OK I am going to compress a really long story that spans months into a tiny post, so here it is.

Patient's old Rx had BO prism, but never really comfortable with it. She goes to a doctor, doctor writes new Rx and doesn't really attempt the prisms and writes, "duplicate prisms in old glasses." The doctor tells me that the patient has intermittent exophoria. Unhappy with this, the patient goes to another doctor who says she has intermittent exotropia and prescribes the following:

OD -4.50 -1.00 x105 1.5 BI prism
OS -3.75 -0.50 x136 1.5 BI prism
Add +2.50 ou

I filled the Rx in 1.67 Varilux Physios with Alize. Within a week the patient came back complaining about the right eye, I called to confirm the Rx and it turned out that the doctor wrote the axis wrong. I re-did the lenses, a week later the patient comes back and says she has a lot of peripheral distortion and overall it just seems wrong. I compared her old Rx, the new Rx, and the Rx the original doctor had written and refracted her myself at the following:

OD -5.00 -1.00 x105
OS -4.25 -0.50 x136
Add +2.50 ou.
Without any prisms

I put her in 1.6 Definity with Alize, she seemed much happier without the prisms, but finds that she really has only a tiny spot for reading in the left eye. I checked two old glasses (progressives) that she brought me and both had about 1.5D of prism base out, AND both were made at a PD of 61 instead of that patient's actual PD of 56. She said neither of these ever seemed right.

So, feeling really bad for this lady who's never had a proper pair of glasses made for her, I'm determined to solve the problem. She does not want to go back to the doctor again because she wrote the Rx wrong and billed her for a followup appointment the following week just to check the Rx (which ended up to be wrong anyway). She seems happy with my refraction, but I am thinking I am missing something. Maybe she does need some type of prism? Maybe it's just a wave in the left lens? Maybe it's the type of progressive? I told her I'd remake the lens in a different progressive (I am thinking the SolaONE - I like this one for a larger reading area), but before I do I wanted to check with some of you experts out there who may have an opinion, or if you could recommend a doctor that really knows how to do prisms in New York City.

Thanks for your help!!!