double vision

**terrance** · 04-11-2012, 11:14 AM

i got one customer make a pr of reading glass few week ago and he come back with new doctor rx and say that he feel his eyes very strain after awhile and when he try to cover one side of his eye he can see shadow beside the words but when i let him try the doctor rx he see the shadow at the bottom of the words.
doctor rx R+150-200X180
L+150 -200X180

the power I checked is R+150-100X180
L+150-100X180

any idea what is the main problem for this case?

**braheem24** · 04-11-2012, 12:22 PM

Astigmatism

**drk** · 04-11-2012, 12:56 PM

Seems like the first pair needed more astigmatism correction, but if he still sees double looking through the new prescription, you have trouble.

Make the newer doctor Rx in a good abbe material and hope for the best. You really have no choice. If the customer still sees double with the second pair, send him back to the doctor, again.

**J.P.** · 04-11-2012, 02:01 PM

What Material are you using?
Does the Lenses have an Antiglare coating?

**RIMLESS** · 04-11-2012, 02:57 PM

Assuming no pathology, my question would be why is there a 1 diopter difference in the cylinder power. From the surface I would have to second guess both refractions. A diopter spread from one refraction to another is outside norms....in my opinion at least. I would also revisit the patholgy issue to be on the safe side.

Once pathology is ruled out and the refraction is verified I would trail frame the rx one eye at a time and have the patient rotate the cyl axis while viewing a reading card to if the symptoms get better at any point.

And if nothing works out I would try to sell him a fancy free form lens, just for the H-ll of it. Only because it seems to be the thing to do now days.

**chip anderson** · 04-11-2012, 04:17 PM

The smarter doctors used to under correct astigmatism and slowly increase it over the years.
Two diopters all to da wonst could be a shock.
However since cyl is the same at the same axis, I'd be supprised if it bothered him. I once had a similar Rx that the lab twisted 5 degrees in the frame to achive 180. It popped audiably and I immediately got a headache, checked glasses and found that one lens had snapped into a 5 degree off axis position.

Chip

**B101875** · 04-11-2012, 04:23 PM

And if nothing works out I would try to sell him a fancey free form lens, just for the H-ll of it. Only because it seems to be the thing to do now days.

[/QUOTE]

LOL GOT TO LOVE IT! RIMELESS.

**CNG** · 04-11-2012, 06:07 PM

You can ask the patient to cover one eye and see if he still sees double. If he still sees double with only one lens then look at material intolerance and switch to another type (if poly go back to plastic). I had a patient that had the same exact problem and let it behold it was the reflection of polished edge! Now if he sees double and you have the blessing of the OD reduce the cylinder (Spherical equivalent) and see if that helps.
cng

**RIMLESS** · 04-11-2012, 10:29 PM

Originally Posted by chip anderson

The smarter doctors used to under correct astigmatism and slowly increase it over the years.
Two diopters all to da wonst could be a shock.chip

Hey Chip I use to do that too but not so much lately, does that mean I'm dumber now days????? On second thoughts don't answer that. !!

**terrance** · 04-12-2012, 12:40 AM

Originally Posted by J.P.

What Material are you using?
Does the Lenses have an Antiglare coating?

i using the 1.56 index lens with multicoat.

**PRECISIONLAB** · 04-13-2012, 08:19 AM

I would check the final adjustment of the eyewear. Retroscopic tilt may help. An extreme angle may be causing birefingence...not to be confused with diplopia. The shadow effect is the result of Material type and index. Check the lens curvature as well. In most cases stock 1.56 are processed with "flatter" than normal curves.

**B101875** · 04-13-2012, 08:22 AM

Prism? maybe?

**Peter J Shaw OD** · 04-14-2012, 10:24 PM

Its a refractive problem, if the blur is vertical then too much cyl X 90, if horizontal then its too much X 180, needs a new/accurate refraction. nothing to do with prism as its monocular.

**chip anderson** · 04-15-2012, 07:37 AM

Any one notice that the overall change on this Rx is minus (these are reading glasses). How old is this patient? You be sho' he doan need a bit of plus sphere to help with his reading?

Chip

**sharpstick777** · 04-16-2012, 10:54 AM

Originally Posted by RIMLESS

Assuming no pathology, my question would be why is there a 1 diopter difference in the cylinder power. From the surface I would have to second guess both refractions. A diopter spread from one refraction to another is outside norms....in my opinion at least. I would also revisit the patholgy issue to be on the safe side.

Once pathology is ruled out and the refraction is verified I would trail frame the rx one eye at a time and have the patient rotate the cyl axis while viewing a reading card to if the symptoms get better at any point.
And if nothing works out I would try to sell him a fancy free form lens, just for the H-ll of it. Only because it seems to be the thing to do now days.

I would look for unwanted prism in the new pair, but Right on target. +1

**sharpstick777** · 04-16-2012, 10:58 AM

Originally Posted by chip anderson

The smarter doctors used to under correct astigmatism and slowly increase it over the years.....

Chip

I think the age of the patient would be a huge factor in determining the best strategy on this. It depends on the Best Corrected Visual Accuity and the patients lifestyle compared between the possible RX's. Trial framing would be a big help, but too few OD's do this anymore.