Help for Slanted vision in intermediate

[SGTANK]

Dear All,

Please give me some advice. I have a patient with old Rx OD-5.25/-0.75 AXIS 110 OS-5.75/-1.25 AXIS 80 OU ADD 2.25 which is done four years ago with Varilux comfort 1.6 with regular corridor, fitting height 19 mm. Recently he made another pair with the same lenses and same fitting height but with new Rx OD-4.25/-2.00 AXIS 95 OS-5.00/-1.25 AXIS 80 OU ADD 2.50 the VA is clearer but patient see slanted vision at intermediate range especially when he is reading emails on his desktop computer screen - all the sentences he is seeing right side higher than left side. It is the same frame so fitting is not an issue. I advised him to wear one week, hopefully the brain can adapt to the new prescription and fuse the image. However, he came back after a week and the problem is still there. What could be the cause and how should I solve his problem?

Thank you in advance for your kind assistance.

[Uncle Fester]

Welcome to Optiboard!!!

Read this thread and the link-

http://www.optiboard.com/forums/show...highlight=SKEW

From the looks of it there will be no easy solution. The right eye change looks like the problem and I would advise the patient it will require much more than a week to adjust to this lens.

A lens design change may help but will be more expensive to both of you.

[DanLiv]

Yes most likely the hefty cyl change OD. If he simply can't adapt the doc may need to cut cyl for comfort purposes, even if it sacrifices some acuity. Let the patient get used to the half measure and then next year go to full Rx again. There is a lot of change here to handle at once.

Also, just in case, carefully double-check to ensure zero prism at the reference point. Probably not the culprit, but there could be a tiny bit of diplopia at intermediate too.

[SGTANK]

Thank you for the valuable opinion,What type of lens design will you suggest?

[SGTANK]

Yes most likely the hefty cyl change OD. If he simply can't adapt the doc may need to cut cyl for comfort purposes, even if it sacrifices some acuity. Let the patient get used to the half measure and then next year go to full Rx again. There is a lot of change here to handle at once.

Also, just in case, carefully double-check to ensure zero prism at the reference point. Probably not the culprit, but there could be a tiny bit of diplopia at intermediate too.

Thank you for the valuable opinion, will try modified the Rx if there is no other way. Prism reference point check is balance both side Base up 1.00.

[SGTANK]

Thank you all for the advice at last settle the issue with modified RX to OD-4.75/-1.25 AXIS 105 OS-5.00/-1.25 AXIS 080 ADD 2.25 extend the lenses height 1mm so that fitting height is 20. Happy ending.