Definition of "Balanced"

**OdTech** · 02-19-2003, 10:34 PM

Hello
A patient has OD +3.00-4.00x125
OS Balance
Add OU +1.50

Please explain the "Balance" i don't get it?

**Framebender** · 02-19-2003, 10:43 PM

Balance lenses usually means that the person doesn't have sight in that eye. Be sure to use poly or trivex. If using a progressive, use single vision for the balance eye.

**Joann Raytar** · 02-19-2003, 10:49 PM

For the reason Framebender, mentions a balance lens is used instead of a plano to balance weight and thickness. Usually, the same Rx is used in both lenses or the spherical equivalent is used as a balance lens.

Ditto about what Framebender said about lens materials.

**Jeff Trail** · 02-19-2003, 10:59 PM

One other thing ODtech you do NOT want to get in the habit of ordering duplicate OU so even though it is a "balance" they would "look the same cosmetically" .. they may have only uncorrectable vision on that balance side and or only light perception BUT they can still be able pick up cylinder...
PLUS it is always good to get in the habit of thinking a little, say they have a defect, facial defect, orbital defect etc., etc.. and you can use the power of the "balance" side to hide this somewhat ..
Pays to check the script over really well and ask a few questions.. especially if it just states "balance" with no note of acuity to fall back on . Just something I learned the hard way many years ago as a "rookie"....

Jeff

**Joann Raytar** · 02-19-2003, 11:20 PM

Good point Jeff!

It is also worth a call to the prescribing doctor if there is any doubt. Often patients will say they have "no" sight in one eye. After a call to the doc, it turns out that they do have some sight in that eye.

**OdTech** · 02-19-2003, 11:27 PM

Hello everyone thanks for useful advices, but the best one is spherical equivalent which was mentioned by JO;
i checked with my professor and exactly what we did and that was acceptable.

By the way the patient was using a Cr-39 but we reccomended progressive. suited well.

appreciate the replies

**JRS** · 02-19-2003, 11:30 PM

To add to Jeff's comments... never order "OU" on balance eye when the 'good' eye has a strong cylinder. The resulting PAIR will not look symetrical since the cylinder alignments will be opposed. The best approach is spherical equivilant (Jo's post) on jobs of this nature.

**chip anderson** · 02-20-2003, 12:49 AM

Another reason for the Rx being stated as ballance. Since the Rx does not have to come out "exact". Most labs charge only 1/2 to 3/4 as much for "Balance" lenses. Some of the more honorable of us, pass this own to the customer.

Chip

**optigoddess** · 02-20-2003, 01:55 AM

I have had a couple of occasions where the DR. ordered "balance" on one lens...only to have the patient not be able to really see as well ..... So, I guess what I am trying to recommend is that it's a good idea to check the previous pair of glasses BEFOREHAND if there is any question....

(it's one thing to learn from your OWN mistake...MUCH BETTER to learn from the mistake of another :D )

Karen

**Tim Hunter** · 02-20-2003, 02:45 AM

I would prescribe a balance lens for patients who have a non seeing or very poorly seeing eye. I might also do it where a patient is so anisometropic that they cannot fuse their prescription, especially if they are waiting for cataract extraction.

I would expect a spherical balance to be issued by the dispenser but if I had a particular preference I would specify it on the prescription. I would not normally note the VA as that would be dependent on the Rx issued!

**Diane** · 02-20-2003, 09:08 AM

OdTech said:
Hello
A patient has OD +3.00-4.00x125
OS Balance
Add OU +1.50

Please explain the "Balance" i don't get it?

Sometimes with an Rx such as this one, it may be good first to confir with the prescribing doctor to be sure of the status of the "BALANCE" eye. IF there is no vision at all. because of the oblique nature of the axis, it may be good to consider an opposite axis with very similar cylinder for cosmesis purposes. Look at the facial needs of the patient. Sometimes we can make them feel better about themselves. I've had instances when sphere's were used on a high cylinder patient and they didn't like how it made them look "different" on each side. Also need to consider all other things, like index of refraction used, etc. A good cosmetic tint also may help. Need to take all of the above information of other posts into account first.

Diane

**OdTech** · 02-20-2003, 08:02 PM

Hello everyone, once again, thank you for replies; as i stated before i have cleared the matter with my professor but u gave a very detailed picture of consequences that i may face and how to solve it.

It is interesting case study, that is why i would like to go further with adding a prism of x numbers either to OD or OS exactly would be to where the prescription was written as in this case it is in OD.

Then how would i now possibly solve the case, if
cosmetically: it will effect so one eye will look different from the other which i would do my best to avoid
Weight: it is effecting too how would i solve it
Doctor: i would confer with MD if i can't comprehend and resolve it independently.
Medical Problems: Ptosis, keratokonus, i.e.

Please give me some example and explanation it's interesting to evaluate further on the issue of "Balance"

Feedback appreciated

**Jedi** · 02-21-2003, 12:55 AM

OdTech said:

It is interesting case study, that is why i would like to go further with adding a prism of x numbers either to OD or OS exactly would be to where the prescription was written as in this case it is in OD.

Od Tech, I think I got this one,
Are you looking for examples of splitting prism between two eyes when a Doctor prescribes prism in one eye only.

Example:

Doctor's RX Lab order
od: +2.00 4D Base Down = od: +2.00 2D Base Down
os: +2.00 os: +2.00 2D Base Up

**dfisher** · 02-21-2003, 12:00 PM

Jedi,

I'm not sure I understood the last example if it is still related to the topic of balance lenses. If the "balance eye" has little or no vision, the prism should not be split. Prism is usually prescribed to reduce muscle imbalance and diplopia which requires binocular vision (two seeing eyes instead of one seeing eye).

As for powers on balance lenses, if significant cylinder is present on the "seeing eye", mirror the cylinder on the balance lens.

Example axis od =45, axis os =135

Especially in thin rim or rimless frames.

**Jedi** · 02-21-2003, 07:18 PM

Dfisher,
I should avoid posting so late at night. I skipped the part related to the topic of balance lenses, and saw prism, cosmetics and weight, and I pounced.;)

**OdTech** · 02-22-2003, 09:29 PM

Hello thanks for replies

Dear Mr Jedi:

Od Tech, I think I got this one,
Are you looking for examples of splitting prism between two eyes when a Doctor prescribes prism in one eye only.

Actually you have misunderstood me. No.
i was thinking if it ever happened in reality for "balanced" Rx.
My fiction rx with out the addpower

OD +3.00-4.00x125 2D Base Down
OS Balance

you see 1eye still balanced yet the other has prism.
Did you have ever faced such a challenge? and how did you solve it.

Dear Me Dfisher:

If the "balance eye" has little or no vision, the prism should not be split. Prism is usually prescribed to reduce muscle imbalance and diplopia which requires binocular vision (two seeing eyes instead of one seeing eye).

As for powers on balance lenses, if significant cylinder is present on the "seeing eye", mirror the cylinder on the balance lens.

Example axis od =45, axis os =135

Especially in thin rim or rimless frames.

Yes and thanks for clearing it up and giving abvice. So when u have prism in one eye while the other is "balanced" i shouldn't split the prism but leave the way it is, riight?

thanks everyone for feedback and academic breakthrough!