Help with this prism patient

I have a patient that needs 6 BO OU in the distance but needs no prism at near vision. He has no horizontal movement outward on either eye due to Duane Syndrome. The doctor increased his prism and it works fine for distance but gets diplopia when he looks up at distances beyond 3-4 feet. The patient is most comfortable at work with a Computer/Multi-Purpose lens and wears a progressive for general use. He has significant demands with near/intermediate at work. Evaluate the following rx and give me some ideas. I am trying to see if my lab can give make the prism on the distance vision portion of the lens only. The patient can tolerate the prism at near but is not recommended due to eye strain and headaches.

+2.00 -1.75 146 6BO
+0.50 -0.50 180 6BO
add 2.50

Labs can't grind prism in dist/near areas only. With above amount of prism you would need to make a Franklin bifocal. If the prism amount was less, you could de-center
a lined bifocal (like a ft 35 or 45) in more than the patients given NPD to counter the BO prism in the dist. But you'd have to de-center a +2.50 24mm extra to counter the 6^ out in the distance.

I would recommend separate sv near and distance. If he can tolerate a computer lens at work, that would also be on the table.

This is definitely, definitely a prime case for multiple pairs.

Epic or Quest can probably do it in a FT. Multiple pairs still highly recommended.

We do "franklin" style lenses regularly...FYI

I have always done these as franklins, however, I heard Epic can do it in a flat top 28 segment. I have not used it yet nor do I know what the cost would be.

I will say the majority of those I have done in franklins end up using their seperate sv pairs much more often than their franklins in my experience. I do a lot of weird prism stuff here.

For progressives the PD's should be adjusted 2mm in OU when edging.

https://www.optiboard.com/forums/sho...escribed-prism

Thank you for your responses. SV near glasses did not work for this patient at work because of diplopia when looking into the distance. Some sort of bifocal appears necessary for him to have the prism at distance and a lens that neutralizes the prism at near. I will talk to Epic and see if we can do a FT. Currently he is using a computer lens but is getting a headache in the mid afternoon.

Pt mght need a different amount of prism in each pair eyewear for each distance. Ie 6Bo for far 4Bo fr intermediate etc?

Yes i think you are right about the prism....the patient did receive a FT seg with 6 BO each eye at distance and neutralized at the seg (no prism)
he has much more comfortable vision at distance and near. the issue is the focusing depth is about 10 inches and he gets diplopia at 14-16 inches.
this works well for TV viewing and holding a cell phone at near (about 10 inches) The purpose of the glasses was for work but he still uses the Digital Office lens for that