I have primarily ocular too and I see you are from Ohio also.

I find that the weather (hot) makes me worse. I was doing pretty good until July hit. Also fluorescent lights make my eyes worse. When I first started with the double vision, Prednisone was the only thing that helped. I've been off it now for 4 months (after being on it 5 months).

Maybe your dosage of Mestinon needes to be changed. Have you talked with your neuro about this? I have my neuro's OK to adjust my Mestinon depending on my symptoms for that day. Some days I take 3 30mg tablets, some days I take 4. On days that I drive more, outside in the bright sun more, on computer a lot, etc. I find I need that extra pill.

Hope you find some answers.