I have a patient who has 1 diopter prism up and down in the RX. I measured mono ocular centers that were 4 mm different..Am I correct in using mono OC even though the DR is prescribing prism to correct a vertical imbalance? -- or am I duplicating the correction by the RX? The DR Rx prism would be sending the gaze of the eyes , higher one down and lower one up, or higher one base up, lower one base down.
Often I feel like I'm the only one that measures OC on everything and then adjusts for panto. (It amazes me how difficult it is to get a straight answer to OC fitting questions in the field and how many people scoff that it is a waste of time--these are aspheric lenses as well.) When I see someone with eyes that are one higher than the other I supply mono OC --and it scares me every time but so far none have come back. This one threw me because I was concerned that the DR may be trying to correct the imbalance with RX prism while I was supplying a mono oc and we would be doubling the correction. Older patient that has mobility issues as well and wants (insists) his glasses mailed to him; therefore I won't be there when he puts them on the first time. Rx off hand I'm not remembering precisely but it was about OD +2.75 , OS +2.25 and +2.50 reading add on both, there was some cyl on OS but can't remember off hand what it was. The patient was only ordering four SV readers that could easily be his last pairs. I did ask the DR and offered to recall from lab and resubmit with an OC that split the diff but they said no , go ahead and see if this works.
Any thoughts on this? many thanks! Maybe I'll update tomorrow when I go in with the correct RX.
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