I have a patient who is stumping me. They had a small change in both eyes, but is having trouble with their right eye, the left eye is fine.
Old Glasses (2007):
+0.75 -1.50 X 95 / 2.25
-1.25 -1.00 X 90 / 2.25
Lens: Comfort in Poly w/SH=22
We're on our second set of lenses:
New set of lenses 1:
+1.00 -1.00 X 95 / 2.50
-1.25 -1.00 X 90 /2.50
Lens: Comfort in Poly w/SH=21
Patient couldn't use the left lens distance of the right was good (since it's the same), but reading was a little week, so we went to:
New set of lenses 2:
+1.00 -1.00 X 95 / 2.50
-1.25 -1.00 X 90 /3.00
Lens: Comfort in Poly w/SH=21
Patient wears a Silhouette 3 piece with frame size and lens shape unchanged between the new and old glasses.
Reviewing my invoices base curve is constant (5.50), but between the old glasses and both pairs of new lenses, 1.25D of prism thinning was added (old lenses have none).
The patient has been re-refracted by our doctor twice (once between pair 1 and pair 2, once after pair 2), both times the patient had subjective improvement of VA between old prescription vs. new prescription, both monocularly and binocularly.
So I have 3 questions:
1. What is the likelihood that this issue is related to the prism thinning?
2. What is the likelihood the issue due to the increased difference between the left and right eyes?
3. What is the likelihood that I'm better off giving the patient their old distance prescription in his right eye (compensating the add to give him the same reading) and hope next year is a better year?
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