Progressive rx evaluation +/-

[PRECISIONLAB]

Need help with the following rx

OLD +3.50-1.00X31
-1.75-1.75X168
ADD 1.75
LENS USED SMALLFIT POLY TRNS BROWN
PRISM PRESENT DISTANCE 2.0 DOWN OD .75 UP OS DISTANCE @ 4MM FROM PRP/MRP
PRISM PRESENT READING AREA 1.75 UP OS 2.0 DOWN 8MM FROM PRP/MRP

PATIENT SEEMED TO DO OK BUT WITH OBVIOUS TROUBLE IN NEAR WITH 2.75
DIFFERENCE @ 90

NEW +4.00-2.00X027
-3.00-2.50X153
ADD 2.25
I'm calculating @ a minimum 6 to 6.5 difference @ 90

So what are my options? I know slab off progressive is in order but have concerns regarding image size @ near etc. Would Sv on the right with progressive in OS work?

[EyeCare Rich]

Huh???? Don't understand the question???? Thanks for the edit Precisionlab, that makes more sense! You are correct in the slab off. Not sure on the SV idea, which eye is dominant, will that come into play for the reading?????

[mshimp]

Slab it! no other choice.

[Paul Smith LDO]

I'd trail frame the patient both distance and near. Is there prism in the MRP. Not every patient fits nicely into the theoretical principles of our practice. It may be that they have made internal adjustments and the addition of slab off could complicate matters.

[Robert Martellaro]

Need help with the following rx

OLD +3.50-1.00X31
-1.75-1.75X168
ADD 1.75
LENS USED SMALLFIT POLY TRNS BROWN
PRISM PRESENT DISTANCE 2.0 DOWN OD .75 UP OS DISTANCE @ 4MM FROM PRP/MRP
PRISM PRESENT READING AREA 1.75 UP OS 2.0 DOWN 8MM FROM PRP/MRP

Check for prescribed and/or thinning prism at the PRP. There appears to be no prescribed prism in the distance.

PATIENT SEEMED TO DO OK BUT WITH OBVIOUS TROUBLE IN NEAR WITH 2.75
DIFFERENCE @ 90

Power disparity at ninety degrees is about 5.75 D.

NEW +4.00-2.00X027
-3.00-2.50X153
ADD 2.25
I'm calculating @ a minimum 6 to 6.5 difference @ 90

So what are my options? I know slab off progressive is in order but have concerns regarding image size @ near etc. Would Sv on the right with progressive in OS work?

Short answer- The wearer was probably suppressing with the old Rx. If the old wasn't slabbed, don't slab the new.

It's an uphill battle with the worsening nuclear cataract in the OS (I suspect), and the brains inability to catch up with the Rx changes. Concentrate on the OD eye if non-amblyopic and healthy.

If the circumstances are not as I just described, please correct them in detail so that the proper advice can be offered.