Accommodation Deficiency in One Eye

Problem:

Today I met a 37 y/o with an Adie's Pupil and Loss of Accommodation in Left Eye Only. Right eye is normal.

Has tried in the past using a no-line on left lens only, but was not successful!

Has moderate myopia OU (about -1.75sph +1.25 cyl) with +1.75 Add.

Does anyone have any experience with this type of situation? And if so, what worked for you?

Would +1.75 Add in both eyes be too much for the right eye?
My first thoughts are +1.25 Add for Right Eye and +1.75 Add for Left Eye.
Or computer glasses for work and SV Distance for general wear.

This person really wants to have one pair of glasses to "fix" the problem!

Thank You.

P.S. Have a good and safe Labor Day Holiday - Be back late Monday or on Tuesday!

Traci,

I wrote a pretty long reply to your post about the Adie's tonic pupil patient but somehow I goofed and send the wrong thing.:hammer:

In a nutshell........thire is not alot you can do for a patient like this. I think your idea of slightly different add powers might work. Or if he didn't have quite as much astigmatism, I might recommend a bifocal (focus progressive) contact lens in the right eye.

You didn't mention how long this patient has had this problem. Sometime the tonic pupil resolves abit over time and some accomodation comes back.

I can't remember all that I said before I lost what I was writing.........but then again, its been a GOOD holiday weekend. My brain is not yet functioning fully.

Good luck

Traci,

Have you checked for dominance? If so and the fixated eye is non-dominant I would suggest fitting the progressive seg 1 to 2 mm higher in that eye. The lack of natural accomidation can be aided by the progressive lens design. I think you are on the right track with the dissimilar seg powers, however keep in mind that the increased seg height will yield an increased feeling of magnification to the patient. You may actually concider lowering the add in that eye. As far as "would the +1.75 add be too strong for the right eye?"....I would call the Dr's office on that one. If thats the Rx in the unafflicted eye I would be surprised concidering the patient is 37 yo. Although an add that strong is not "unheard of", you need to give the perscribing Dr's office a call and get some pt history. Like NC-OD said, is this condition something that has been on-going for years, months, weeks or days? Also, what was his previous Rx? Compare the Rx for changes in both distance and near.
This combined with a good progressive lens design should yield something usable. I would highly suggest the Varilux Panamic. In raising the seg for accomidation purposes this lens will be a charm for several reasons. #1: The edge distortions are damn near non-existant. #2: It gives you more margin of error that you can utilize for the higher fitting. #3: Essilor is a chump for "progressive non-adapts" so you can get a credit if the patient gives up on the fit. #4: You can "break-it-off" in the patient for the use of "premium materials" to correct his visual needs.

I hope this helps, it has been useful to me in the last couple of these I've seen in the past. (Although the Panamic was not available the last time I had a pt like yours.)

If it doesn't work....just beat the patient till he looks like this--------------> :shiner:

If it does work.....this------------------------------------------------> :cheers:

-J