To preface: I've been fitting glasses on-and-off for five years; I started my most recent optical job 2.5 years ago. I now work at an optical located inside a medical clinic with a large ophthalmology department. The learning curve has been steep for me, and while I feel competent enough to address most patients' issues, I still feel adrift without a paddle when it comes to issues like recommending multifocal lenses for anisometropes. So, any advice you all can offer is greatly appreciated.
I saw a patient today who complains of near vision diplopia and general difficulty focusing at objects closer than 6-8 feet. The doctor consulted with me (yikes!) about how to approach prescribing prism. Here's how the patient's Rx came out today:
OD -0.75 +0.50 x005 +2.00 add, 1.5 PD up
OS -2.50 +0.50 x163 +2.00 add, 1.5 PD down
Because of the degree of anisomyopia, I thought he may be on the cusp of needing a slab off. I mentioned this to the doctor, and he recommended it on the prescription.
Here's the thing: my gut tells me that we should either grind prism or slab off, but not both. I am reluctant to order slab off for this patient, because it severely limits the progressive lens options available, and other complaints he had about his vision could be better remedied by newer/digital PALs (which my labs tell me they can't slab off).
This patient has never previously been prescribed prism, but in neutralizing the Rx of his current pair of glasses, I found (approximately):
- no prism at the OD PRP
- 2 PD up at the OD NRP
- 1.5 PD down at OS PRP
- 1.5 PD down at OS NRP
He has been wearing Comfort 2 DRX in poly since last October. He has not had issues with his distance vision.
His prescription has not changed very much since last year, and I'm worried that the amount of prism prescribed by my doctor will still create imbalance for the patient since it's not really taking into account the amount of prism induced by a PAL add.
What are your recommendations? Should I specify a lower OC and go with a digital (camber) lens? Go with the slab-off in a Physio and place it partway down into the intermediate zone?
Thanks!
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