Sagging Eye Syndrome

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Sagging eye syndrome (SES), first described by Rutar and Demer in 2009, is a cause of acquired, small-angle horizontal and vertical strabismus that most often occurs in elderly patients [1].

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My client was post-IOL with subsequent diplopia, diagnosed as 4th nerve palsy (CT not MRI due to metal in ear) and was referred to a surgeon. Second opinion from neuro-ophthalmologist found Sagging Eye Syndrome. Rx'd spectacle lenses with 6 PD vertical.

https://webeye.ophth.uiowa.edu/eyefo...agging-eye.htm

That's a new one for me. That's a killer case presentation. Smart dudes. (I have to laugh at the term "prisms", when the correct term is "prism", but that's nitpicky.)

With that much vertical, how did you apply it?

What material?

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Originally Posted by drk

That's a new one for me. That's a killer case presentation. Smart dudes. (I have to laugh at the term "prisms", when the correct term is "prism", but that's nitpicky.)

With that much vertical, how did you apply it?

What material?

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Spread the word.

The the prism was 6 ∆ total- very manageable when split. I used Trivex in a progressive (Physio traditionally surfaced). As expected, the pupil heights were unequal at 22/19, 2mm for the prism (confirmed with a handheld 6 ∆) and 1mm for a higher rt eye.

Robert

New for me too, though, I've probably had one or two over the years and didn't know their particular case had a name other than "diplopia".

I actually did post your case on an optometry site, and it was appreciated.

Hey, I like the Trivex. I like Physio. Curious: did you do Physio over, say, Comfort2 because of the horizon-sparing in a potentially optically-challenged Rx?

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Originally Posted by drk

I actually did post your case on an optometry site, and it was appreciated.

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Cool. Southern Wisconsin is loaded with medical/research MDs and PHDs with the Medical College in Wauwatosa, and UW Hospitals in Madison.

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Hey, I like the Trivex. I like Physio. Curious: did you do Physio over, say, Comfort2 because of the horizon-sparing in a potentially optically-challenged Rx?

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1) The Comfort2/New Comfort isn't available in Trivex.

1a) Higher Abbe was required for the strong prism value.
1b) Best possible impact resistance and lightest weight (compared to 1.60 refractive index material)

2) Client was not an avid reader, using OTCs for near. I selected a semi-finished PAL design that has a bias towards a more generous (horizon) distance zone.

Best regards,

Robert Martellaro