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Each case has to be individually-evaluated for possible treatment. When you mention diabetic retinopathy and glaucoma, this sounds like a form of highly advanced diabetic retinopathy, such as vitreous hemorrhages with retinal detachment. Normally, these don’t occur in both eyes at the same time, and, normally, this level of retinopathy would be seen with a dilated exam well before it got to this point. If treatment (usually laser) could have been started before the hemorrhages occurred, the outcome would have probably been much better. Although retinal detachment alone without diabetic retinopathy can occur suddenly, it is usually only in one eye.

Having said all that, and not knowing the specifics of your aunt’s sudden loss of vision in both eyes, my recommendation is to consult with a retinal specialist to get a second opinion. If no treatment is recommended even by the second opinion, you could consult with a low vision specialist who may be able to help your aunt with devices to make the most use of any possible partial vision remaining.

Some people have naturally large pupils and can be more sensitive to light (photophobia) than most others. However, any changes occurring with your pupils that are new are a concern and should be evaluated by an eye doctor and/or neurologist. Some of the possible simple causes could be using anti-red over-the-counter drops or using most any of the anti-seasickness pills or patches. Also, prescription medications, especially those for gastrointestinal problems, can cause larger pupils.

When the pupils get fairly large, there tends to be a slight shift in the focus error, and any focus error that is not corrected will cause much more blur than with a normal pupil. People with naturally very small pupils are not as sensitive to being slightly out of focus.

Both optometrists and ophthalmologists are trained to do a thorough dilated eye exam with the same equipment. However, if ocular surgery is indicated, the optometrist would refer you to an ophthalmologist who is a trained surgeon. Some ophthalmologists have gone through even more extensive surgical training, such as a retinal specialist, to whom we refer for diabetic retinopathy.
 
A VSP WellVision Exam® is a thorough eye health exam, which includes a complete case history and visual system evaluation with a VSP doctor.

For most people, cataract surgery is a short outpatient surgery with no stitches or patches and provides better vision even on the same day. However, any surgery can have complications, and as you indicated, your wife has a complicating factor, Stargardt’s Disease. More can be found about this disease at Lighthouse International. 

 
With Stargardt’s as well as with age-related macular degeneration, the loss of vision is in the center. However, most of the time, there is no loss to the peripheral vision. Because of that, I would recommend a consultation with a retinal specialist to see if cataract surgery would be contraindicated, because cataracts make the vision dim in the periphery as well. I have worked with many patients who have macular degeneration, and although the cataract surgery did not improve their central vision, they were very pleased with the improved peripheral vision.

Soft contact lenses are relatively inexpensive, and for some of my diabetic patients whose prescription is rapidly changing, I just order several sets of contacts that can be changed even weekly as their refractive changes settle down with the stabilization of their blood sugar control. The best measure of this diabetic control, which relates very closely with refractive shifts, would be the A1C blood test. As it seems as there is no retinopathy to follow closely, I would probably schedule a monthly brief visit until the refractive shifts stabilize. This could be more or less frequent depending on how quickly your daughter complains about blurry vision. I would also want to assure you and your daughter, as she has a lot to adjust to with a new diagnosis of diabetes, that these refractive shifts do not mean that she will lose her vision from diabetes. With good maintained control during her life, she will most likely be able to prevent any permanent loss of vision from diabetes.

A torn retina is an ocular emergency and should be seen by a retinal specialist within 24 hours for laser treatment around the tear to keep the rest of the retina from detaching. The tear allows fluid to seep behind the retina causing it to peel down like loose wallpaper falling off a wall. If the retina actually does become detached, the surgery to repair it is quite extensive, and even if it is successful, the recovery is slow and difficult.

The treatment for just a torn retina is usually done at the same office visit in which it is confirmed by the retinal specialist with little or no recovery time. The first step, therefore, is to see any eye doctor, who can then confirm or rule out the presence of a tear. If one is found, they then would arrange an appointment with a retinal specialist right away.

First, he should have a dilated eye exam right away to rule out any diabetic retinopathy. Then, he could get some glasses to clear up the temporary refractive changes that occur within days to a week as a person is being brought under proper diabetic control. There is a general hesitation among eye doctors to prescribe lenses right away because they may only be good for about a week or so. However, with an understanding of this, and an acknowledgement that the prescription may have to be changed with an additional cost to the patient even within a week, I will order simple lenses without any special treatments to ensure getting the glasses quickly. Temporary glasses can be much less expensive than losing a week of work and the frames can be reused.

I am sorry to hear about the central retinal vein occlusion in your right eye with severe visual loss. This would naturally make you more concerned about any symptoms in your one good eye. The first concern I have is to make sure you are in the care of a primary physician who understands that you have already had a stroke. Although this was apparently just in your right eye, it was still a stroke that could have affected other areas in your brain as well. You have done well in consulting with the eye doctor to make sure that your retina in your left eye remains healthy. You should continue your regular visits with your eye doctor to also watch for diabetic retinopathy. However, vessel occlusions can happen in other areas of the brain, which also can affect your vision. Sometimes, a flourescein angiography done by a retinal specialist can detect poor circulation to the retina, but overall imaging studies may also be indicated. Also, you mentioned laser treatment of the right eye which is normally done to prevent new vessels from growing that are very subject to hemorrhage. You might be having some of your visual symptoms from your treated right eye, as they can occur even with your right eye shut. Sneezing can cause the natural vitreous body in your eye to tug on your retina giving these transient sparks.
  
Those of us with diabetes have to watch our lipid levels very carefully as we are much more prone to having strokes than those without diabetes.

Eye doctors have a variety of instruments available to them to exam the retina. It is possible to diagnose stage one diabetic retinopathy without dilation, and I have done that myself. However, I will not stop there, and I will proceed to dilate so I can find other possible changes, such as macular edema. The reason the ADA states the need for a dilated exam is that it helps us detect some more subtle, but significant diabetic changes that would not be seen without the dilated, binocular view.

Diabetic mono neuropathy can cause a very dramatic eye turn which is very bothersome. There are 12 different muscles (6 for each eye) that have to continually coordinate with each other to keep the two eyes aligned with each other. Diabetic mono neuropathy is where the nerves that control one or more of these extra-ocular muscles become partially dysfunctional. In most cases, it will recover in three months or so and will not affect the pupil size. If the pupil is affected or the eye turn lasts much longer than 3 months, a brain scan should be done to rule out other possible neurological causes.

If the eye turn is not too large, I will order temporary glasses with some “prism” in the lenses to allow alignment of the two eyes without having to patch one eye all the time. Also, if the eye turn is large and seems to be permanent, eye muscle surgery can be considered.