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    Originally posted by Hayde View Post

    I'm wondering if there's an angular variance between his orbitals that takes his OS off the same plane as the OD? Something that shifts his line of sight while obscuring the lateral vector of his pupil on the standard plane of measurement. If I'm thinking that through correctly, that might escape notice of both the pupilometer and my check with the stick? (Still throwing spaghetti at the wall...)
    I know this was his first PAL, but did he have an issue with his previous Rx? If he always had this issue somewhat then I'd think it's a "him" problem. If not then it might be the lenses or difference in the axis making everything screwy(there was something in Systems about this I think)?

    I don't know. I had a post cataract pt take a a bifocal in one eye that was like a -0.50 sphere with a +2.50 add and she was freaking out that things seemed "lopsided". That one got me good.