Progressive for Monocular patients

[nabin]

Hello all,
I came across a patient who has right eye visual acuity of 6/9 with the correction of +3.00/-2.00@90 but 6/60 with the Left eye , no improvement with the glasses(+1.50). His near acuity improves to NV6 with +1.50 add, but only NV14 with LE. He is interested in PALs so shall i give him the PAL for one eye and spherical lens for next eye or PAL for both eye. He is also likes that the thickness of the lenses on both eyes similar so that his eyes looks equal in appearance.
Seeking for answers from you all..........
Bye
Thanking you.

[chip anderson]

I would find out what his acuity, especially at near is with a conventional sv or line type bifocal first. If appreciably better I would try to convince him not to use a PAL. If as good or better with Progressive, then let him have the progressive.
I might suggest something other than poly (yeah, I know lawyers and monocular vision).
But Trivex, or any of the high index stuff should give him better acuity, less color distortion and keep the cosmetic magnification down.

Chip

[Robert Martellaro]

Hello all,
I came across a patient who has right eye visual acuity of 6/9 with the correction of +3.00/-2.00@90 but 6/60 with the Left eye , no improvement with the glasses(+1.50). His near acuity improves to NV6 with +1.50 add, but only NV14 with LE. He is interested in PALs so shall i give him the PAL for one eye and spherical lens for next eye or PAL for both eye. He is also likes that the thickness of the lenses on both eyes similar so that his eyes looks equal in appearance.
Seeking for answers from you all..........
Bye
Thanking you.

Welcome to OB. Is NV6 equivalent to about 20/50? If so, I'd use a multifocal for both eyes. Select a flatter/aspheric base curve surface design for reduced magnification. Fit close to the eyes and accurately. Consider a progressive design that has very good distance peripheral vision. Atoric designs are desirable for this level of astigmatism. Check the near PD for less than normal convergence (not likely). Hope this helps.

[Yeap]

Welcome to Optiboard.

strongly agree with robert, if i were to handle this i iwll definately git the patient with multifocal, better design like free-form or customize to maximise the patient visual field since he may depend only on his right eye. preferable to select airwear or polylite material for protection purpose, treat his right eye as his precious eye.

hope this help.

[nabin]

Welcome to Optiboard.

strongly agree with robert, if i were to handle this i iwll definately git the patient with multifocal, better design like free-form or customize to maximise the patient visual field since he may depend only on his right eye. preferable to select airwear or polylite material for protection purpose, treat his right eye as his precious eye.

hope this help.

Thank you all for the reply. I must mention that in Nepal the market of PALs is just emerging we don't have variety of Designs available, can u advice which brand of essilor will be best for this patient. Shall I fit PALs in both eyes or only one eye, if its complicated then we can advice for bifocals as well.
Thanks.

[Yeap]

if you want the widest visual field of cause nothing but Physio 360 and remember it has to be in Airwear and never fit him with glass lens as high risk of eye injury.

For distance Rx it seem no improvement and its just for balance up the weight. but i do feel positive about the near. give it a try. at least he able to appreciate binocular vision at near.