Rare condition.

[DragonLensmanWV]

We had a customer come in the other day who said he had a rare eye condition (he didn't name it) that prevents his eyes from moving at all. During my conversation with him, it was apparent that they indeed did not move. He also has moderate plus (around +2.50) with 8 D prism Base out OU.
He was wearing 1.60 Comforts, and we put him in Hoya GPW 1.70 index. We'll see how nice they look when they come back.
Does anyone have a clue what the eye condition would be? I was wanting to research it some more, and I am kicking myself for not asking him what it was called.:hammer:

[1968]

We had a customer come in the other day who said he had a rare eye condition (he didn't name it) that prevents his eyes from moving at all. During my conversation with him, it was apparent that they indeed did not move. He also has moderate plus (around +2.50) with 8 D prism Base out OU.
He was wearing 1.60 Comforts, and we put him in Hoya GPW 1.70 index. We'll see how nice they look when they come back.
Does anyone have a clue what the eye condition would be? I was wanting to research it some more, and I am kicking myself for not asking him what it was called.:hammer:

A number of things could cause ophthalmoplegia. If he has complete paralysis of all the extraocular muscles, I'm wondering how he can take advantage of progressive lenses.

[HarryChiling]

A number of things could cause ophthalmoplegia. If he has complete paralysis of all the extraocular muscles, I'm wondering how he can take advantage of progressive lenses.

I was about to say you could give them a dog of a progfressive and say it will perform miracles and they wouldn't notice the difference.

[OPTIDONN]

From time to time I get this very condition when a lovely lady enters the store :D. Seriously that is very strange and interesting.

[DragonLensmanWV]

From time to time I get this very condition when a lovely lady enters the store :D. Seriously that is very strange and interesting.

Me too, but it's one of my reps.:D

I'll find out more about it when he comes back. I'm guessing he's a peripheral vision reader.

[chip anderson]

Does he converge? If not you better not inset the segs in any type lens.

Chip

[DragonLensmanWV]

Does he converge? If not you better not inset the segs in any type lens.

Chip

Just to be on the safe side, we measured his old lenses for PD, seg relationship, etc and we matched them in the new frame. I noticed his old lenses were normally inset, because that was what I was thinking, that we'd have to rotate the axis and the lens to get vertical segs, not angled. So if he was working OK with his old ones he should be fine with the new ones.
Apparently the 8 BO prism does most of his converging for him.

[orangezero]

I was reading a thread on here the other day of a frame line that had patient-adjustable nosepads. Would something like this help this patient, potentially? perhaps I read the other thread incorrectly.

[FVCCHRIS]

Sounds to me like he must have some limited ability to converge or the progessives would not work smoothly. Amblyopic perhaps? I'd try SV dist and SV near just to see how well he sees with them. He might thank you for them, at least as some spares.

[DragonLensmanWV]

Sounds to me like he must have some limited ability to converge or the progessives would not work smoothly. Amblyopic perhaps? I'd try SV dist and SV near just to see how well he sees with them. He might thank you for them, at least as some spares.

That does sound like a good idea. I'll suggest some SV readers for him when he returns.

[1968]

Sounds to me like he must have some limited ability to converge or the progessives would not work smoothly.

...as well as some limited ability to move the eyes vertically.

[LENNY]

Apparently the 8 BO prism does most of his converging for him.

Base out!? In both Distance and near?

[MarcE]

if his eyes don't move at all, progressives are completely worthless, right? Am I missing something?

It's true that even 'normal' hyperopes like BO prism. It does help them converge. Wait, or is it BI prism? Anyway, if it is both distance and near, how does that help convergence?

[drk]

Was it "progressive external ophthalmoplegia" ?

http://www.emedicine.com/oph/topic510.htm

[Laurie]

Hello,

My guess is that it would be Base In (A Relieving Prism, which will move the images out to his eyes), rather than Base Out (A Working Prism, which will move the image even closer inward, forcing him to try to strengthen/turn his muscles)...which he can't do.

probably BI.

?

: )

Laurie

[DragonLensmanWV]

Hello,

My guess is that it would be Base In (A Relieving Prism, which will move the images out to his eyes), rather than Base Out (A Working Prism, which will move the image even closer inward, forcing him to try to strengthen/turn his muscles)...which he can't do.

probably BI.

?

: )

Laurie

OK OK. I'll post his complete RX already.:bbg::bbg:
His still have yet to return from Hoya but here it is:

+2.75-2.00 X 12 8 BO
+3.50-1.50 X 153 8 BO
+2.25 add

[chip anderson]

Suspect if the eyes are "frozen" in place. They may be slightly turned in and the prism is to bring the images together when looking straight ahead.
Rather doubt if any accomodation is present. And if the patient cannot move the eyes in, out, up or down any type bifocal, expecially progressives will be completely useless. Unless of course, the patient moves them up and down manually with his hand, or has one of those little trick bridge frames that elevates the frame on the nose for near.
Still a progressive would be the lens of last choice for this patient.

First choice would be two pairs of glasses, one for near, one for distance with the same P.D. on both pair.

Chip:cheers:

[DragonLensmanWV]

Suspect if the eyes are "frozen" in place. They may be slightly turned in and the prism is to bring the images together when looking straight ahead.
Rather doubt if any accomodation is present. And if the patient cannot move the eyes in, out, up or down any type bifocal, expecially progressives will be completely useless. Unless of course, the patient moves them up and down manually with his hand, or has one of those little trick bridge frames that elevates the frame on the nose for near.
Still a progressive would be the lens of last choice for this patient.

First choice would be two pairs of glasses, one for near, one for distance with the same P.D. on both pair.

Chip:cheers:

I discussed this some more today with the optician who primarily cared for him. Turns out he can move them up and down, just not horizontally. She had more time to talk with him than I did at the time.

Oh, did I not mention the toothpicks he has embedded into his eyes so he can manually move them???:D:D

[Laurie]

I am surprised that it is BO...

Any orthoptic types here? So far, I think Chip has the best advice, two pair, same PD.

Are you going to fill it as is, or maybe try temporary Fresnel prisms first?

Please let us know how it turns out...I enjoy relating these interesting cases to our optical students. Nothing beats real life scenarios.

: )

Laurie

[FVCCHRIS]

I am surprised that it is BO...

Any orthoptic types here? So far, I think Chip has the best advice, two pair, same PD.

Are you going to fill it as is, or maybe try temporary Fresnel prisms first?

Please let us know how it turns out...I enjoy relating these interesting cases to our optical students. Nothing beats real life scenarios.

: )

Laurie

You are right Laurie, that is why I so love this Board! Chris.

[Uncle Fester]

Ryser equation..... The success rate of a progressive is proportional to the motivation of a patient to wear them:bbg:

Harry- Is this a theorem or an equation:hammer:Can you express this in a mathematical formula?

[DragonLensmanWV]

I am surprised that it is BO...

Any orthoptic types here? So far, I think Chip has the best advice, two pair, same PD.

Are you going to fill it as is, or maybe try temporary Fresnel prisms first?

Please let us know how it turns out...I enjoy relating these interesting cases to our optical students. Nothing beats real life scenarios.

: )

Laurie

I'll keep y'all posted about them when they return. I did not do the Fresnel prism trial because he's already wearing that much prism.
As for Fresnel prisms though.. my next door neighbor has an aneurysm in his brain. Several years ago, it had made his right eye turn all the way in to his nose. We put increasingly strong prisms in his lenses until there was too much to grind and we went top Fresnels. Over the course of a year he went from 8 diopters prism to the max they make the Fresnels, 40 diopters.:drop:
The MDs here said they couldn't help him so he went to Ohio State where there was al ady neuroophthalmologist. She examined him and said she could help. He had the surgery and sure enough, his eye was normally placed. We scrapped his prisms, but needed them later as after a couple of years it had moved most of the way back in. He has since had many strokes, I found him face-down by our fence once, his wife found him in the back yard once. He has been under Hospice care for a very long three months now - they just can't figure out why he doesn't die. He's told me he is praying to die, but those old WW II submariners are a tough lot.:cheers:

[drk]

The MDs here said they couldn't help him so he went to Ohio State where there was al ady neuroophthalmologist. She examined him and said she could help. He had the surgery and sure enough, his eye was normally placed.

That's Susan Benes. She's nice and very competent.

[DragonLensmanWV]

Okay, the patient came in today to pick up his new glasses. He loved them, was able to read the 20/20 line and had no diplopia evident. YAY!
He said what he had was Duane's Retraction in both eyes. Usually he said it was only in one eye.
http://www.revoptom.com/HANDBOOK/oct02_sec6_1.htm
That seems to back it up as per the unilateral aspect.
This is the first time I have encountered this disease, and fortunately, the local MD was right on the Rx.
All's well!:cheers: