Question about prism

[shield]

I have a patient where the doctor gave prism in a pair of PALs. This is the patients first pair of bifocals. She had previously worn readers with prism. She has a pulling sensation with the PALs at distance. Is it possible to only have the prism at near in a pal?

Thank you for any insight and help.

[HarryChiling]

I have a patient where the doctor gave prism in a pair of PALs. This is the patients first pair of bifocals. She had previously worn readers with prism. She has a pulling sensation with the PALs at distance. Is it possible to only have the prism at near in a pal?

Thank you for any insight and help.

Simple answer, No. Any suggestions that people may offer like glued on segments and such would negate the fact that you asked about a PAL not a multifocal.

[shield]

Simple answer, No. Any suggestions that people may offer like glued on segments and such would negate the fact that you asked about a PAL not a multifocal.

What would be helpful? She now has a job with many working distances and readers are not convenient.

Thanks again.

[Darryl Meister]

Is this horizontal prism then?

[chip anderson]

Give de woman a line + Franklin, if prism is needed only at near. Her eye doctor should have determined and stated on the Rx if prism was needed only at distance or only at near, or if different in each location.
He could test with with fresnel pasters but people that have fusion problems should never be concidered PAL cantidates at all.

There are definitel some circumstances where vision conciderations far out-weigh cosmetic or optical profit conciderations. This is one of those.

Chip

[Jacqui]

I agree with the Franklins. She should be worried more about the visual quality than the appearence.

[Darryl Meister]

I agree that patients with significant binocular vision anomalies are often poor candidates for progressive lenses, unless they are sufficiently motivated.

However, in the absence of significant vertical imbalance, there generally isn't a need to provide differing amounts of prism at near and distance, unless the patient has presented with non-concomitant strabismus.

[eye-spec]

you can do a slab off on a pal , not seen many but it can be done

[sharpstick777]

I would do an RX recheck on the patient before trying something unusual. She may have too little or too much prism and but its only manifesting itself in the distance. I always ask a Dr. to perscribe as little prism as absolutely necessary.

I have fit many high prism patients into progressives sucessfully so it can be done.

If the RX / and prism checks out fine, see if the lenses can be ordered without Prism thinnning. You can also use a digitally processed progressive (I would favor the Definity) to minimized the narrowed intermediate a progresive with prism can create.

Sharpstick