Hello Opti-boarders, I have an interesting patient. I will start with his rx.
First Time Pal Zeiss Individual 2
OD +1.75-2.25x005 Add +2.00 BC 6.00
OS +2.25-1.50x180 Add +2.00 BC 7.00
PD 32.5/31.5 Seg ht 21 OU (I will need to raise the OS seg to 23)
Material: Polycarbonate

OC's line up horizontally. He is experiencing pulling and headache noticed in his right eye. He is experiencing about 1.25 BU OS currently. I know that he really shouldn't need slab off but his symptoms seem to match. I can't get a slab off in a digital progressive from the VSP lab I had to use. So I am thinking of manipulating the equithin to alleviate some of the prismatic imbalance at near. When I raise the seg I will add another .5 diopters of vertical prism which the doctor has okayed putting prism in the distance part of the glasses to cancel that. Does this seem reasonable? Is there anything I might be missing? And does anyone think the slight BC difference could be playing a role? Distance vision is great. Thanks for your help.