. When I close one of my eyes, my double vision is gone. Same with the other eye. I really don’t know what I have.

June 15, 2023 at 12:59 pm

You should see your eye doctor asap! All the best

July 29, 2023 at 6:26 pm

Check for myasthenia gravis, and thyroid eye disease.

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October 8, 2023 at 3:46 pm

I had cataract surgery in July on left eye , around 12 days after I started noticing halos at night on ceiling lights, lights on heater, tv, quite a few floaters, then when I looked at my cellphone or I pad it was like it had a halo/glare all around it, if I watch tv or go to a movie, when screen gets darker I see multiple halos. I have to have screen brightness up high, then this problem goes. Also I have an area in the left eye where it looks like something is in my vision, a whiteish/ghostlike , I have mono lenses and my faraway vision is great, I need glasses for reading.

The left eye has never felt right from the get go, and still feels on some days uncomfortable like a hair in eye or similar.

I did have my right eye done 4 weeks later, my specialist assured me that left eye will get better and lense was in correct position. The right eye felt quite different to left eye after op, far-away vision good as in left eye, I do get slight halo effects etc in this eye but nothing that really bothers me and can’t live with, although I do have quite a few floaters in both eyes.

The left eye does not feel ‘right’ not with vision, but the haloes, ghosting? Etc

Vision is fine during the day, these issues occur when starts to get darker, or if I walk into wardrobe during day, I notice odd area in my left eye, to the right.

They tell me it can take longer for people to get accustomed to these things after cataract surgery, but it does not feel right to me, it has been over 3 months. I feel I have more issues now than when I had the cataracts, and it should not really be this way. Looking forward to reply with any helpful information.

October 9, 2023 at 1:56 pm

You should ask your doctor if you can try a drop to constrict your pupil. This may help with your symptoms. All the best

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November 1, 2023 at 4:09 am

Dr. Berger Israeloff,

I had the oddest symptoms today and I am kind of concerned. Today is October 31st, 2023, and this afternoon I was preparing for the trick or treaters that would be coming later on this evening. I was getting ready to carve a pumpkin to set out near our front door. I printed out the pattern and taped it to the Pumpkin. The image I printed consisted of two very bright orange eyes that were outlined in black. When I was ready to sit down and carve the pumpkin, one of the bright orange eyes I had been looking was now in my field of vision, no matter where I looked. The image that was on the piece of paper that I printred out was now floating around in front of my left eye. I could see it perfectly, it was the left eye from the pumpkin carving pattern, but much, much smaller. This tiny bright orange eye outlined in black floated a round in front of my left eye all afternoon. Finally, I thought that I would try toI lay down and rest for a little bit to see if it would go away.

About two hours later, I decided that I need to get up and continue with my preparations for Halloween. This is when I realized that my floating tiny orange eye “image” had changed into another image that I had been looking at just a few minutes earlier. This time it was piece of black thread that was all knotted up as I had just been working on a piece jewelry that I weaving together using a KumiHimo disc and the thread somehow got had gotten all tangled up into a knot. The same thing was occurring only this time I was seeing the black knotted thread float around in front of my left eye. This has been going on all day and night and it is now 1:00 AM in the morning and I am getting ready to head to bed.

I just had my eyes examined 2 months ago and I was told my eyes looked really good and healthy. I will be 66 years old in 9 days. I have worn glasses since 4th grade and I am very near sighted and my vision prescription requires that prism be built into to my prescription glassess.

I am concerned because this has never happened before, at least, not for 10 straight hours in row. Do you know I may have been experiencing

November 1, 2023 at 1:36 pm

Hi Julie, I am not sure but it sounds like you were having a persistent afterimage or possibly a vitreal detachment. I would return to your eye doctor and them look at your retina. All the best, The Neuro Visual Center

November 2, 2023 at 9:50 am

Thank you. FYI – The image is still there in my field of vision. I don’t know if Medicare covers eye problems or not, but I guess I need to find out. Thank you again.

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what is ghosting vision

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Prior to being treated by Dr. Cheryl, I constantly felt off balance. I had suffered from frequent migraines since I was 12 years old. I often suffered from neck/ back pain, and always felt like I was straining my neck and/or tilting my head to focus on the computer. My family had always noticed that I walked a bit sideways as well, but they attributed that to me being “clumsy”. I had awful anxiety about walking down flights of stairs or through the mall, as I always had this irrational fear of f… Read more
My family would always tease me about how clumsy I was. I couldn’t even walk in a straight line. This got worse as I got older until I tripped and fell in the subway. I became so nervous to go out because I couldn’t walk straight or judge how to step off a curb. I consulted many doctors who diagnosed me with anxiety disorder. I really didn’t think I had anxiety disorder at all. I was anxious because I was afraid I was going to fall due to my poor depth perception. I learned about Dr. Debby Feinb… Read more
For years I have suffered from migraines and more recently severe neck pain. Dr. Cheryl took one look at me and knew what was wrong. She explained that my neck pain was due to tilting my head to compensate fro my vision deficits. Tilting my head was a way to stabilize my vision but it was taxing my body. She asked me a variety of questions, which ranged from when I experience pain to how I feel in crowds. I would have never known that all of my anxieties in crowded places and my inability to wal… Read more
Unfortunately, I have been suffering from migraines since I was 7 years old. I spent countless hours in doctors’ offices trying to resolve this issue but was left unrewarded. I started wearing glasses when I was in elementary school but they did not relieve my headaches. Being an active child, I found that these headaches hindered my ability to participate in certain activities. As the years went on the headaches became more frequent and debilitating, leaving me with symptoms of nausea, vomiting… Read more
Have you ever felt dizzy and anxious when driving or riding in a car? If so, you could be experiencing one of the many symptoms of vertical heterophoria (VH), a binocular vision dysfunction caused by a misalignment of the eyes. This misalignment is typically the result of a head injury, but it can also occur when one eye is physically set a little higher than the other, causing the eyes to see images at slightly different levels. How the Brain Responds to VH The brain isn…
I was never happy with my vision. I always felt things didn’t look quite right. Everyday, I would suffer from eyestrain and tension at my temples. I went to many eye doctors and they all said my eyes were fine. At a routine eye appointment with Dr. Cheryl, I complained about these feelings of strain and eye pain. She asked tons of questions and did the most detailed eye exam that I ever had. She not only tested my vision in each eye but she tested how my two eyes worked together. My problems wer… Read more
I never really had headaches before this year, but my balance felt off, I felt crooked. We went to a lot of doctors until my pediatrician said to go to the eye doctor. I suffered academically and socially because the headaches started to get worse and they were constant. They rarely let up. The morning was the worst, I was nauseous every morning. This went on for three months until I came to Dr. Israeloff. We never thought it was my eyes because my eyesight was always fine! What a wonderful s… Read more
Who, indeed, could have supposed that a mere ocular defect could have given rise to so serious a train of evils….And who that had not seen it, could believe that the correction by glasses of the eye trouble could have given a relief so speedy and so perfect that the patient described it as a miracle?


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what is ghosting vision

Liza Torborg

Mayo Clinic Q and A: Double vision can often be effectively treated

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DEAR MAYO CLINIC: I have double vision in my right eye and can read with glasses, but distance is not very clear. What causes double vision? Is there a procedure to correct it?

woman having an eye exam

Double vision, also called diplopia, is either monocular or binocular. Monocular double vision is present in each eye separately. Binocular double vision is only present with both eyes open. This distinction is very important because monocular double vision is never dangerous, while binocular double vision can be caused by some serious neurologic conditions.

If you have new symptoms of double vision, a quick way to assess which type you have is to close each eye separately. Using your question as an example, “I have double vision in my right eye,” suggests that you have monocular, or “one-eyed,” diplopia. This means that when you close your left eye, you see images as double out of your right eye. But when you close your right eye, the double vision goes away. If you have binocular double vision, when you close either your right eye or left eye, the double vision goes away.

Monocular double vision in one eye often appears as a ghosting or shadow that overlaps with the primary image. It can affect the right eye, the left eye, or both eyes at the same time. The most common cause of this type of double vision is dry eye syndrome.

Dry eye syndrome causes double vision and blurred vision because the tear film along the surface of your eye becomes uneven due to the dryness. People who have dry eye syndrome often complain that their eyes burn or feel scratchy and itchy. It also can feel like something is caught in the eye. Symptoms of dry eye are often made worse by reading or by doing computer work because you unconsciously blink less while concentrating on reading. Treatment of dry eye syndrome usually begins with the use of artificial tears .

Other causes of monocular double vision include an irregular cornea, a cataract  or retinal disease . With these causes, symptoms of double vision do not tend to fluctuate as much as double vision associated with dry eye syndrome.

It’s possible that the source of the problem could also be your glasses. Prescription glasses can contribute to poor vision and monocular double vision if they are out-of-date, the frames are bent or the lenses are scratched.

Binocular double vision, or binocular diplopia, is caused by misalignment of the eyes. This causes the images from each eye to be off a bit, making you see two images. With this type of double vision, the images often are completely distinct with space between them.

Conditions that may cause binocular double vision include previous trauma, stroke, systemic disorders and other diseases. If you develop symptoms of binocular diplopia suddenly, seek medical care right away. Some of the causes of binocular double vision can be neurologically dangerous.

Treatment of binocular double vision usually begins with the use of prisms in your glasses to realign the two images into a single image. Covering one eye with a patch is another option. Once the double vision is stable, then referral to a surgeon may be appropriate to correct the misalignment of the eyes.

Make an appointment to have your double vision evaluated by your eye provider. He or she can determine the exact cause of your symptoms, rule out other problems that may require regular monitoring — such as corneal, lens or retinal diseases — and help you decide on a treatment plan that fits your needs. — John J. Chen, M.D., Ph.D. , Ophthalmology, Mayo Clinic, Rochester, Minn.

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what is ghosting vision

What Is Ghost Vision? [Learn the Cause of Double Vision]

  • By: Baptist Eye Surgeons
  • In: Eye Abnormalities , Knoxville Eye Care
  • May 4, 2022

ghost image eye vision

What Is Ghost Vision?

Ghost vision is the phenomenon of a shadow or a “ghost image” overlapping with the actual object that you are looking at. It can affect only one eye or both eyes resulting in a type of double vision. It creates a shadow that overlaps with the primary image that you are looking at. This secondary image appears almost ghost-like, earning the nickname “ghost vision.”

Ghost vision that only affects one eye is known as monocular double vision or monocular diplopia . You can test to see if you have this type of double vision by alternating closing your left eye and your right eye. Whichever eye is open when you see visual disturbances lets you know which eye is experiencing double vision.

Binocular diplopia occurs when ghost images appear when you have both eyes open. Since it affects both eyes, this condition results in two sets of ghost images overlapping the primary image. In this case, the only way to remove the ghost images from your field of vision is by closing or covering one or both eyes. 

What Causes Ghost Vision?

Ghost vision can have different causes depending on the type that you have. For example, monocular double vision is usually caused by dry eye syndrome with refractive errors being another common cause. Binocular double vision is the result of misaligned eyes. This can cause the images you see to be off, resulting in ghost images.

Monocular Double Vision

Common causes of monocular double vision include:


Dry eyes occur when your eyes don’t make enough natural tears or make poor quality tears. Tears are very important to the health of your eyes since they help keep them lubricated and comfortable. However, you don’t need to cry in order to achieve this! Your eyes are lubricated every time you blink, keeping the eye’s surface clear and smooth.

Dry eyes can occur for a number of reasons, but it’s usually due to a problem with a layer in the tear film, which is comprised of:

  • An oily layer
  • A watery layer
  • A mucus layer

Dry eyes can often be treated with over-the-counter artificial tears. Talk to our ophthalmologists for brand suggestions and other tips for maintaining a healthy tear film.

Click here to learn more about how dry eye syndrome is diagnosed and treated!

Astigmatism is a common refractive disorder that affects the shape of your eye. Most eyes are shaped similarly to a basketball, but astigmatism is caused by a more football shape to the eye. This affects the curve and shape of your cornea or lens and causes light to be refracted (bent) improperly, resulting in vision problems such as ghost vision.

Astigmatism can be easily treated with corrective eyewear. Prescription eyeglasses and more rigid contact lenses used to be the only treatments available. Now softer contact lenses are available to treat the problem. Similarly, LASIK could not previously be used to treat astigmatism, but new advances have improved most cases.

To learn how LASIK surgery changed one man’s life, click here !

Binocular double vision.

Common causes of binocular double vision include:

  • Grave’s ophthalmopathy
  • Myasthenia gravis
  • Cranial Nerve Palsies

Grave’s Ophthalmopathy

Around 30% of people with Grave’s disease will develop Grave’s ophthalmopathy. This aspect of the disease causes inflammation and other problems with your immune system which affects the muscles and tissue around your eyes.

Along with ghost vision, those with Grave’s ophthalmopathy may experience:

  • Bulging eyes
  • Eyes that feel gritty
  • Pain or pressure in the eyes
  • Retracted or puffy eyelids
  • Redness in the eyes
  • Sensitivity to light
  • Vision loss

Mild forms of Grave’s ophthalmopathy may be treatable with over-the-counter artificial tears and lubricating gels. More advanced cases may require medication, prism glasses, surgery, and radiotherapy.

Myasthenia Gravis

Myasthenia gravis is an autoimmune disorder that causes antibodies to attack and destroy communication between nerves and muscle. This results in weakened skeletal and voluntary muscles, especially those that control your:

Treatment for myasthenia gravis can vary depending on factors such as your age, medical history, the severity of your condition, and your ability to handle specific treatments. There is currently no cure, but your symptoms can be controlled with medication, surgery, and other forms of treatment.

When To See a Doctor

You should schedule an appointment with your eye doctor whenever you experience changes in your vision. In some cases, all you may need is an updated prescription. However, changes in your vision may be a sign of a more serious condition that requires immediate treatment. By seeking treatment early, you can prevent symptoms from getting worse.

Monocular double vision is more common than binocular double vision. It also tends to be less serious , being treatable with stronger eyewear prescriptions and other non-invasive means. Binocular double vision, on the other hand, may indicate a more serious underlying issue. Your eye doctor will be able to diagnose the problem and provide treatment to protect your vision. 

Have you experienced a sudden onset of double vision? If so, please contact us today to schedule your appointment!

A second shadow image of an object in your field of vision is known as “ghost vision.” It can affect one eye or both eyes with the latter possibly indicating a serious underlying condition. Monocular ghost vision is often a result of astigmatism or dry eye syndrome. Binocular ghost vision may indicate a serious issue such as Grave’s ophthalmopathy or myasthenia gravis. Be sure to seek medical attention to sudden changes in your vision to receive the care that you need.

Baptist Eye Surgeons is an ophthalmological practice in Knoxville, TN, and Morristown, TN. Give us a call at 865-579-3920 for more information or to schedule an appointment .

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How can I fix vertical double vision?

I have vertical diplopia (double vision) . Both eyes are affected to the same degree. Whether I am covering each eye individually or looking with both eyes, the double image is present in a similar manner (the ghost image appears directly above the stronger image). I did see an ophthalmologist, but he indicated that I probably just have tired eyes. I did receive a pair of glasses for a minor vision issue with some astigmatism (irregularly shaped cornea) from this same doctor at that time, and this does help my vision, but in reality, it just makes the two separate images more clear. It has never gone away in two years, and increases in intensity irregularly. Should I see another doctor? If so, what type?

When a person sees a ghost image with each eye alone and with both eyes open, it means the problem is in the focusing portion of the eye and not in the eye motor system (muscles of the eyes). A frequent cause of ghosting is astigmatism, but it can also come from abnormalities of the lens . As you note it can be improved somewhat by refraction (glasses), but not always. In any case this is a situation that requires a comprehensive exam to try to determine the cause. Any type of ophthalmologist should be able to investigate this issue.

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Double Vision, Floaters, and Other Common Eye Phenomena

Dr. jonathan woolfson.

Double Vision, Floaters, and Other Common Eye Phenomena

As humans we’re likely more dependent on our vision than on any other sense. Sometimes our eyes do weird or abnormal things that are a cause for concern, which creates anxiety and questions in the back of our minds, such as, “Am I losing my vision?”

Today, we’re going to discuss floaters, double vision, and ghost images — three common eye phenomena we hear about from patients on a routine basis. We’ll go over what these problems are, the underlying issues that cause them, and if you need to seek treatment for these conditions.

I see floating spots. What is going on here?


The floaters you see are likely caused by particles of vitreous breaking loose and floating around toward the back of the eye. Think of your eye as a snow globe; when things change in the eye, the small pieces of vitreous may float around much like small snowflakes floating around inside of a snow globe.

When you’re seeing spots in your vision, you’re actually seeing the shadows of vitreous material, not the vitreous material itself. It’s not usually anything to be concerned about (just annoying). Fortunately, our nervous systems are very good at adapting to such changes, and as time moves on, the floater will either disappear or become much less noticeable.

A word of caution on floaters: If you see floaters in conjunction with a missing area of vision or flashes of light, this can be a sign of retinal detachment, a potentially serious medical issue. If you’re having this problem, please contact us at Woolfson Eye Institute , or contact your local optometrist immediately.

I’m seeing two of everything (double vision)

No, we’re not talking about the song by the band Foreigner from the late 1970s; we’re talking about your vision, and why you may be seeing double.

Most often, when people say they are seeing double, what they are really referring to are ghost images (which we’ll discuss below). However, if you are truly seeing double, it’s likely due to your eye muscles malfunctioning, which needs to be addressed.

There are a variety of disorders that can cause double vision, including:

  • Corneal irregularities (such as keratoconus )
  • Head injuries (such as concussions from sports or work-related injuries)
  • Stroke or other brain injuries

If you are truly seeing double, it can be a sign of something serious and you should be seen by your optometrist immediately.

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Ghost images and astigmatism


Astigmatism is caused by uneven focus, which is a result of either a misshapen cornea or lens inside the eye. Typically, astigmatism is either corrected with glasses, contact lenses, or our LASIK procedure (if you’re a good candidate for LASIK).

If you suffer from astigmatism and have thought about having LASIK surgery to correct the problem, you may want to read this article:

Is there any cause for concern?

If you’re experiencing any visual disturbances, it’s in your best interest to get your eyes checked. Most often, ghost images, floaters, and other visual disturbances are nothing serious.

However, if you’re experiencing double vision or floaters with loss of vision or bright light, you need to schedule an appointment with your primary eye care professional right away. If you aren’t seeing a local optometrist, give our office nearest you a call .

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10 warning signs of age-related eye problems

By Marilyn Haddrill and Gary Heiting, OD

Older woman with bright blue eyes

Being aware of warning signs of vision problems as you age can help you take appropriate steps to protect your eyesight . Certain eye problems — such as with a detached retina or certain types of glaucoma — require prompt attention by an eye doctor to avoid or minimize permanent vision loss.

10 signs and symptoms of eye problems

The following signs and symptoms can indicate a medical emergency or an urgent condition that could cause significant vision loss over time. In most cases, you should see your eye doctor as soon as possible if you experience:

1. A sudden onset of many spots and floaters in your field of vision

Usually,  eye floaters  are due to a benign, age-related condition called  vitreous detachment . This occurs when the eye's gel-like interior liquefies and separates from the  retina , the light-sensitive inner lining of the back of the eye. 

But a sudden onset of spots and floaters also can be caused by a serious, sight-threatening tear or detachment of the retina. If you suddenly see a shower of spots and floaters, see an eye doctor immediately.

2. A sensation that a dark curtain has settled across your field of view

This could be caused by a retinal detachment, which occurs when the retina separates from the underlying layer of nourishing blood vessels (choroid) . If the retina is not reattached within hours, vision loss can be permanent.

3. Sudden eye pain, redness, nausea and vomiting

These symptoms can signal a sudden (acute) attack of  narrow-angle glaucoma , which can permanently damage the eye's  optic nerve . Immediate treatment is required to prevent permanent vision loss.

what is ghosting vision

Blurry vision, ghost images and nighttime halos around lights all can be warning signs of eye problems.

what is ghosting vision

A simulation of peripheral vision loss, also known as tunnel vision.

4. Double vision, double images or "ghost" images

Double vision  can be caused by many eye conditions. In some cases, double vision also can signal an underlying health emergency such as a stroke. If you have a sudden onset of double vision, see an eye doctor immediately.

5. Sudden blind spot in one eye

If you are over 60, your chance of developing a  macular hole  in the most sensitive part of the retina. Because macular holes can worsen and cause permanent loss of vision, it's important to see an eye doctor immediately if you notice a gray area or blind spot when viewing objects with one eye.

6. A narrowing of your field of view

A reduction of your ability to see objects off to the sides could be a sign of glaucoma. Without intervention, peripheral vision loss could continue to worsen, leading to  tunnel vision  or even blindness.

7. A gray, blurry or distorted spot in the center of your visual field

These symptoms may be caused by  macular degeneration  (AMD), a leading cause of blindness among older Americans. In the past, there was no effective treatment for macular degeneration. But today, new medical treatments sometimes can halt or limit AMD-related vision loss.

8. Poor night vision, halos around lights or less vivid color vision

These vision changes may be due to  cataracts . Cataracts tend to worsen gradually over time and are not a medical emergency. Nevertheless, as your eye's natural lens continues to cloud with aging, your vision will continue to deteriorate unless you have  cataract surgery  that replaces your cloudy lens with a custom  intraocular lens  (IOL). If you wait too long for cataract surgery, you increase your chance of complications such as glaucoma. Also, if cataract surgery is postponed too long, the cloudy lens can harden and become more difficult to remove.

SEE RELATED : What causes halos around lights?

9. Blurred vision and gray areas in your visual field

If you have diabetes, these vision problems may be due to the onset of  diabetic retinopathy . Regular eye exams are essential for diabetics, particularly if you are over age 60. By evaluating the condition of your retina, your eye doctor can provide valuable information to your general physician about the control and severity of your diabetes.

10. Red, "scratchy," irritated eyes

These signs and symptoms are most commonly due to  dry eye syndrome . Dry eyes usually are more of a nuisance than a sight-threatening condition. But symptoms can be severe, particularly as you grow older and your body produces fewer tears or your tear chemistry changes. Consult your eye care practitioner for advice about remedies, which may include over-the-counter or prescription  eye drops .

Preventing age-related eye problems

It's much better to prevent age-related eye problems than to try to minimize their impact on your vision after they have begun.

You can reduce your risk of developing serious eye problems later in life by maintaining a healthy lifestyle and having routine eye exams. Eye vitamins and good nutrition also may reduce your risk of certain eye problems. [Read more about tips for preventing vision loss .]

See an eye doctor

The best way to protect your eyes as you age is to make sure you have a comprehensive eye exam at least every two years. Click here to find an eye doctor near you.

Page published on Wednesday, February 27, 2019

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Women’s vision: Understanding risks and ways to protect it

Alice in Wonderland syndrome depiction of a large fish in a small bowl, and a small fish in a large bowl, which is how a person with Alice in Wonderland syndrome might perceive themselves in their surroundings

Alice in Wonderland syndrome (AIWS)

Police officer conducting a field sobriety test

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Is This Normal? Vision Changes That Could Signal a Serious Condition

take vision changes like eye pain seriously

Vision changes are common as we age. However, problems with eyesight also can be an early indicator of a more serious injury or condition. How do you know when to seek out medical advice? Neuro-ophthalmologist Steven Newman, MD , provides clarification on some of the more common vision problems and possible causes below.

Double Vision

When your eyes don’t work together as a team to focus on an object, you’ll likely see two images of the same object instead of one clear image. This is known as double vision or diplopia.

Double Vision: Probable Causes

According to Newman, structural abnormalities of the eye muscles or the nerves that stimulate them may cause double vision. When one eye sees a second image (often a ghost image) while the other eye is covered, this is known as monocular diplopia. It is most commonly caused by astigmatism (a defect in the curvature of the cornea or shape of the lens) or early formation of cataracts (clouding of the eye lens).

Double Vision: Possible Causes

Any condition that impairs the muscles or nerves controlling the eyes also can result in double vision. Some of these conditions are:

  • Myasthenia gravis , an autoimmune disorder that interrupts transmission between the motor nerves and the eye muscles. This weakens the muscles that move the eyes and often the eyelids (resulting in a drooping eyelid).
  • Graves’ disease, a thyroid condition that causes inflammation in and around the eyes. It can produce double vision by interfering with the ability of the enlarged muscle to relax. Typically, this results in vertical double vision, which worsens while looking up.
  • Multiple sclerosis (MS), a disease that attacks the central nervous system and causes optic neuritis or inflammation of the optic nerve in 50 percent of MS patients. It often leads to decreased or blurry vision. When the brainstem is affected, it also may cause an abnormality in eye movements. The most common result is an inability to move an eye in (toward the nose).
  • Miller Fisher syndrome, a variant of Guillain-Barre syndrome that causes weakness of the eye muscle.
  • Diabetes and high blood pressure, which can cut off blood flow to one of the nerves that control eye muscles. This is referred to as a microvascular cranial nerve palsy or ophthalmoplegia.
  • A brain tumor , which may directly affect one of the motor nerves going to the muscles that move the eye or lead to increased intracranial pressure, which may produce a cranial nerve palsy or paralysis that inhibits eye movement.

When Double Vision Is Serious

Double vision is most concerning when it comes on suddenly, or is prolonged, recurrent or progressive. However, it’s always a good idea to consult a doctor any time you experience double vision.

Some of the conditions mentioned above may resolve on their own or may be treatable. But double vision may be a sign of a life-threatening problem. For example, if double vision is accompanied by paralysis of the eye and there is an enlarged pupil, then you may have an aneurysm or a bulging artery that can rupture.

“An aneurysm is one of those things you don’t want to miss because it has a 30 percent mortality risk,” says Newman.

Sudden Vision Loss

Sudden vision loss may occur in one or both eyes. It may happen in minutes or over the course of a couple of days. Your eyesight may diminish entirely or it may just become foggy or blurry. Symptoms may be temporary or, in some cases, permanent.

Sudden Vision Loss: Probable Causes

Conditions that cause increased pressure within the eye are the most common causes of optic nerve dysfunction. This can lead to vision loss. Most often, these conditions cause slow but progressive peripheral visual field loss, but occasionally there may be sudden, temporary vision loss.

Migraine headache sufferers, for example, may experience blurry vision, periods of darkness or even visual disruptions often described as flashing, or zigzagging lights. But the symptoms will typically diminish, and vision will return to normal. If the symptoms do not resolve on their own, you should be evaluated for other possible causes.

Sudden Vision Loss: Possible Causes

Diabetes is one of the most common causes of not only temporary vision loss or impairment but permanent blindness. In fact, diabetes-related complications are the leading cause of preventable or treatable blindness among adults in the U.S., according to the Centers for Disease Control and Prevention .

High blood sugar can damage blood vessels in the retina, which causes diabetic retinopathy. This condition leads to fluid build-up in the retina, the development of scar tissue in the eye or detachment of the retina, all of which negatively impact your ability to see. Thus, if you are a diabetic, it’s imperative that you receive regular eye exams.

When Sudden Vision Loss Is Serious

According to Newman, eye problems, including vision loss, may signal a problem within the brain. “Many common neurological problems have eye manifestations,” he says. Depending on where it’s located in the brain, a tumor may cause double vision, as mentioned above, abnormal eye movements or decreased vision. Acting on these visual cues may allow you to catch problems like cancer sooner and have a better shot at treating the underlying condition and improving symptoms.

Another rare but serious cause of sudden vision loss is stroke. Should a bleed or interruption of circulation occur in the portion of the brain responsible for visual processing, you may experience vision loss in one eye or, more commonly, trouble seeing to one side.

Even if symptoms subside, you may still have had a ministroke or transient ischemic attack (TIA), so be sure to talk to your doctor.

“It is sometimes possible to limit the effect of a stroke or even reverse the symptoms if the patient is seen immediately at an emergency room with a stroke team available,” says Newman.

Vision Changes? Find an ophthalmologist near you.

“Floaters” in the Eye

The small specks or spots that travel across your field of vision are often referred to as “floaters.”

Floaters: Probable Cause

As we age, the vitreous or clear, jelly-like substance that makes up the middle of the eye begins to shrink. “When the vitreous jelly shrinks, it may pull away tissue from the back of the eye that then floats across the visual pathways,” says Newman. “These often persist, but most patients get used to them and ignore them.”

When Floaters Are Serious

Should the vitreous pull away from the retina, this can cause a retina tear, which can then lead to a retinal detachment. Permanent vision loss may follow if not treated. Fortunately, this is uncommon.

However, if you see persistent flashing lights, hundreds of floaters and especially a curtaining coming up or down over your vision, you should see your healthcare provider promptly. “If caught early, retinal tears and even developing detachments can be treated,” says Newman. “Once the center part of the eye is involved, the chance of an excellent result following surgery decreases.”

The cornea, the layer that makes up the front of the eye, has the body’s second highest number of pain receptors, according to Newman. “This is why eye pain due to corneal injury or pathology can be quite troublesome or even debilitating,” he says.

Eye Pain: Probable Causes

“Anything that affects the surface of the eye will usually lead to eye pain,” says Newman. This may include a scratch, overuse of contact lenses, chemical irritant, infection or a foreign object hitting the eye surface.

Inflammation in the eye due to a specific infectious agent or a particular immune system response can also cause eye pain, says Newman.

Eye Pain: When It’s Serious

Some symptoms suggest a more serious problem, such as a tumor at the base of the skull or a sudden rise in eye pressure. These can cause permanent vision loss if not treated immediately. They include:

  • Vision loss
  • Numbness of the face or eye

“Our eyes are very valuable to us. Any symptoms of visual loss or double vision should be investigated,” says Newman.

Our bodies do all kinds of weird things. How do you know when to ignore something and when to get to the doctor ASAP? We break down what’s normal and what’s not in this occasional series .

I am 70 and in my mid 40 I needed glasses to read and as the years went by I need d them more and more, this may sound funny but over the last year my eyes have improved to the point I do not need glasses for anything. Just wondering if this is quite a common or am I just lucky. Sandie Mansell

I had some eye pain that started yesterday. It was as if there was something that was sticking in my eye. Thank you for suggesting that this could be a scratch or having my contacts in too long. I will check with an eye doctor tomorrow to see if there is some inflammation.

I appreciate that you pointed out that “double vision” can be a result of physical pathology or neurological pathology such as astigmatism that affects the actual shape of the lense or MS that affects the nervous system. This is article makes it clear that I should seek out a professional in ophthalmology to help me.

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Double vision

Double vision (diplopia) is not usually serious but it's important to get it checked, even if it comes and goes.

Check if you have double vision

Double vision is when you look at 1 object but can see 2 images. It may affect 1 eye or both eyes.

Signs that your child may have problems with their vision include:

  • narrowing or squinting their eyes to try to see better
  • covering 1 eye with their hand
  • turning their head in unusual ways (for example, tilting their head)
  • looking at you sideways instead of facing forward

Non-urgent advice: Go to an opticians or see a GP if:

  • you think you or your child might have double vision

What happens at your appointment

If you have double vison, an optician or GP can ask about your symptoms and do some simple, painless eye tests.

They may refer you to an eye specialist in hospital for tests and treatment.

The optician can also let you know if you need to see a GP instead.

Urgent advice: Ask for an urgent GP appointment or get help from NHS 111 if:

  • you have eye pain and double vision
  • you have a severe headache with blurred or double vision

You can call 111 or get help from 111 online .

Treating double vision

Your eyecare team or GP can advise you about the best treatment for double vision once they work out the cause.

In some cases, this may be simple treatments such as eye exercises, wearing an eye patch or being prescribed glasses or contact lenses.

Some conditions that cause double vision may require eye surgery to correct the problem.

Causes of double vision

Double vision has many possible causes, depending on whether 1 eye or both eyes are affected.

Try covering 1 eye at a time to see if your double vision goes away.

If you still have double vision in the eye that is not covered, it's probably only affecting that eye.

Double vision affecting both eyes (binocular)

Double vision affecting both eyes is usually a symptom of a squint .

This is where problems with the eye muscles or nerves cause the eyes to look in slightly different directions.

Squints are more common in children but they do not always cause double vision. An untreated squint in children under 7 causes a lazy eye instead.

Squints in adults are sometimes a sign of a more serious condition.

Double vision affecting 1 eye (monocular)

Double vision affecting 1 eye is less common. It's usually caused by eye problems such as:

  • dry eyes – where the eyes do not produce enough tears
  • astigmatism – a common condition where part of the eye is not a perfect shape
  • cataracts – cloudy patches over the front of the eyes
  • keratoconus – where the clear outer layer of the eye (cornea) gets thinner and changes shape

You must tell the Driver and Vehicle Licensing Agency (DVLA) if you're diagnosed with double vision as it could affect your ability to drive.

Find out how to tell the DVLA about double vision (diplopia)

Page last reviewed: 22 October 2020 Next review due: 22 October 2023

Help with Ghosting Vision After PRK Eye Surgery

Ghosting Vision PRK

Many of us suffer from common problems with our vision, such as myopia (nearsightedness), hyperopia (farsightedness) and astigmatism, that we want to improve. However, not many of us suffer ghosting or double vision. While these conditions are not widespread or well known, people who suffer from them certainly want relief.

Let’s look at what ghosting and double vision are and what particular issues cause this lesser-known condition.

Ghosting vision or double vision, also more properly known as diplopia, is a condition that occurs when your eyes that normally work together start to see two slightly different images. Double vision occurs when these two different images cause you to see them transposed next to each other. Ghosting vision is slightly different from double vision (though it is essentially the same condition) where only a partial (or ghost) of the image is seen to the side or around the image you are looking at.

The reason for this difference in symptoms is because usually, ghosting vision happens in one eye .

What causes ghosting vision or double vision  .

There are actually a variety of different things that can cause diplopia.  First, it should be made clear that there is a difference between long-term and short-term diplopia. Long-term diplopia is a lengthier health issue which can be an indication of major health issues. In contrast, short-term diplopia is usually not a serious concern for your long-term health since the causes of it are easily overcome. As a matter of fact, many of us have suffered from double vision temporarily before. Short-term double vision is often caused by temporary and more easily combated factors such extreme fatigue, extensive alcohol or drug consumption.

Long-term or recurring diplopia, however, can be caused by many different issues in the body.

Some of these issues can actually become life-threatening conditions.

1) Corneal irregularities – The cornea is the transparent layer on the outer edge of your eye that helps focus images onto your retina so you can see clearly. Any irregularity with this clear outer edge could certainly cause long-term ghosting or double vision.

2) Severely dry eyes – If your eyes don’t produce sufficient tears, they will also have a hard time focusing and operating optimally. Conditions that cause dry eyes, such as Sjogren’s syndrome, can often cause sufferers to have double or ghosting vision as well.

3) Cataracts – Since the lens part of your eye becomes cloudy when a cataract develops and because cataracts don’t attack both eyes simultaneously, they are a common cause of ghosting vision in one eye .

4) Cranial nerve palsies – A cranial nerve palsy happens when one or more of the muscles that control the eyes and its ability to focus get paralyzed or can’t coordinate any longer with the other muscles that control the eye. This cause of double vision can be caused by a variety of things such as head injuries, multiple sclerosis, diabetes, tumors, a blockage of an artery and other serious health conditions.

5) Brain tumor, stroke or a brain aneurysm – These type of illnesses and conditions are usually extremely serious and can even be life-threatening. Since these conditions can happen out of the blue, so do the corresponding diplopia symptoms that can come with them. This is why it is extremely important to see a doctor if you are ever suffering from double vision and don’t know what its cause is.

Last, but not least, PRK and other laser eye surgeries may cause diplopia problems. This is because these corrective eye surgeries physically change the shape of your cornea and can cause dry eyes. This type of diplopia can take a few weeks to months to disappear but can be easily treated by using eye drops for a while or with another laser eye surgery.

If you are suffering from diplopia or ghosting vision in one eye or want to learn more about  what causes ghosting vision , please contact us at Diamond Vision . We can help you get your knowledge and eyesight crystal clear! If you’re from Georgia visit our PRK Eye Surgery Center in Atlanta .

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What Is Ghosting?

When a Friend or Romantic Interest Disappears Without Explanation

Wendy Rose Gould is a lifestyle reporter with over a decade of experience covering health and wellness topics.

what is ghosting vision

 Verywell / Catherine Song

  • Increased Use
  • Why It Happens
  • How to Cope
  • Why You Shouldn't Ghost

Alternatives to Ghosting Someone

  • Is It Ever OK?

Ghosting is a relatively new colloquial dating term that refers to abruptly cutting off contact with someone without giving that person any warning or explanation for doing so.

Even when the person being ghosted reaches out to re-initiate contact or gain closure, they’re met with silence. As you can see, it’s called ghosting because it involves someone essentially “vanishing” into thin air as if they were a ghost.

The term is generally used in reference to a romantic relationship, but it can technically refer to any scenario where contact unexpectedly ceases, including friendships and family relationships.

Signs of Ghosting

Ghosting is often obvious, but it can also be a gradual process. The other person might start by 'soft ghosting,' where they progressively minimize contact over a period of time. Some early signs that someone might be ghosting you include:

  • They regularly bail out on plans to get together
  • They struggle to make commitments
  • They don't like to share personal information
  • They don't want you to meet their friends or family
  • They disappear from social media
  • They rarely respond to your texts or calls
  • Your conversations with them lack depth, and they seem disinterested

If you have made repeated efforts to contact someone and they won't respond, it is a strong indicator that you've been ghosted.

Ghosting can also occur on social media. It involves cutting off all social media contact with another person without explanation. The other person may unfriend, unfollow, or even block you on all social media platforms. They may even go so far as to deactivate or delete their social accounts to prevent all contact.

The History of Ghosting

The term "ghosting" became mainstream about seven years ago alongside the surge in online dating ; it became an official entry in the Merriam-Webster dictionary in 2017 . Interestingly, though, the term was actually used as far back as the 1990s. Some pop culture writers and scholars have even used the term to describe ghostwriting in hip-hop music.  

Bree Jenkins, LMFT

The word ‘ghosting’ gained popularity long before [2017] via ‘90s hip-hop, often in the sense of escaping.

Though a new term, the act of ghosting existed well before the digital age. “I think references of ‘going for a loaf of bread and never coming back’ are examples of ghosting," says Bree Jenkins, LMFT , a dating coach in Los Angeles, Calif. "Ghosting used to be leaving a person and moving away or not leaving [them with] your contact information—its earlier origins are even the simple act of leaving a party or social gathering without notice and goodbyes.” 

How the Term Became Popular

So why did the term “ghosting” become mainstream just within the last decade? The argument is that online dating has simply made it way easier to ghost people.

With the higher frequency of ghosting instances, and with more people who could relate/understand being ghosted or doing the ghosting, the term was widely adopted.

Why Do Some People Choose to Ghost?

Ghosting is often seen as an immature or passive-aggressive way to end a relationship. In other instances, it may even be a form of emotional abuse.

There are two primary reasons why a person ghosts another, and often it's a combination of the two.

It's the Easy Route

The first is that some find it's way easier (in the short-term, anyway) to ghost someone than to have an awkward, uncomfortable heart-to-heart about why you’re not interested in maintaining contact.

The person doing the ghosting often wants to avoid confrontation or dealing with someone else’s hurt feelings, so they simply cease all communication and hope the hint is delivered.

Option Overload and Fatigue

“With internet dating comes what may seem like infinite choices as opposed to walking into a bar and having limited options," explains Margaret Seide, MD , a board-certified psychiatrist based in New York City.

"Because there are so many choices, online daters are quick to have the ‘OK, next’ or the ‘Yeah, but what else?’ mindset," says Seide. "Sometimes the person is nice enough, but is juggling a few other people and that person just didn’t make the cut.”

There are also other reasons why people ghost, including being fearful of the other person's reaction to rejection.

How Ghosting Can Impact the Ghosted

As you can imagine (or know from personal experience), ghosting can have a real psychological impact on the person who’s being ghosted.

It’s almost like sudden loss [or] grief, especially the first time you’ve ever been ghosted. You are shocked, and you’re in denial, thinking things such as ‘maybe they didn’t see my text.’ Then you feel anger.

Jenkins adds, “Next, the feelings of depression [can] kick in along with feelings of poor self-esteem as you mentally reexamine your relationship and last conversation for possible warning signs."

Ghosting is inherently ambiguous because there is a lack of explanation for why the relationship ended. For the person who has been ghosted, it can lead to significant feelings of rejection, guilt, grief, and shame.

A person who has been ghosted may be left wondering what this type of behavior says about them, but it is important to remember that ghosting says more about the person who cuts off contact than the person who is ghosted.

Working Through Grief After Being Ghosted

The grief cycle may not run that exact course, but being ghosted often triggers a flood of ranging emotions. Thoughts of ‘Not only did the person not want to date me, but I wasn’t even deserving of an explanation’ can make someone feel dehumanized and devalued.

It’s often more painful when it’s a relationship that’s marinated a bit, but the ghosted person can also feel this way if it was a new connection. It can take some time to work through the pain, but with acceptance the person being ghosted can move on.

To gain closure in a situation where you feel you’ve been ghosted, Meide says it can help to send a message by saying something like, “Hey, I haven’t heard from you in a while. I’m not sure what happened, but I don’t want to continue pursuing this. My time is valuable and I don’t want to leave this door open. Best of luck with things.” While the ghoster may not respond, it can help provide closure.

How Ghosting Can Impact the Ghoster

Ghosting doesn't just impact the ghosted; it also is a detriment to the ghoster. The bottom line here is that ghosting is either a passive aggressive way to end a relationship, or it is the “easy way out.” Either way, it’s not doing the ghoster any favors in their ability to communicate with others.

“Ghosting doesn't take into account how you affect other people and it makes it easier for the person to dip out or disengage when things get uncomfortable. There’s no way to have a healthy, long-term relationship without being able to work through problems and use your communication skills,” says Jenkins.

Jenkins adds that ghosters create unhealthy problem-solving patterns for themselves, and that they also contribute to a larger pattern of societal flakiness that increases their chances of being ghosted as well.

Avoiding the easy route of ghosting someone will benefit both parties. Meide says that the best thing you can do when ending a relationship , however long or short, is to treat the other person as you’d like to be treated.

“I usually suggest two spoons of sugar with the medicine in the middle for delivery,” Meide says. “It can sound something like ‘Hey, you seem like a really great catch, but I don’t feel it’s working between us. I respect your time and just wanted to be honest. Warm regards and take care.’

"Or, ‘Hi—it’s been cool getting to know you, but I’ve decided to take a break from dating and don’t want to waste your time or be dishonest. Best of luck with everything.’"

These messages are short, sweet, honest, and end with an outro to signal that you don’t want to have a long and drawn out conversation. It’s possible that you may get a negative or hurt reaction from the other person, but it’s far better to exit the relationship after giving an explanation than to ghost completely.

Is Ghosting Someone Ever OK?

In many cases, ghosting is considered a rude route to take when trying not to talk to someone anymore, or especially when ending a more serious or established relationship. However, there are most definitely exceptions—when further communication can be a bad thing or even potentially unsafe.

Situations in which ghosting can make sense is if you find out the person is married or in a relationship , participating in illegal or unsavory behaviors, or if they display toxic traits.   In such cases, you do not owe that person an explanation for abruptly ending the relationship. 

If you are uncomfortable or feel threatened by someone in any way, remember it's best to follow your gut instinct. You may simply have a bad feeling. In cases like this, you don't need to prove that this person "deserved" to be ghosted—ghosting might be a useful mode of self-protection and peace of mind.

If you feel your best interest would be to completely cut off contact with the person in question, don't let your feelings of guilt keep you from doing what's right for you and what will ultimately keep you safe.

A Word From Verywell

Ghosting has become more commonplace in the digital age, but just because something is easy or common doesn’t mean it’s always the ideal route to take. Consider how ghosting might impact both parties and do your best to treat others with kindness and honesty. If you’re the person who’s been ghosted, it’s OK to feel confused, sad, and angry. Sending a quick note to end the relationship yourself can help you regain a sense of power and confidence in yourself and give you closure.

However, if you feel threatened or deeply uncomfortable by someone, you don't owe them anything. Sometimes ghosting, when used thoughtfully, can be a healthy mode of self-protection and removing yourself from a potentially bad situation.

Navarro R, Larrañaga E, Yubero S, Víllora B. Psychological Correlates of Ghosting and Breadcrumbing Experiences: A Preliminary Study among Adults . Int J Environ Res Public Health . 2020;17(3):1116. doi:10.3390/ijerph17031116

Anderson HE. No Bitin’ Allowed: A Hip-Hop Copying Paradigm for All of Us . 2011.

 Vilhauer J. When Is It OK to Ghost Someone ? Psychology Today . 2019.

By Wendy Rose Gould Wendy Rose Gould is a lifestyle reporter with over a decade of experience covering health and wellness topics.

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what is ghosting vision

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Lens FAQ #4: What is “ghosting” and “flaring”?

We are often told to be careful of ghosting and flaring when shooting in backlight, or in other conditions with a strong light source in the frame. But what exactly is ghosting and flaring, and how do we prevent them? Let's find out in this article. (Reported by Shirou Hagihara, Digital Camera Magazine)

Lens FAQ flaring ghosting hero

What causes ghosting and flaring?

Flaring , also known as "veiling flare", occurs when light reflects off the lens, or other elements such as the lens barrel and mirror box, making part or all of an image appear soft or hazy.

Ghosting , also known as "ghosting flare", is caused by a strong light source being reflected repeatedly. It appears as a clear artefact that is usually located symmetrically opposite to the light source.

Some factors that influence flare and ghosting

- Number of lens elements: The more lens elements, the more things there are inside the lens that can reflect light.

- Focal length: A shorter focal length makes the light source appears smaller, which can make ghosting and flaring less visible.

- Anti-reflective coatings:  Some lenses, such as those from Canon's L series, have special anti-reflective coatings that help to reduce flaring and ghosting.

Tip: On Canon lenses, look out for coatings such as Air Sphere Coating (ASC) and Subwavelength Structure Coating (SWC) . Note that even with these coatings, it is difficult to completely eliminate ghosting and flaring. 

- Dust and dirt:  Dust accumulating inside the lens, as well as dirt and smudges on the front lens element or UV filter can all cause additional light reflection, contributing to ghosting and flaring.

Examples of ghosting and flaring

Image with flaring

With flaring There is rather strong sunlight entering the frame, causing flaring and resulting in an image that appears hazy. This couldn't be eliminated even by narrowing the lens aperture.

Image without flaring

No flaring I cut out the excess sunlight by using my hand to shade the lens, taking care to make sure that my hand remained outside the frame. This reduces flaring to the extent that it is only faintly visible in part of the top edge of the image.

Image with ghosting

With ghosting The sun (light source) is to the upper right of the image. Ghosting appears in the lower left, which is symmetrically opposite the light source. A characteristic of ghosting is the clear shape observed.

Image without ghosting

No ghosting I did two things to prevent ghosting here: 1. Shade my lens using a hat, and 2. Adjust my shooting position slightly so that the direction of light didn't cause visible ghosting.

Know this: Ghosting and flaring is not always bad!

In general, ghosting and flaring are considered to degrade image quality. But if it is not necessary for your images to be absolutely clean and clear, you can also deliberately incorporate them into your images as an artistic effect.

Photographer tsukao loves creating lens flare with the EF50mm f/1.4 USM. Find out more here .

How do I prevent unwanted ghosting and flaring?

Use a lens hood

It's the very least that a photographer should do to address these effects. 

Lens hoods

(from left to right) EW-63C / ET-63

Each lens hood is shaped differently to match the characteristics of different lenses, so make sure you get the right one for your lens. For example, the EW-63C lens hood is compatible with the EF-S18-55mm f/4-5.6 IS STM standard zoom lens , while the ET-63 lens hood is compatible with the EF-S55-250mm f/4-5.6 IS STM . 

Also read:   3 Reasons Why You Should Start Using a Lens Hood

Use something to block out excess light

In a pinch, you can also cut out flare-inducing light using objects such as your hand, a hat, or a board-shaped object.

If all else fails, fix it in post-processing

It's hard to completely eliminate ghosting and flaring. If you have done everything you can to prevent them but they are still visible in your images,  you will have to fix them in post-processing. Warning: It can be a painful, time-consuming process!

If the ghosting and flaring area is not too big, you can use the cloning, brush or spot removal tools in your favourite post-processing software to correct the image.

If you shoot in DPRAW format, you can use the Ghosting Reduction feature in the DPRAW Optimizer , available in Digital Photo Professional version 4.5.0 and above. 

Now that you know how to handle ghosting and flaring, check out these lovely backlit images and learn how they were achieved: How I Nailed this Shot: Adding Impact to a Grand Forest Landscape 4 Steps to Capture a Soft, Dreamy-looking Backlit Portrait Decisions in Landscape Photography: Whether or Not to Include the Sun in the Frame

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About the Author

Born in 1959 in Yamanashi. After graduating from Nihon University, Hagihara was involved in the launch of the photography magazine Fukei Shashin where he worked as an editor and a publisher. He later resigned and became a freelance photographer. Currently, Hagihara is engaged in photography and written works centring on natural landscapes. He is a member of the Society of Scientific Photography (SSP).

A monthly magazine that believes that enjoyment of photography will increase the more one learns about camera functions. It delivers news on the latest cameras and features and regularly introduces various photography techniques. Published by Impress Corporation

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In Focus: Lenses FAQs

Part1: Lens FAQ: What Does a Lens Name Mean and Why are Some Lenses White?

Part2: Lens FAQ #1: What Does “Closest Focusing Distance” Refer To?

Part3: Lens FAQ #2: Can A Fast Lens Really Make It Easier To See Through The Viewfinder?

Part4: Lens FAQ #3: How are Image Stabilisation Stops Determined?

Part5: Lens FAQ #4: What is “ghosting” and “flaring”?

Part6: Lens FAQ #5: What are the Pros and Cons of an ND Filter?

Part7: Lens FAQ #6: My Zoom Lens Doesn’t Have a Very Bright Maximum Aperture. How Can I Get a Large Bokeh Out of It?

Part8: Lens FAQ #7: What is the difference between a 200mm and 300mm telephoto lens?

Part9: Lens FAQ #8: Where Should I Focus On to Capture Beautiful Bokeh Circles?

Part10: Lens FAQ #9: What is the difference between an f/2.8 and an f/4 telephoto zoom lens?

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The defocused portion of the image obtained in wearers of bifocal and multifocal contact lenses often appears as a “ghost.” Relatively few methods exist to quantify the ghosting perceived with lenses. The purpose of the current study is to validate and implement a questionnaire to help patients quantify the ghost images perceived with bifocal or multifocal corrections.

Ten subjects viewed simulated bifocal vision images displayed on a monitor. Images contained a focused and a defocused (ghost) component of a specific dimension (direction, position-offset, intensity, and focus). Using a test card, subjects identified the ghosting dimension level displayed on the monitor. An additional 54 presbyopic subjects wearing a multifocal correction monocularly viewed a well-focused stimulus and then compared the perceived image to that of the other well-corrected eye looking at the ghosting test card to quantify their visual experience of the 4 proposed ghosting dimensions.

Regardless of ghost letter size and orientation, subject responses were within 1 rating unit of expected on >95% of all trials for all four dimensions when asked to directly match a single dimension of ghosting. With bifocal images containing random amounts of these four dimensions most response errors were also within +/−1. In presbyopes wearing a multifocal lens, the focus dimension was most strongly associated with overall ratings of ghosting.


Subjects can accurately and reliably report on ghost intensity, focus, direction and position-offset, and well-focused ghosts are most correlated with the overall perceptual saliency of ghosting.


Visual acuity (VA) is routinely used as a surrogate measure of optical quality. For example, subjective refractions strive to maximize VA and refractive surgeries are often judged by the levels of uncorrected VA they deliver. 1 – 2 Additionally, VA is also often used as a surrogate measure of retinal image quality. For example, VA loss is often utilized to indirectly monitor the progression of macular disease. 3 – 4 However, in eyes utilizing bifocal or multifocal contact lenses, there is clear evidence that visual acuity is a poor indicator of visual quality in that patients with high levels of VA are often dissatisfied with their bifocal corrections. 5 – 8 Also, high contrast visual acuity has been shown to be limited in its ability to indicate the levels of higher order optical aberrations in an eye, 9 and may also have limitations in describing true quality of vision in many circumstances. 10

The inability of acuity measures to adequately describe patient visual quality has motivated the development of methods for quantifying subjective visual quality directly 11 such as numeric rating scales (e.g. 0–100), 8 visual analog scales, 12 or some form of categorical (or Likert) scale. 13 These different types of scales have been reported to have similar capabilities for describing visual quality in the presence of small levels of spherical defocus. 14 – 15

Although a visual quality scale may be effective at capturing the description of the impact of a one dimensional change in optical quality, (e.g. reduced spatial bandwidth due to increasing defocus), 15 it is clear that retinal images can simultaneously vary along multiple dimensions (e.g., spatial bandwidth remains high, but with reduced contrast) in the presence of defocus and higher order aberrations 16 – 20 and in the presence of bifocal optics. 21 Images produced by bifocal, 5 , 7 multifocal, 8 , 22 or intraocular lenses 23 – 24 can include both a focused image and a simultaneously present defocused or “ghost” image. Therefore, patients with such lenses may experience poor subjective quality due to the poor quality of the nominally focused image or/and due to the simultaneous presence of the defocused ghost image. The impact of ghosting may be further complicated because in most cases, contact lenses decenter when on the eye, 25 and move with the blink 26 – 27 and eye movements. 27 This alters the location of the defocused ghost image relative to the focused image, 21 and may affect visual quality. Also, multifocal lenses with spherical aberration that decenter on the eye will induce coma 6 , 15 , 28 – 29 that is in direct proportion to the amount of decentration and spherical aberration within the lens design. 30 Several other factors that may alter the appearance of the defocused (ghosted) image include: add power, zone geometry (number, arrangement, and size of zones), pupil size 31 and level of monochromatic aberrations in the eye. 20

It is clear that ghost images may be a key factor in the success or failure of bifocal or multifocal presbyopic corrections, but we currently have no subjective method to quantify the multiple dimensions along which the ghosting may vary. In the present study we examine the ability of subjects to characterize four dimensions of ghost images when seen simultaneously with a well-focused image, and we examine the relationship between each of these perceptual dimensions and overall quality in a sample of 54 presbyopic patients fit with a multifocal contact lens.


Part 1: ghosting questionnaire development and validation.

In the first part of this study, we evaluated the ability of subjects (n=10) to quantify four dimensions of ghosting using the printed score sheet shown in Figure 1a . Four ghosting dimensions were examined: direction, position-offset, focus/blur, and intensity. Each ghosted image was generated with custom computational optics software (MATLAB 4.2; Mathworks, Inc, Natwick, MA) and included both a focused letter and a simultaneously present ghosted letter “R,” which had its position-offset, direction, intensity and focus levels adjusted. The defocused letters were computed separately and added numerically to the focused image. On the printed score sheet the “direction series” of images consisted of a ghosted “R” being offset from a focused “R” in one of the 8 cardinal directions. In this series, the ghost portion of the letter had 0.50 D blur, a relative intensity of 50% of that of the focused image, and a 16 arc min offset. The “position-offset series” consisted of 10 separations, in which the ghosted “R” was offset horizontally from the focused “R” in increments of 1/10 of the letter width (equivalent to 3.2 arc min increments for these 20/160 letters). In this series, the direction of ghost offset was horizontal, the blur was 0.50 D, and the relative intensity was 50%. The “focus series” consisted of the ghosted “R” containing one of ten levels of focus ranging from 0.2–2.00D (computed for a pupil size of 3.5 mm and letter size of 20/160). Subjects scored how focused the ghost appeared. A score of 10 indicated a perfectly focused ghost, while a score of 1 indicated a ghost so blurred that no spatial detail could be identified. In this series, the ghost was offset by 8 arc min down and 8 arc min right, with a relative intensity of 50%. The “intensity series” consisted of 10 contrast levels spanning from a 100% contrast focused “R” and a 0% contrast ghosted “R” to a 100% contrast ghosted “R” and a 0% contrast focused “R”. Letter (Weber) contrast increased in average (measured) steps of 11% per grade increment. In this series a focus level of 0.50 D was used, with an offset of 8 arc min down and 8 arc min right. In the offset, focus, and intensity dimensions, therefore, a higher score is associated with a more visible ghost.

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(a.) Printed Questionnaire (FUJIFILM Fujicolor Crystal Archive photographic paper) consisting of four image dimensions series: Direction (8 images), Position-offset (10 images), Focus (10 images) and Intensity (10 images). (b.) Sample images for each of the 4 series of ghosted images.

A letter ‘R’ was chosen as a letter common to the Sloan letter set 32 that participants would be familiar with and would possess a range of characteristics common to most letters/symbols found in common text, including horizontal, vertical, radial, and curved lines. Steps of 10 were used for each attribute dimension. The number of steps was again chosen based on part on participant familiarity, as well as based on the number of steps required to provide adequate resolution throughout the entire desired range of each task. Previously, measurement reliability has been shown to steadily increase up to 7–10 steps, and then remain constant with increasing number of steps, so we did not feel the need for more than 10 steps. 33 – 34

Ten pre-presbyopic subjects (6 male, 4 female) binocularly viewed single computationally ghosted images of black letter ‘R’ stimuli displayed on a linearized 26″ LED monitor (Apple, Cupertino, CA), with a white level luminance of 120cd/m 2 . All subjects had best-corrected distance and near visual acuity of at least 20/20 and normal ocular health. Subjects wore their best sphero-cylindrical (distance) correction in a lightweight spectacle trial frame (UB-4 Universal Messbrille; Oculus; 12–15mm vertex distance) and viewed the display binocularly from 69 cm using a chin rest. Four series of ghosted images were displayed on the monitor: (1) ghosted 20/160 R images that exactly matched individual letters on the ghosting score sheet, (2) a series of ghosted 20/160 letters in which the ghosted letter was displaced in a different direction to those on the score sheet, (3) a series of 20/80 ghosted letters similar in all ways to those in the first series, in which the letter size and blur size were both reduced by a factor of two, and thus, retained the same relative scaling described above, (4) a series of ghosted 20/160 letters in which the four ghosting dimensions were randomly combined and thus, the displayed letters were not a perfect match to any single letter on the score sheet, but included direction, position-offsets, focus levels and intensities that were individually represented on the score sheet. Examples of each series are shown in Figure 1b . The subjects’ task was to observe the single ghosted letter on the display and, using the printed score sheet, quantify the direction, position-offset, focus level and intensity of the ghost image. Note, in the case where all four ghosting dimensions varied simultaneously, is was impossible to distinguish a “ghost” and a “focused” image with intensity levels of 1 and 10 if these intensity levels occurred simultaneously with certain levels of focus and position-offset. As one could not even distinguish whether the letter observed was the ghost or focused letter, one was also unable to quantify any of the other ghosting dimensions. Therefore, in the current study, these two extreme intensity levels were omitted from the randomized trial sequences created prior to testing for the section of the experiment in which all dimensions were able to vary. These intensity levels were still included in testing when only one dimension varied at a time.

Before testing, sample images with no ghosting (e.g. only a focused “R” on the screen) and others containing visible ghost images in each of the 4 dimensions were used to explain the subject’s task. During testing, subjects were allowed as much time as they needed to score the stimuli, but typically responses required around 10 seconds per presentation. Each stimulus level within each dimension was displayed in random order with 5 repetitions, resulting in 40–50 images per dimension.

A limits of agreement analysis 35 was used to assess the level of agreement between the measured and expected response as a function of response level. For each outcome we used mixed effects regression to model the association between the expected and observed values to allow for the correlation among repeated observations by each subject. We tested whether the slope and intercept of the regression line were zero. A p-value of 0.05 was used. Although we have identified seemingly independent ghosting dimensions, they may not segregate perceptually, and thus, subjects’ reports of one dimension may be influenced by another dimension. Therefore, we used Analysis of Covariance (ANCOVA) to perform simultaneous comparisons between model-based estimates of the intercept and slope in the conditions where the stimulus and questionnaire directly matched (i.e. same size) relative to when the stimulus conditions did not directly match (i.e. different letter size, different orientation, etc). This procedure enabled us to perform a simultaneous test of both the intercepts and slopes between the matched and unmatched conditions. To do this analysis, we first created a dummy vector coded ‘0’ for the reference condition and ‘1’ for the comparison condition, and then regressed the difference scores (Observed-Expected) for the two conditions on a model that included a categorical main effect for condition, a continuous main effect for expected value, and the interaction between condition and expected value.

Linear mixed-effects modeling was used to investigate whether there were any systematic differences in the observed deviation scores (i.e., observed-expected) across the 5 trial repetitions (i.e., 1–5). Specifically, a separate model was evaluated for each stimulus condition using the data represented in Figures 2a – 4d . Each model included subject as a random effect and trial repetition both as a fixed effect and as a within-subject grouping factor. All models were fit by Restricted Maximum Likelihood (REML) estimation.

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Limits of agreement for the difference between the observed and expected rating responses for the ghosting attributes of (a.) Direction, (b.) Position-offset, (c.) Focus, and (d.) Intensity for the direct match case of a 20/160 target on the monitor and this same size target on the ghosting questionnaire. The symbols represent the mean difference for each subject’s five trials for each rating number in the series. The x-axis represents the expected rating on the ghosting questionnaire. The solid black horizontal line represents the mean difference score for all subjects and rating levels. The black long dashed line represents the best-fit linear regression line, and the short dashed black horizontal lines the 95% Limits of Agreement for the difference scores. Note that when the stimulus level is 1, the difference scores can range from 0 to 9, when the stimulus level is 5, can range from −4 to +5, and when stimulus level is 10, the difference score can range from 0 to −9.

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Limits of agreement for the difference between the observed and expected rating responses for the ghosting attributes of (a.) Direction, (b.) Position-offset, (c.) Focus, and (d.) Intensity for a 20/80 size stimulus. The symbols represent the mean difference for each subject’s five trials for each rating number in the series. The x-axis represents the expected rating on the ghosting questionnaire. The solid black horizontal line represents the mean difference score for all subjects and rating levels. The black long dashed line represents the best-fit linear regression line, and the short dashed black horizontal lines the 95% Limits of Agreement for the difference scores. Note that when the stimulus level is 1, the difference scores can range from 0 to 9, when the stimulus level is 5, can range from −4 to +5, and when stimulus level is 10, the difference score can range from 0 to −9.

To guard against an inflation of the Type I error rate, follow-up pairwise comparisons were performed only if the mixed model yielded an effect of trial that was significant at p<0.05. Each comparison involved computing a t-test on the differenced deviation scores and evaluating the probability level for each 1-df contrast against the Bonferroni-adjusted rate of 0.05/10 = 0.005. Note that the divisor for this per comparison rate incorporates all possible pairings of five trial means, i.e., (5*(5−1))/2 = 10.

Part 2: Clinical implementation of ghosting questionnaire

In the second part of the study, we implemented the validated ghosting questionnaire in a typical clinical situation to allow subjects wearing soft multifocal contact lenses to quantify the ghosting they perceived. In this part of the study fifty-four presbyopic subjects (43 females, 11 males) with a mean age of 56.3±4.5 years and a mean add of +2.00±0.50 Diopters wore a soft spherical and soft multifocal contact lens (MFCL) correction in one eye, while the other eye wore the best sphero-cylindrical near correction in a trial frame. All subjects had best-corrected distance and near visual acuities of at least 20/20 and normal ocular health. Each subject viewed a completely focused, high contrast (95%) 20/160 letter (‘R’) stimulus at 40cm with the MFCL corrected eye and viewed the ghosting questionnaire sheet at 40cm with their other eye wearing the best sphero-cylindrical near correction. Subjects observed the focused image with their MF eye, and scored any ghosting they observed along the four dimensions quantified on the ghosting score sheet used in part 1 of this study. Subjects also verbally rated the overall amount of ghosting using a standard 0–100 numeric scale, where 0 was “Poor Quality - significant ghosting” and 100 was “Excellent Quality– “no ghosting”). The multifocal lenses used were a commercially available center near aspheric design (Air OptixAqua Multifocal, CIBA Vision, Duluth, GA). The spherical lenses were of the same material design, by the same manufacturer (Air Optix Aqua, CIBA Vision, Duluth, GA). All subjects had cylinder <0.75 D, and were fitted according to the manufacturer recommended fitting guide. Each subject wore the spherical monofocal contact lens design and one multifocal add design; the low, medium or high add. The average±std pupil size of the subjects was 4.5±1.3mm. The spherical aberration of these lens designs was measured using a validated contact lens aberrometer 36 , because knowledge of the spherical aberration inherent in each lens designs is necessary as each design may be expected to contain slightly different levels of spherical aberration, which may then be expected to produce varying levels of quantifiable ghosting. Primary Zernike spherical aberration was quantified by the Z40 coefficients which, for all four types of contact lenses with a distance power of −6.00 D and a 6 mm pupil diameter, were −0.20, −0.30, −0.36, and −0.42 microns of Zernike (Z40) spherical aberration, for the monofocal, and three multifocal lenses, respectively. The mean sphere power (mean±std) of the contact lenses used in this study were 0.46±2.11 D, −1.38±1.49 D, −1.12±1.67 D, and −0.72±2.44 D, for the sphere, low, medium, and high add designs, respectively. Note that the sphere powers used were less minus as they included the necessary near add power. Additionally, based on a linear regression of subsequent contact lens aberrometry measures for 60 lenses of each design type across the power range of −8.00 D to +2.00 D, primary SA was found to vary by 0.02 microns per diopter for the sphere and medium add lenses, and by 0.01 microns per diopter for the low and high add designs. The four ghosting dimensions quantified with the scoring sheet used in the first part of this study were compared to their 0–100 numeric ratings of overall ghosting, using a multivariate regression analysis.

Ethical approval for this study was obtained from the Indiana University Institutional Review Board. All subjects gave written informed consent prior to beginning this study, and all procedures were conducted in accordance with the tenets of the Declaration of Helsinki.

The limits of agreement results ( Figure 2 – 5 ) adopt a common graphical format. In each case, the diamond symbols represent the mean difference between the observed and expected (observed – expected) responses (y-axis) as a function of response level (x-axis) for each subject. The short-dashed lines represent the 95% limits of agreement for these difference scores, the solid line the mean difference (e.g., bias) between the responses, and the long-dashed lines note the best-fit linear regression of the difference scores. Note that when the stimulus level is 1, the difference scores can range from 0 to 9, when the stimulus level is 5, can range from −4 to +5, and when stimulus level is 10, the difference score can range from 0 to −9. Figures 2 , ​ ,4, 4 , and ​ and5 5 each contain four sub-panels describing the results of the (a) direction, (b) position-offset, (c) focus, and (d) intensity attributes for the “direct match” (e.g. stimulus presented on screen was identical to that on the score sheet)( Figure 2 ), “incomplete match” (e.g. stimulus presented on screen differed in one dimension from that on the score sheet)( Figure 4 ), and “completely non-matching” (e.g. no attribute was exactly the same in the stimulus presented on the screen as on the score card).

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Limits of agreement for the difference between the observed and expected responses for the simultaneous presentation of randomized attribute combinations for the following ghosting attributes of (a.) Direction, (b.) Position-offset, (c.) Focus, and (d.) Intensity for a 20/160 target. The symbols represent the mean difference for each subject’s five trials for each rating number in the series. The x-axis represents the expected rating on the ghosting questionnaire. The solid black horizontal line represents the mean difference score for all subjects and rating levels. The black long dashed line represents the best-fit linear regression line, and the short dashed black horizontal lines the 95% Limits of Agreement for the difference scores. Note that when the stimulus level is 1, the difference scores can range from 0 to 9, when the stimulus level is 5, can range from −4 to +5, and when stimulus level is 10, the difference score can range from 0 to −9.

Overall, subjects were able to correctly match the presented stimuli to the correct value on the score sheet when there was a direct match in the attributes on the screen and score sheet (e.g. size (20/160) and position-offset (horizontally shifted ghost image)). Observed scores most closely matched the expected scores when matching the direction ( Figure 2a ), as neither the slope (m=0.00, p=0.71) nor intercept (b=−0.01, p=0.56) differed significantly from 0, and the 95% LoA are less than 1/10 of the scoring increments (95% LoA: −0.08, 0.07). The position-offset judgments ( Figure 2b ) also closely matched the expected (m=−0.00, p= 0.70; b=−0.02, p=0.62), but with more variation in the responses generating wider 95% LoA, but still smaller than the scoring increments (95% LoA: −0.40, 0.33). Within the focus dimension, subjects had more difficulty directly matching the presented stimuli ( Figure 2c ). The 95% LoA were wider and approximately a single increment on the scoring sheet (95% LoA: −1.26, 0.87), and both the slope (m=−0.07, p<0.001) and intercept (b=0.17, p=0.02) were significantly different than 0. The significant negative slope indicates that on average, subjects reported that highly blurred targets (low focus score on the focus scale) appeared more focused or less blurred than expected, and, conversely, reported well-focused targets (e.g. ghosts with focus/blur levels of 8, 9 and 10) as less focused, or more blurred than expected. Performance on the intensity-matching ( Figure 2d ) task was quite similar to that of the focus matching (95% LoA: −0.85,0.74). Again, the slope (m=−0.04, p=0.005) was significantly different than 0. The intercept (b=0.16, p=0.063), however, was not significantly different than 0, indicating no average bias across the rating scale. Overall, however, the most significant result from this figure is that the ghosting attributes of direction, position-offset, focus and intensity can be accurately reported with errors very rarely exceeding 1 rating unit on the 8 and 10 point score scale used in this study.

Rating of ghosting position-offset performance when the 20/160 size stimuli were presented at an (a) oblique and (b) directly vertical position-offset are shown in Figure 3 . These position-offsets were scored with the same score sheet that represented ghost offsets horizontally ( Figure 1a ). For both directions, the 95% LoA were slightly increased (95% LoA: −1.98, 1.21, and −0.97, 1.23, respectively) from the direct position-offset match described in Figure 2b , but again, errors were generally less than 1 step in the 10 point scale. In the oblique letter orientation ( Figure 3a ), the slope of the regression line of the difference scores was significantly different from 0 (p<0.001) and was also significantly different from that of the direct match (p<0.001) case shown in Figure 2b . There was no significant difference in intercept from 0 or from the direct match case. In the vertical deviation case ( Figure 3b ), the slope of the difference scores was not significantly different from 0 or from the direct match case ( Figure 2b ).

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Limits of agreement for the difference between the observed and expected rating responses for the ghosting attributes of an (a.) Oblique and (b.) Vertical ghosted image position-offset for a 20/160 target. The symbols represent the mean difference for each subject’s five trials for each rating number in the series. The x-axis represents the expected rating on the ghosting questionnaire. The solid black horizontal line represents the mean difference score for all subjects and rating levels. The black long dashed line represents the best-fit linear regression line, and the short dashed black horizontal lines the 95% Limits of Agreement for the difference scores. Note that when the stimulus level is 1, the difference scores can range from 0 to 9, when the stimulus level is 5, can range from −4 to +5, and when stimulus level is 10, the difference score can range from 0 to −9.

Overall performance when the subjects attempted to match the smaller (20/80) size stimuli presented on the screen with the larger (20/160) targets on the score sheet was quite similar to that of the 20/160 direct matching paradigm ( Figure 4 ). Errors were generally less than 1 point on the scoring scale, the 95% LoA were virtually identical to the direct match case (direction 95% LoA: −0.08, 0.09; position-offset 95% LoA: −0.57, 0.49; focus 95% LoA: −1.32, 1.38; and intensity 95% LoA: −0.91, 0.77), and in all but the direction scoring, a small but statistically significant (p<0.05) negative slope to the data was observed.

As expected, variability in performance when all rating attributes were allowed to randomly vary ( Figure 5 ) was higher than in either the direct match or orientation series. Specifically,, the 95% LoA were wider (direction 95% LoA: −1.27, 1.12; position-offset 95% LoA: −1.24, 1.99; focus 95% LoA: −1.90, 2.20; and intensity 95% LoA: −3.51, 1.40) relative to the perfect match cases ( Figure 2 ), and the negative slopes were steeper (slope difference of −0.08, 0.03, −0.23, −0.38 units/D for the direction, position-offset, focus, and intensity attributes, respectively). Interestingly, the mean ghost intensity scores were lower than all other cases evaluated by 1.2 rating units. The negative slopes and positive intercepts indicated that on average, subjects significantly (p<0.01) over-estimated lower levels and under-score higher levels in every case, except for the position-offset attribute.

These results indicate that the direct matching task was easiest ( Figure 2 ) and the completely non-matching combination of all randomly varying attributes ( Figure 5 ) the most difficult. However, in each condition, the majority of scores were within +/−1 rating unit of a perfect match ( Figure 6 ). For example, in the direct matching task, participants were able to match all attributes within one rating unit on over 93% of the trials. In the case of the completely non-matching task, participants were still able to accurately describe the direction of the stimuli on 92% of the trials, position-offset on 84% of the trials, focus on 77% of the trials, and intensity on 53% of the trials.

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Grouped barplots for each ghosting attribute depicting the percentage of trials that were within +/−1 unit for the Direct Match series (i.e., matching 20/160 images of the questionnaire to 20/160 targets on the monitor)(white bars), the Incomplete Match series (i.e., matching 20/80 images on the monitor to the 20/160 images on the questionnaire, but other stimulus aspects remained the same)(hatched bars), and the Non-Match series (i.e., simultaneous presentations of random combinations of all stimulus dimensions of 20/160 letter sizes)(black bars).

When investigating the effect of trial repetition on the attribute ratings provided in the various conditions (i.e., do the results on 1 trial agree with the results of subsequent trials), mixed modeling analysis did not show any effect of trial repetition, except for the intensity series (F 4,36 =2.878; p=0.036) ( Figure 4d ). Although follow-up t-tests using uncorrected probability levels suggest that paired comparisons involving the first trial differ significantly from all other trials, the Bonferroni-adjusted probability levels for these comparisons are all not significant. Overall, the modeling results indicate that there is no strong evidence of an effect of trial repetition in any of the stimulus conditions reported here. In other words, scores provided on the very first use of the questionnaire remain similar following repeated presentations, indicating little training may be required for the use of this questionnaire for short term evaluations like those employed in the current study.

In the second experiment, which employed the real-world scenario of presbyopic subjects wearing MFCL utilizing the ghosting questionnaire validated in part 1 of this study, we examined how an overall numeric ghosting rating (0–100) co-varied with the scores of each of the four attributes included in the ghosting questionnaire ( Figure 1 ). It is important to note that unlike in Part 1 of this experiment where presented images were always ghosted, and a corresponding ghosting rating was always needed, in Part 2 in some instances the subjects may not have noticed any ghosting, in which case they rated a 0 on all attribute scales. Additionally, the overall ghosting rating and ghosting questionnaire data sets employ reverse scales. In the individual attribute ghosting scales of the questionnaire ( Figure 1 ), more visible ghosting (higher intensity ghost, better focused ghost, and more off-set ghosts) were assigned higher scores (e.g. 10), whereas the overall image ghosting rating scale employed 100 for no ghosting (high quality image without any sign of a ghost) and one for the case of very obvious ghosting. We scaled all of the individual attribute data to make it range from 0 to 100, and thus, expected slopes of −1 for scales that perfectly co-varied.

Figure 7 explores the covariance of each individual ghosting questionnaire attribute rating and the corresponding 0–100 overall ghosting score provided by the subject while wearing the same lens. A matrix of bivariate regression sub-panel scatterplots is shown in the upper off-diagonal sub-panels. The correlation data of interest are depicted at the “intersection” of the data listed in each row and column, respectively. For example, the first row and first column depict the correlation results for direction with each of the other attributes and overall 0–100 near rating. The second row and column depict the correlation of the position-offset attribute with all other attributes. The remaining panels depict the covariance of one attribute with another attribute. For example, the subpanel in the fourth column from the left and third row down from the top depicts the covariance between the focus and intensity attributes. In all cases, each sub-panel has: (1) the pairwise data grouped by lens type (i.e., sphere, low, medium, or high add), (2) 50 and 90% probability ellipses that correspond to 1.18 and 2.15 standard deviation units, respectively, and (3) a robust regression linear fit to all data points. Histograms representing the univariate response distribution of the ratings are shown along the diagonal sub-panels of the plot. Pairwise Spearman rank-order correlations are noted in the lower off-diagonal sub-panels, along with the corresponding estimated slope of the regression line in parentheses (i.e., bottom left square plot lists the correlation of ghosting direction and overall 0–100 near rating). As before, the data of interest occur at the “intersection” of a corresponding row and column. For example, the correlation of the direction and intensity attributes is provided in the sub-panel in the first column from the left and fourth row from the top. As predicted, the correlations between individual attribute ratings and overall ghosting were significant (p<0.001) and negative in all cases. Also notice, however, that the 4 ghosting attributes are highly correlated with each other, with significant (p<0.001) correlations of around 0.90.

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A matrix of bivariate regression scatterplots is shown in the upper off-diagonal panels. Each panel has: (1) the pairwise data grouped by lens type (i.e. sphere, low, medium, or high add), (2) 50 and 90% probability ellipses that correspond to 1.18 and 2.15 standard deviation units, respectively, and (3) a robust regression linear fit to all data points. Histograms representing the univariate distribution of each response are shown along the diagonal panels of the plot. Pairwise Spearman rank-order correlations are noted in the lower off-diagonal cells, along with the estimated slope of the regression line in parentheses. The first row and first column depict the correlation results for direction with each of the other attributes and overall 0–100 near rating. The second row and column depict the correlation of the position-offset attribute with all other attributes. The third row and third column depict the results of the focus/blur dimension, and the fourth row and column depict the results of the intensity dimension.

Several interesting results can be seen in Figure 7 . First, when wearing the low, medium and high asphericity MFCLs, subjects reported a wide range of ghost focus levels (range 0–9), intensities (0–7), and ghost off-sets (0 – 6), in all possible directions of off-set. The latter two dimensions presumably related to the direction and magnitude of the contact lens decentration. However, subjects reported ghosting with any lens on only 35% (38/108) of the trials. Only twenty-three percent (11/54) of subjects wearing the sphere correction reported ghosting, whereas 33% (4/12) and 34% (8/23) reported ghosting with the low and medium add multifocal lens. Neither of these proportions of subjects reporting ghosting were significantly different than expected (one-sample proportions test with continuity correction, p>0.5 (i.e. 50%)). On the other hand, a significantly larger than expected proportion of subjects (79%; 15/19) wearing the high add lens reported ghosting.

Linear multiple regression analyses were then performed to assess the relative importance of the four stimulus-domain attributes on the observed overall numeric ghosting ratings. The initial model contained the response variable (i.e., ratings) and four explanatory variables only (i.e. direction, position-offset, focus, and intensity (no higher-order or interaction terms were included). The underlying rationale for excluding both non-linear and multiplicative terms from this model was that the 4 dimensional attributes (i.e., direction, position-offset, focus, and intensity) are, technically, uncorrelated in the stimulus domain. Based on all observations, the overall model was statistically significant (F(4,104)=7.17, p<.0001) and yielded a multiple R 2 of 0.22. The only significant explanatory variable in the model was due to the focus/blur dimension. The estimated coefficient for focus/blur was b=−2.95 (t=2.32, p<0.05), and was not dependent on the order in which variables were entered into the model. These modeling results indicate a substantial relative importance of focus/blur on rating judgments, and agree with the correlation results ( Figure 7 ), in which the focus dimension had a correlation with each of the other dimensions of greater than 0.90.

However, given that a substantial proportion of the total variance in the ghosting ratings remained unexplained by the current model including focus/blur, a new model was formulated, which also contained the lens type worn during the rating (i.e. sphere, low, med, high add), as well as an interaction between focus and lens type. The overall test of this model was also statistically significant (F(7,101)=5.97, p<.0001) and yielded a multiple R 2 of 0.29. More importantly, the association between overall ghosting ratings and ghost focus was evident only for the Medium and High add multifocal designs, and was not present for the Spherical or Low add designs. This result highlights the fact that subjects may have experienced little perceived ghosting in the Spherical and Low add designs,

The first part of this study established that the four attributes of ghosting (direction, position-offset, focus/blur and intensity) can be quantified with high accuracy (90% of responses within +/− 1 of perfect using the 8 and 10 point visual scales on the ghosting score sheet). Ghost direction and position-offset were the easiest to correctly quantify, whereas the attributes of focus level and intensity were slightly more difficult. An error analysis revealed that confusion about which image was the ghost and which was the focused image was the source of many errors. This most often occurred with medium intensity levels (e.g. ghost and focused image about the same contrast) and horizontal shifts.

Participants had most difficulty and overall porrest performance quantifying the intensity dimension which was also the most difficult dimension to accurately represent on the score sheet. Although the average contrast difference of the intensity series on the paper questionnaire was 11%, due to limitations in our photographic printing capabilities, the actual contrast step varied non-linearly from 8–14%, whereas the ghost intensities displayed on the monitor employed a fixed step of 11%. Therefore, these rendering errors between the score sheet and monitor were much smaller (<3%) than the step size, and would not be responsible for error scores greater than 1.

In evaluating the focus/blur dimension in more detail, it appeared that subjects were hesitant to utilize the extreme ends of the scale. It is uncertain why this occurred, but could merely be that subjects also wanted to leave available ratings for the image to get “better” or “worse”. It is clear, however, that as the complexity of the task increased (e.g. not directly matching, smaller target sizes, more than one dimension to consider at a time), accuracy decreased.

In many cases, a fit to the difference scores yielded a significant negative slope, potentially indicating that on average, subjects overestimate their rating at lower rating levels, and underestimate their ratings at higher levels of blur. However, given that a participant cannot give a score under 1 or above 10, a line of negative slope may actually be the expectation when employing this analysis of data of this type. To investigate this theory, we refit the data shown in Figures 2 – 5 restricting the range of our analysis to ratings units of 3–8 only, and then evaluated the significance of the slope of these regression lines. For the direct match case ( Figure 2 ), the varied direction case ( Figure 3 ), and the smaller letter size case ( Figure 5 ), all slopes that were previously significant became no longer significant. However, in the completely non-matching case ( Figure 5 ), where variance was greatest, the slopes remained significantly different than 0 (p<0.01).

Overall, however, the clinical implementation of the questionnaire demonstrates its general agreement with the standard numeric rating scale currently typically used to quantify ghosting 8 . There was a strong association between the overall numeric representation of ghosting and each ghosting attribute explored, indicating that overall perceived ghosting levels increased as ghost intensity, ghost off-set, and ghost focus increased. Conversely, less ghosting was perceived with ghosted images shifted less, blurred more, or when the ghost had lower intensity. Of the four attributes explored, however, “focus/blur” was the main driver of ghosting numeric ratings, with higher levels of blur in the ghosted image associated with better overall numeric ratings. This indicates that if the ghosted image is blurred to a certain level, the noticeability of the ghosted image is decreased. If, however, the ghost is well-focused, subjects will report more ghosting. Ghost position-offset was also significantly correlated with overall perceived ghosting and therefore, as add power increases, and blur of the ghost will generally increase, Prentice’s Rule predicts that ghost offset will increase. Thus, the potential strategy of reducing ghosting by employing higher add powers may fail in the presence of significant lens decentration.

Although this ghosting questionnaire had been employed briefly in a pilot setting, this was our first validation and implementation of a scale of this nature. As a result, there are several issues with the current scale that may need to be refined. First, as highlighted above, in the case of intensity ratings of 1 and 10, combined with low levels of defocus (high focus rating) and position-offset, it is impossible to distinguish whether the dominant aspect of the stimulus is the ghost or focus portion of the image. Fortunately, however, it is believed this combination of attributes (low contrast focused image and high contrast ghosted image) would not be one that would commonly occur in the clinical setting. Second, also as highlighted above, the variation in the three lowest focus ratings (highest amounts of dioptric blur) were quite high, indicting an inability of subjects to distinguish between these blur levels. This indicates that refined levels of focus/blur with greater separation between levels may be needed within a scale. Third, as the description and reference of the terminology becomes difficult to describe and remember at times (e.g. low focus rating corresponding to large amounts of defocus), some revision in the scale terminology and ordering may ultimately make it easier to clinically implement. Lastly, the current ghosting questionnaire approach only allows monocular quantification, whereas clinically someone may most commonly wear a design that may cause ghosting in both eyes. Previous literature suggests that the presence of ghosted images in each eye simultaneously may cause anomalous fusion leading to the perception of a “depth” disparity or “3-D” effect in some cases 37 – 38 However, further work is needed to investigate this effect in more depth.

Regardless of these potential issues, the novel method developed to quantify monocular levels of perceived ghosting provides accurate assessments of the perceived ghosted image along four stimulus dimensions, and this technique can be easily employed in the clinical environment to evaluate ghosting with different lens designs.


Support of BoKaye Dietmeier by T35EY013937.

Conflicts of Interest

The authors have no conflicts of interest to disclose related to this work.

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Ghosting images after cataract surgery, ghosting in the eye - astigmatism or dry eye will sclerals help, ongoing ghosting vision, possible cause of monocular diplopia complicated case :).

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What Is Monitor Ghosting and How Do You Fix It?

Is your monitor displaying visual artifacts? Don't head straight to the trash heap. There might be a way to fix it.

Looking at video artifacts while gaming is any gamer's nightmare, and monitor ghosting is one that tops the list. Not only does ghosting make gaming distracting, but it also affects how you consume content.

So, what do you do when a silhouette of delay follows your every move when you play your favorite FPS title?

Do you rush to the monitor service team to get the issue resolved, or is there something that you can do to fix monitor ghosting on your own?

What Is Monitor Ghosting and Why Does It Happen?

Monitor ghosting is a visual defect seen on monitors while playing fast-paced games or viewing content with expeditious action. This fast-paced nature of the content causes the pixels on the screen to give up— causing a shadow/trail of the object to be seen behind it. So as the name suggests, monitor ghosting is a visual defect that causes a ghost trail of the object to be visible behind it.

But why do the pixels on your display give up, and why does monitor ghosting occur? To understand why ghosting happens, we must understand how a display works and how data is sent from your CPU/GPU to the display.

You see, your GPU/CPU is responsible for creating the visuals you see on your screen. Once created, the CPU/GPU sends this information to your monitor based on its refresh rate. The monitor then collects the information and displays the visuals on the screen.

Therefore, if your monitor has a refresh rate of 60 hertz , information on the visuals is sent to the display every 16.6 milliseconds. Once the information is received, the monitor gets to work and starts manipulating the millions of pixels on the screen to display the received images.

This brings up the next question, how does the monitor change the images displayed on the screen every 16 milliseconds? Each of the millions of pixels on your monitor comprises sub-pixels consisting of three colors: red, green, and blue. A pixel can display any color using these three colors by changing its sub-pixel brightness. To do this, monitors use liquid crystals.

Liquid crystals are special compounds containing molecules whose orientation can be changed by applying a voltage. This change in orientation changes the amount of light that can pass through the liquid crystal. Due to this change, the brightness of each sub-pixel can be changed, and the monitor can display any image on the screen.

But there is a catch here: although the monitor can change the brightness of each pixel, the liquid crystals take some time to react to the change in the voltage, and this delay is known as the monitor's response time. Therefore, if your monitor has a response time of 20 milliseconds, then the liquid crystals on your monitor take 20 milliseconds to react to the changes in voltage. This delay causes ghosting on your monitor.

As explained earlier, if your display has a refresh rate of 60 hertz, then new information reaches the display every 16 milliseconds. That said, the liquid crystals in the display can't react to the information so fast, as they have a response time of 20 milliseconds. Due to this, your monitor shows a shadow of a fast-moving object as the liquid crystals have not changed the brightness levels, and part of the older image is still visible on the monitor.

We have taken the example of a monitor with a 60-hertz refresh rate, and as the refresh rate goes up, the response time of the liquid crystals plays a more crucial role. Therefore, ghosting can increase if you have a monitor with a high refresh rate.

Understanding Differences in Liquid Crystals and Their Response Times

Now that we know why ghosting happens, we can look at ways to solve it. That said, before trying to fix the issue, it's important to understand that every monitor in the market uses different types of liquid crystal technology, offering different advantages and disadvantages.

Broadly speaking, monitors use three types of liquid crystals: Twisted Nematic (TN), In-Plane Switching (IPS), and Vertical Alignment (VA). Each of these liquid crystal technologies offers different response times.

TN panels offer the lowest response time—being the most responsive, while VA panels are the slowest. IPS panels are somewhere in between the two when it comes to response time.

Therefore, if you look at it, each monitor will offer different levels of monitor ghosting based on its technology. So, if you are planning to buy a new monitor and don't want to fall prey to monitor ghosting, it's best to test the monitor for ghosting using the UFO test .

If you are satisfied with the results of the test, you can go ahead and buy the monitor. If not, we advise you to keep looking.

But what do you do if your monitor shows these visual artifacts? Don't worry; we have a set of solutions to help you solve monitor ghosting.

1. Update Your Drivers

Your GPU creates the visuals you see on screen. If there is an issue with how these graphics are created or sent to the display, you are bound to see some ghosting on your screen.

Hence, it is a good idea to update the GPU drivers on your system before blaming the monitor for the ghosting issues you are seeing.

In addition to this, you should also update the drivers on your system , as it could also solve the ghosting issues you are experiencing.

2. Check for Cable Damage

The cable connecting your monitor to the system is responsible for transmitting all the video data to the monitor. So, if the cable is damaged, you are bound to get some video artifacts while you game on your monitor.

Therefore, it is advised that you check the wire for any physical damage or fraying of the cables. If you find any external damage, then simply changing the cable could solve the problems that you are facing.

In addition, you can also look at the connectors on the two ends, and if they show signs of corrosion or are damaged in some way, it's best to replace the cable itself.

If you are using an HDMI cable for connecting to your display, it is advised to shift to a display port as it offers better video quality when compared to HDMI.

3. Change the Location of Wireless Devices

All the wireless devices you have connected to your system use radio waves to communicate with one another. In some cases, these waves can interfere with the signal sent over the video cable and cause ghosting.

So, if you have a lot of wireless devices connected to your system, you can disconnect them one at a time and see if it fixes the issues you are facing. Not only this, but you can also try to move around the devices that are connected to your system and see if ghosting reduces.

4. Change Your System Refresh Rate

As explained earlier, a higher refresh rate can increase monitor ghosting. So, if you want to reduce ghosting, you can decrease the refresh rate on your system . Doing this will give the pixels on your monitor more time to react, reducing ghosting.

5. Tweak the Video Settings on Your Monitor

When it comes to display settings, you can tweak video settings to reduce ghosting . Right from contrast ratios, gamma levels, brightness values, and shadow correction to color values, your display allows you to make several changes to improve display quality.

Although changing these parameters does not reduce ghosting at a physical level, these changes can reduce the amount of ghosting visible on the screen. For example, decreasing the contrast ratio can reduce the ghosting you see, as the difference between the brightest and darkest pixels is reduced.

6. Enable Pixel Overdrive on Your Monitor

As explained earlier, your monitor uses voltages to change the orientation of liquid crystals. Pixel overdrive increases this voltage so that the response time of the liquid crystals is reduced.

Most monitors offer three different intensities for pixel overdrive, and selecting the right one can help reduce ghosting drastically. That said, increasing pixel overdrive can cause inverse ghosting as the increased voltage can cause the pixels to overshoot the colors they are supposed to show.

7. Get Help From the Experts

If you have tried everything listed above and feel that the ghosting on your monitor hasn't reduced, it is best to contact the technical support team for your monitor.

In some cases, a damaged video port could cause ghosting, and such defects can only be fixed by changing the video decoding hardware on your monitor.

Can Monitor Ghosting Be Fixed, or Should You Buy a New Monitor?

Introducing a visual defect that follows fast-moving objects, monitor ghosting is a video artifact that makes your gaming experience less rewarding. That said, ghosting is not a permanent defect like pixel burn-in, and it can be fixed by tweaking the settings on your system/display.

Not only this, modern gaming displays come with overdrive technology that is designed to fix ghosting. So, if you are tired of monitor ghosting, tweak your monitor settings, but if that does not fix the issue, you might need to get a new monitor.

Eye Surgery Guide

  • Should My Vision Still Be Blurry 1 Week After PRK?
  • How Many Days After PRK Can I See Clearly?
  • Does Astigmatism Go Away After PRK?
  • Why is My Vision Getting Worse After PRK?
  • Cataract Surgery
  • LASIK Surgery
  • PRK Surgery

What is LASIK Ghosting?

Brian Lett

Some patients experiencing LASIK can experience ghosting vision for about one month post-op; this is considered normal and typically resolves as the eye heals.

However, if it continues to persist beyond this threshold then it could be an indicator that something is wrong with either your eyes or surgery. Longer-term ghosting may be caused by residual astigmatism not fully corrected during surgery or central islands (wrinkled cornea called striae) remaining from previous procedures – though this phenomenon is becoming less frequent with conventional and wavefront custom Lasik treatments than previously.

LASIK surgery aims to reshape the cornea so it better reflects light; however, every eye differs and occasionally the surgery misses certain irregularities within it, leading to ghosting images after treatment.

Temporary ghosting images that arise during the six-month post-LASIK healing period after conventional or wavefront custom LASIK tend to be caused by irregularities in the cornea. When it only affects one eye at a time, this condition is called monocular diplopia and could be related to factors like edema, astigmatism, epithelial defect healing or incision wound healing; when both eyes are open simultaneously it could indicate binocular diplopia which usually indicates issues related to pupil size or alignment issues.

Though most cases of LASIK ghosting resolve on their own within two or three months, patients should visit their physician if their problem continues to worsen; ghosting could be a telltale sign of an underlying condition like glaucoma or cataracts that needs immediate medical attention.

Ghosting after LASIK can also be caused by corneal irregularities such as astigmatism, decenter ablation or large pupils, which allow light to pass through multiple images of an object which then create multiple ghost images when exposed to light at night. Such issues can usually be resolved with either enhancements or wearing contact lenses with larger pupil diameters.

Ghosting may also be an indicator of medical problems such as diabetes, high blood pressure or brain tumor. Therefore, it’s essential that if this issue persists you visit your physician so they can assess and offer appropriate solutions.

Ghosting due to age-related changes can also occur with LASIK surgery. While these changes should not dissuade someone from seeking it out, they can be managed using moisturizing eye drops, punctal plugs, or Intacs implants. It should also be noted that LASIK might not always be the ideal solution for older patients who suffer from chronic astigmatism or corneal irregularities – in such instances corneal transplant or surgery may provide better solutions.

If you are experiencing glare, ghosting and double vision after Lasik surgery, this could be considered a normal part of the recovery process. The condition occurs when light passes through irregularities in your cornea that were not corrected during LASIK; most often this issue resolves itself as your eye heals; however it could also signal more serious eye issues that need attention.

If your symptoms continue after several weeks, it’s wise to visit your physician as they will be able to diagnose the source and offer suitable solutions for treatment.

Your doctor may conduct various tests to establish the cause of your symptoms and may order additional assessments – from reviewing past medical histories and performing physical exams, to ordering various diagnostic procedures and looking for signs of infection such as red and swollen eyes – in order to ascertain their source. Should they suspect infectious keratitis as being responsible, antibiotics and antivirals will be prescribed in order to treat it effectively.

Your doctor may suggest using a dry eye lubricant to alleviate your condition. These eye drops mimic the natural tears produced by your eyes and help rehydrate them; in severe cases they might suggest taking additional measures like taking an anti-inflammator medicine and/or prescribing specific eye drops to reduce inflammation and promote healing.

Flap misalignment issues may also contribute to ghosting after LASIK surgery, creating folds in your cornea due to laser treatment. This may be caused by improper positioning during surgery or injury to the flap afterward; your doctor will need to manually move or stitch it back into place if the issue persists.

LASIK can be an effective procedure to correct irregularities in your cornea and improve your vision, but results will differ for every patient. Therefore, before having surgery it is wise to discuss your recovery timeframe with your physician so you can be realistic with expectations as well as anticipate potential issues during recovery.

Ghosting and halos are generally only temporary issues; they typically appear during the immediate recovery period after LASIK surgery and resolve as your eye heals. Furthermore, irregularities in your cornea could also contribute to ghosting/halos formation; which should be rectified with further laser treatment.

PRK laser treatment can be used to address irregularities that cause double vision and haloes. The laser is applied directly on top of the cornea and used to reshape it, effectively correcting both glare and ghosting symptoms most noticeable at night or dim lighting conditions.

If the ghosting and halos persist for more than two months, it is essential that you see your doctor immediately as it could be a telltale sign of dry eyes, residual refractive error or another eye health issue that needs treating.

When diagnosing you with LASIK ghosting, your doctor will likely prescribe special eye drops to ease its symptoms and may also suggest wearing contact lenses or punctal plugs to alleviate discomfort. If it stems from corneal irregularity such as Keratoconus then further action such as corneal transplant or Intacs implants might be suggested as potential solutions.

Laser in Situ Keratomileusis (LASIK) is the most frequently performed form of eye surgery. LASIK can effectively correct myopia, hyperopia and astigmatism by reshaping the cornea with an excimer laser; additionally it may correct higher-order aberrations such as starbursts, halos or ghosting.

LASIK surgery has been around for more than two decades and is considered safe, effective and well-researched. Unfortunately, any surgical procedure carries with it potential risks; LASIK is no exception.

LASIK is widely recognized as an easy and safe solution to vision issues such as myopia, hyperopia and astigmatism. While considered safe, its laser can cause ghosting halos or double vision which are usually temporary but should still be corrected as soon as possible with additional procedures if they become bothersome to the patient’s quality of life.

LASIK surgery has proven safe and effective at relieving patients of their need for glasses or contacts, yet any medical procedure carries with it an inherent risk of complications – ghosting being one such risk that could occur for various reasons. Luckily, ghosting is easily treatable; to reduce its likelihood, make sure both eyes have been thoroughly tested by your physician to ensure both flaps have healed correctly before scheduling surgery.

Ghosting following LASIK surgery can often be linked to residual refractive error; once healed, this should resolve itself. Another potential source is dry eye syndrome which may require moisturizing eye drops as treatment or further consultation with an eye specialist in order to alleviate its symptoms.

Finally, large pupils in low light environments may contribute to LASIK ghosting issues. When your pupil contracts, light passing through irregular components of your cornea causes focal points that do not align with your retina’s centers causing multiple focal points that creates an unpleasant halo effect that becomes particularly apparent during darkness or poor lighting environments. If this is indeed the cause for your ghosting symptoms it can be corrected through prescription eyeglasses.

Halos, glare and ghosting can be very disturbing and significantly decrease quality of life for patients. Anyone experiencing these issues should seek assistance from an expert in refractive surgery to ascertain whether further LASIK treatments might help, or whether further measures need to be taken in order to address them.

Most doctors consider ghosting to be normal after having undergone LASIK and should be expected for approximately the first month or so after treatment, and within this timeframe should reduce and clear up by itself. If however it persists for longer, it may be worth consulting an ophthalmologist to make sure there are no underlying issues contributing to it; such as an eye injury, disease such as autoimmune or immunodeficiency states or certain medications which interfere with healing after LASIK surgery.

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  1. What Is Ghost Vision? [Learn the Cause of Double Vision]

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  1. What are "Ghost" Images and What Causes Them?

    Ghost images are a type of double vision that is a sign of a binocular vision dysfunction. There are two different types of double vision (diplopia): monocular and binocular. While monocular double vision can be caused by corneal disease or cataracts, binocular double vision can be caused by serious neurologic conditions.

  2. Mayo Clinic Q and A: Double vision can often be effectively treated

    Monocular double vision in one eye often appears as a ghosting or shadow that overlaps with the primary image. It can affect the right eye, the left eye, or both eyes at the same time. The most common cause of this type of double vision is dry eye syndrome.

  3. What Is Ghost Vision? [Learn the Cause of Double Vision]

    Ghost vision is the phenomenon of a shadow or a "ghost image" overlapping with the actual object that you are looking at. It can affect only one eye or both eyes resulting in a type of double vision. It creates a shadow that overlaps with the primary image that you are looking at.

  4. Double Vision (Diplopia): Causes, Definition & Treatments

    Sometimes, the term "ghost image" is used to describe the less dominant image seen during diplopia. Types of diplopia include: Horizontal diplopia: Double vision where the two images are separated laterally (horizontally). Vertical diplopia: Double vision where one image is higher than the other.

  5. How can I fix vertical double vision?

    Answer: When a person sees a ghost image with each eye alone and with both eyes open, it means the problem is in the focusing portion of the eye and not in the eye motor system (muscles of the eyes). A frequent cause of ghosting is astigmatism, but it can also come from abnormalities of the lens.

  6. What Does Ghosting Vision Look Like?

    Ghosting vision is a condition that affects your eyes, causing them to see a shadowy image. It can occur in both monocular and binocular forms and may be due to dry eye syndrome or refractive errors like astigmatism. Cataracts may cause vision to blur as well, if only one eye is affected by these problems and the other has normal vision.

  7. Double Vision (Diplopia): Monocular, Binocular and Other Types

    Astigmatism — Refractive error (like nearsightedness or farsightedness) that affects how your eyes bend light. This can result in blurred or double vision at any distance. Cataract — Clouding of the eye's lens caused by age, smoking, diabetes and/or steroid medication use.

  8. Double Vision, Floaters, and Other Common Eye Phenomena

    Ghost images and astigmatism As mentioned earlier, many people who report "double vision" are more accurately experiencing blurriness or ghost images. Unlike true double vision, which is a sign of something serious, ghost images are often linked to a condition known as astigmatism.

  9. 10 Warning Signs Of Age-Related Eye Problems

    A simulation of peripheral vision loss, also known as tunnel vision. 4. Double vision, double images or "ghost" images Double vision can be caused by many eye conditions. In some cases, double vision also can signal an underlying health emergency such as a stroke. If you have a sudden onset of double vision, see an eye doctor immediately. 5.

  10. Is This Normal? Vision Changes That Could Signal a Serious Condition

    Any condition that impairs the muscles or nerves controlling the eyes also can result in double vision. Some of these conditions are: Myasthenia gravis, an autoimmune disorder that interrupts transmission between the motor nerves and the eye muscles. This weakens the muscles that move the eyes and often the eyelids (resulting in a drooping eyelid).

  11. Double vision

    Check if you have double vision. Double vision is when you look at 1 object but can see 2 images. It may affect 1 eye or both eyes. Signs that your child may have problems with their vision include: narrowing or squinting their eyes to try to see better. covering 1 eye with their hand. turning their head in unusual ways (for example, tilting ...

  12. Help with Ghosting Vision After PRK Eye Surgery

    Ghosting vision or double vision, also more properly known as diplopia, is a condition that occurs when your eyes that normally work together start to see two slightly different images. Double vision occurs when these two different images cause you to see them transposed next to each other.

  13. Ghosting: What It Means and How to Respond

    Ghosting doesn't just impact the ghosted; it also is a detriment to the ghoster. The bottom line here is that ghosting is either a passive aggressive way to end a relationship, or it is the "easy way out." Either way, it's not doing the ghoster any favors in their ability to communicate with others.

  14. What is the difference between double vision and ghosting?

    Muscle imbalance: Double vision is due to the eyes pointing in different directions. Cover either eye and the image becomes single. Ghosting is typically due to astigmatism.It goes away by looking through a pin hole in a piece of cardboard, or proper glasses or contacts. If one eye is covered and there is still double the astigmatism is strong, if there is just ghosting the astigmatism is mild.

  15. Lens FAQ #4: What is "ghosting" and "flaring"?

    Flaring, also known as "veiling flare", occurs when light reflects off the lens, or other elements such as the lens barrel and mirror box, making part or all of an image appear soft or hazy. Ghosting, also known as "ghosting flare", is caused by a strong light source being reflected repeatedly. It appears as a clear artefact that is usually ...

  16. Vision ghosting

    Ghost vision is when one image is different and usually fainte... Read More Created for people with ongoing healthcare needs but benefits everyone. Learn how we can help 4.5k views Answered >2 years ago

  17. Ghosting After Cataract Surgery

    Ghosting is the term used to describe white or black areas appearing in a patient's field of vision after cataract surgery. It's not common, but some people experience this symptom. Generally, ghosting occurs in one eye only. The best way to prevent ghosting is to take good care of your eyes, including getting regular checkups.

  18. Quantification of Ghosting Produced With Presbyopic Contact Lens

    Ten subjects viewed simulated bifocal vision images displayed on a monitor. Images contained a focused and a defocused (ghost) component of a specific dimension (direction, position-offset, intensity, and focus). Using a test card, subjects identified the ghosting dimension level displayed on the monitor.

  19. Strange vertical ghosting in vision : r/optometry

    The pinhole test (poke a tiny hole in a piece of paper with a pin and look through it) - removes the polyopia. I also have other issues like light sensitivity and constricted peripheral vision. I've went to a Neurovision therapy place (it's called vision therapy) and that has helped my Binocular issues (two eye issues).


    If its night time and im looking at a bright object such as a street sign its much worse... I see it under the read image both sides and many above... No one had a clue... Anyway i went to a (forgive spelling) opthomologist... then another then another... All said they never heard of it... Months past and i went to a nurologist...

  21. Help with ghosting/double vision : r/optometry

    About 10 years ago I noticed a sudden onset of floaters and double vision around the same time. I soon learned the double vision is actually called monocular diplopia and a better term for it is ghosting, because double vision will get you sent down a rabbit hole of binocular workups and neurological avenues. My diplopia is definitely refractory.

  22. What Is Monitor Ghosting and How Do You Fix It?

    Monitor ghosting is a visual defect seen on monitors while playing fast-paced games or viewing content with expeditious action. This fast-paced nature of the content causes the pixels on the screen to give up— causing a shadow/trail of the object to be seen behind it.

  23. What is LASIK Ghosting?

    Laser in Situ Keratomileusis (LASIK) is the most frequently performed form of eye surgery. LASIK can effectively correct myopia, hyperopia and astigmatism by reshaping the cornea with an excimer laser; additionally it may correct higher-order aberrations such as starbursts, halos or ghosting. LASIK surgery has been around for more than two ...