anisometropia in a single vision lens

[Michael Davis]

Patient rx has changed from OD-1.75 OS-3.00 to OD plano OS -3.00, she had cataract surgery OD, always took off glasses for near and happy with that. She notices in the new glasses that vision straight ahead all is well but if she moves her head up or down it looks "funny". Obviously induced prism. What to do? Go to a smaller frame size? Would something like a Shaw lens work, I think that would just even up image size (which she is not bothered with) not induced prism.

Appreciate any thoughts (she is not interested in contacts with readers over top)

[drk]

OD: plano
OS: -2.00

Start there...

[Michael Davis]

Or maybe OD-1.00 and keep OS at -3.00; trial frame it each way and see what she prefers.

Any other thoughts?

[optical24/7]

Yea, #1 get the other eye’s catx done, wear one cl to balance, tell the patient they need to turn their head and nose point.

#1 she should have been advised prior to surgery the can of worms that would be opened by having a 3 diopter power imbalance post surgery. ( The OMD is the one who really needs counciled.)

[Michael Davis]

Yea, #1 get the other eye’s catx done, wear one cl to balance, tell the patient they need to turn their head and nose point.

#1 she should have been advised prior to surgery the can of worms that would be opened by having a 3 diopter power imbalance post surgery. ( The OMD is the one who really needs counciled.)

There is no cataract in the other eye. Yes it would have been nice if the patient was informed, but here we are

[Kwill212]

24/7's reply are the only viable solutions. There are no magic glasses to fix this.

[drk]

Typically what a better surgical strategy would have been a target OD of -1.00. Then in the future OS can be made plano.

[drk]

Or maybe OD-1.00 and keep OS at -3.00; trial frame it each way and see what she prefers.

Any other thoughts?

No, I don't like that. Who likes overminus? Nobody. Who likes underminus? Not nobody.

[Robert Martellaro]

OD: plano
OS: -2.00

Start there...

Yes, or let the pt. dial it down until accepted. Or try no eyeglasses for distance, and try OTCs for near.

I wonder if she's bilateral or unilateral, VAs, work and hobby history, etc.

Yea, #1 get the other eye’s catx done, wear one cl to balance, tell the patient they need to turn their head and nose point.

#1 she should have been advised prior to surgery the can of worms that would be opened by having a 3 diopter power imbalance post surgery. ( The OMD is the one who really needs counciled.)

I'd do more than recommend counseling if she was unilateral with otherwise healthy eyes!

Michael

Assuming failed adaptation of about ten days, and must have the fellow eye corrected w/o CLs, one could manipulate the base curves and thicknesses to minimize image size disparity and prism imbalance, but the cosmesis will be poor and cost spendy, similar to Shaw's design.

Robert

[optical24/7]

There is no cataract in the other eye. Yes it would have been nice if the patient was informed, but here we are

Couldn’t she still have an IOL put in the OS? (Even if it’s out of pocket).

[Barry Santini]

Try Shaw SV lens

[jefe]

How about one CL for the left eye as 24/7 suggested? Then she could wear PALs or OTC readers. That's pretty simple.

[drk]

The problem with a SV lens is that neither eye can accommodate (typically) and the glasses would have to come on/off all day long. Nope, spectacle monovision is the "simplest" answer.