I have a patient that needs 6 BO OU in the distance but needs no prism at near vision. He has no horizontal movement outward on either eye due to Duane Syndrome. The doctor increased his prism and it works fine for distance but gets diplopia when he looks up at distances beyond 3-4 feet. The patient is most comfortable at work with a Computer/Multi-Purpose lens and wears a progressive for general use. He has significant demands with near/intermediate at work. Evaluate the following rx and give me some ideas. I am trying to see if my lab can give make the prism on the distance vision portion of the lens only. The patient can tolerate the prism at near but is not recommended due to eye strain and headaches.

+2.00 -1.75 146 6BO
+0.50 -0.50 180 6BO
add 2.50