Fresnel Prism

**LENNY** · 09-16-2013, 11:43 AM

RX calls for a prism OD 12BU
OS 12BD

If Fresnell prism is used would you recommend to use one or two of them? 25?

**optical24/7** · 09-16-2013, 12:10 PM

Use one 25 in the least dominate/worst va eye.

**Uilleann** · 09-16-2013, 12:26 PM

Fresnels will degrade contrast and VA's pretty noticeably above what...a 4 is it? Just bear in mind what the patient may feel they're seeing either way in a Fresnel that high vs. ground in.

**fjpod** · 09-16-2013, 01:07 PM

The doctor should really determine that. If I had written that Rx, I would have written it the way I wanted it filled...12 in each eye, fresnel/no fresnel... I think you have no choice but to contact the prescriber and ask.

**LENNY** · 09-16-2013, 01:58 PM

Patient does not want grind in prism because of the price and appearance. I am asking because I dont think I ever saw the Fresnel prism OU!?!?!?!?

**Uilleann** · 09-16-2013, 02:00 PM

Originally Posted by LENNY

Patient does not want grind in prism because of the price and appearance. I am asking because I dont think I ever saw the Fresnel prism OU!?!?!?!?

While it *can* be done, I don't think it's wise OU for this pt. Particularly if they still operate a motor vehicle at high speeds etc.

**fjpod** · 09-16-2013, 02:06 PM

Originally Posted by LENNY

Patient does not want grind in prism because of the price and appearance. I am asking because I dont think I ever saw the Fresnel prism OU!?!?!?!?

It really depends on the patient's ocular condition. Whether they have reduced vision in one eye or both...central suppression, yada, yada... It's best to ask the doctors intentions...or take him at his Rx...12 in each eye.

**Jacqui** · 09-16-2013, 02:34 PM

Grind the prism, he'll love you for it

**fjpod** · 09-16-2013, 03:21 PM

Originally Posted by Jacqui

Grind the prism, he'll love you for it

Yeah, I wanted to say the same thing...but maybe the frame size and PDs aren't right.

**LENNY** · 09-16-2013, 03:23 PM

Originally Posted by fjpod

Yeah, I wanted to say the same thing...but maybe the frame size and PDs aren't right.

And crappy insurance!

Davis already made 4 pairs that she does not like!

**Uilleann** · 09-16-2013, 04:11 PM

Originally Posted by LENNY

And crappy insurance!

Davis already made 4 pairs that she does not like!

In that case, inform the pt that their insurance company exists only to make profit for themselves (which is true), that they choose to hire incompetent lab staff with no skill and almost no training (also true), and that they cannot in any way hope to create useable eyewear for them given their SRx.

Tell them the cost of having the glasses made properly from a competent lab. ANY competent lab. That is the black and the white of it really. We never like to figure out we've been duped by our insurance, but it is what it is.