10D+ power differences; time to ask Optiboard.

[SergeTrigger]

getting through to these offices is also an utter nightmare. Usually goes: 15 minute hold, followed by "hey I have an Rx question", then they "transfer me to that Dr's tech", the tech picks up and is useless and the Dr. is not in that particular day. So then you have to spend a few days chasing them down and that's just fun.

Pro tip: Every office has a backline that does straight through. Try to get it

Lucky for me the Ophthalmologist works for the same hospital our optical is a part of, so it was easy to get a hold of her. It turned out she wanted a FT35 blended bi-focal because the doctor and her mother felt the kid would refuse to wear the glasses if they had a line in them. This resulted in me having to explain that blended flat tops don't exist, that I'm unable to get a blended bifocal in anything but a round 22 in cr39, and that the blended bifocals have a large blended zone that would disrupt her distance vision if I tried to bisect her pupil with it.

We ended up trying a progressive.

[SergeTrigger]

I'm assuming there HAD TO BE patching done for that +26 eye. Also, I've seen a few kids that get a contact lens put in at a young age and the parents change it.

it was a very young child (less than year old) and if I remember correctly there was definitely contact lenses and infant eye surgery involved.

[drk]

Only try-hards measure axial length. The rest of us use keratometers to see if the difference is on the cornea. If not, assume axial. Your typical ansiohyperope and anisomyope are axial.

Refractive surgery/cataract cases are obviously refractive aniso.

[Uilleann]

These are the discussions that make OB great! Excellent Q & A here friends!

[AndyOptom]

Lucky for me the Ophthalmologist works for the same hospital our optical is a part of, so it was easy to get a hold of her. It turned out she wanted a FT35 blended bi-focal because the doctor and her mother felt the kid would refuse to wear the glasses if they had a line in them. This resulted in me having to explain that blended flat tops don't exist, that I'm unable to get a blended bifocal in anything but a round 22 in cr39, and that the blended bifocals have a large blended zone that would disrupt her distance vision if I tried to bisect her pupil with it.

We ended up trying a progressive.

Nicely done by the ophthalmologist to try and encourage patient compliance though, and well done by you to do the best possible to make it happen.

How did the progressive fit go? I'm presuming short corridor, fitted a touch high? :)

And regarding the OP, I agree, unlikely to have any binocular vision, the patients are probably suppressing the poorer eye, correction notwithstanding.

[SergeTrigger]

Nicely done by the ophthalmologist to try and encourage patient compliance though, and well done by you to do the best possible to make it happen.

How did the progressive fit go? I'm presuming short corridor, fitted a touch high? :).

that's exactly right. Fit her in an Intouch 15 with a slightly higher seg. At dispense she had the normal complaints of everything "looking weird" but encouraged her to try them for a few days and come back if they still weren't working and so far, haven't seen her again so I presume she adapted to them.

[SamBlumenthal]

The prior week I've seen two outside Rx's for pediatric patients from MDs with a negligible correction on one eye, but -10D or more on the other. Notes were made that best corrected is 20/30 on the worse eye, 20/20 in the other. (One of these patients has had similar-enough Rx filled in the past with apparent success. The other is following a recent corneal transplant--apparaently the surgeon believes the Rx is stable enough to fill.)

1. If this isn't a recipe for aniseikonia, I'm not sure what is. What do you brilliant people know that I don't of how this can be ok where acuities aren't already severely compromised? We can't possibly be talking about binocular fusion, how are these patients seeing?

2. Depending on how question 1 shakes out, is the Shaw lens of utility here?

3. Segue into Shaw in general, anyone want to school me on the parameters of whom the Shaw lens can reach?

Thanks!

The significant anisometropia in these cases is impressive. Binocular fusion and adaptation likely play a role in the patients' visual function. A Shaw lens could potentially improve visual comfort, but a consultation with an eye care professional is recommended