Hi guys I really hope someone here can shed some light on this for me:
I have a patient who has recovered from a severe concussion from years ago. He has always been a high myope with prism. His neurologists told him not to get new glasses during these few years because he was experiencing all kinds of symptoms from the concussion.
They walk into my shop. The lenses are 7 year old polycarbonate in which the coatings have long ago failed - they are just pure uncoated substrate after years of environmental abuse. It is amazing there is ANY vision at all through them.
The RX I could garner in the manual lensometer (the auto wouldn't even read them) was:
OD -8.00 -2.00 x 013
OS -7.75 -1.75 x 001 3 prism diopters Base Down
Add +2.25
Ok so this patient gets a new exam and this is the RX that is prescribed:
OD -7.00 -1.75 x 035 1 prism diopter Base Up
OS -6.75 -1.50 x 005 1 prism diopter Base Down
Add +2.00
I fit him in an Autograph III 1.67 variable compensated RX
Vertex:13
Pantoscopic tilt angle: 4.5
Wrap: 10
RT: -6.74 -2.02 033 Prism= 1.03 @75
LT: -6.55 -1.56 178 Prism 1.00 @274
RTAdd: 209
LTAdd: 191
Patient's initial impression: Vision VERY bright, almost too bright. I advised the patient that this was most likely due to the clarity of the new lenses and the old destroyed poly acting as a tint. This got better after a few weeks.
Now his complaints are: Vision out of left eye is great in all but the farthest distances. Vision out of RIGHT eye feels like there is a haze everywhere. In addition to this haze patient feels like they must look out of the bottom of the lens to see midrange and finds it difficult to "find" the area of the left lens to see up close. This is in stark contrast to the ease with which the right eye is working. Patient gets stress and double vision if he reads for too long. Optometrist sent patient to local Opthomologist for lens and retinal exams. Everything clear.
My proposed solution: Add -0.25 diopter back into the RX. Optometrist says patient was already "overminused" in the RX compared to his results in the room but also agreed to bump it back up by -0.25 more.
As far as the double vision - I can't decide if I should raise the seg in the Right eye by a millimeter (which seems inconsequential when compared to ANSI tolerances) or choose a shorter fixed corridor autograph for the right eye than in the left. I have never done this before.
Any suggestions? Am I crazy to use an 11 mm corridor in the right eye and a 15 mm corridor in the left? It sounds like it may solve the issue, but it also makes me feel like it could be a terrible idea.
Also its a VSP job, so yeah...
RXed Vertical Prism difficulties
I have a patient who has recovered from a severe concussion from years ago. He has always been a high myope with prism. His neurologists told him not to get new glasses during these few years because he was experiencing all kinds of symptoms from the concussion.
They walk into my shop. The lenses are 7 year old polycarbonate in which the coatings have long ago failed - they are just pure uncoated substrate after years of environmental abuse. It is amazing there is ANY vision at all through them.
The RX I could garner in the manual lensometer (the auto wouldn't even read them) was:
OD -8.00 -2.00 x 013
OS -7.75 -1.75 x 001 3 prism diopters Base Down
Add +2.25
Ok so this patient gets a new exam and this is the RX that is prescribed:
OD -7.00 -1.75 x 035 1 prism diopter Base Up
OS -6.75 -1.50 x 005 1 prism diopter Base Down
Add +2.00
I fit him in an Autograph III 1.67 variable compensated RX
Vertex:13
Pantoscopic tilt angle: 4.5
Wrap: 10
RT: -6.74 -2.02 033 Prism= 1.03 @75
LT: -6.55 -1.56 178 Prism 1.00 @274
RTAdd: 209
LTAdd: 191
Patient's initial impression: Vision VERY bright, almost too bright. I advised the patient that this was most likely due to the clarity of the new lenses and the old destroyed poly acting as a tint. This got better after a few weeks.
Now his complaints are: Vision out of left eye is great in all but the farthest distances. Vision out of RIGHT eye feels like there is a haze everywhere. In addition to this haze patient feels like they must look out of the bottom of the lens to see midrange and finds it difficult to "find" the area of the left lens to see up close. This is in stark contrast to the ease with which the right eye is working. Patient gets stress and double vision if he reads for too long. Optometrist sent patient to local Opthomologist for lens and retinal exams. Everything clear.
My proposed solution: Add -0.25 diopter back into the RX. Optometrist says patient was already "overminused" in the RX compared to his results in the room but also agreed to bump it back up by -0.25 more.
As far as the double vision - I can't decide if I should raise the seg in the Right eye by a millimeter (which seems inconsequential when compared to ANSI tolerances) or choose a shorter fixed corridor autograph for the right eye than in the left. I have never done this before.
Any suggestions? Am I crazy to use an 11 mm corridor in the right eye and a 15 mm corridor in the left? It sounds like it may solve the issue, but it also makes me feel like it could be a terrible idea.
Also its a VSP job, so yeah...
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