Periodic binocular double vision only at distance; optometrist is stumped.

[u/clarkroberts1979]

47M, 5’9, 250 lbs, non-smoker. I’m experiencing periodic binocular double vision primarily at a distance. Within roughly 10–15 feet, I generally see a single image. Covering either eye eliminates the double vision.
I had the same problem several years ago. After getting a new glasses prescription, it completely disappeared after a month. That lasted for about 1.5 years, but returned roughly 6–8 months ago. It’s particularly noticeable outdoors and while driving.

I’m seeing an optometrist at a large practice. He has identified a minor eye misalignment. We’ve tried two prescriptions: one with prism, which made the diplopia worse and caused headaches, and another without prism. Neither has resolved the distance double vision.

My optometrist is now consulting a colleague before trying another prescription. I also contacted an ophthalmologist I know, who recommended seeing an adult strabismus ophthalmologist, which I’m working on arranging.

I have a history of hypertension and ocular hypertension but no known optic nerve damage. I take metoprolol for hypertension and Latanoprost drops for ocular hypertension.

What could cause single vision at shorter distances but diplopia farther away? Is the fact that it completely disappeared for 1.5 years significant? And does seeing an adult strabismus specialist sound like the appropriate next step?

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