The College of Optometrists

I had a Px (age 29) today that was 6/4 (6/5 uncorrected) in the left and 6/5+3 (6/36 uncorrected) in the right but she had an 4 prism XOT @ distance and near. She came in complaining of H/As (migrane & nausea). She doesn't wear specs at the moment as she lost them but when she did have them they didn't help.

LE was +0.75/-0.50x180

RE was -2.00/-3.00x180

Bagolini showed that she suppressed the RE @ D therefore no microtropia. & suppressed Maddox rod

In CHx she mentioned that she wore a contact lens in one eye when she was younger.

I eventually just ordered a balance R lens but was wondering could she suppress at D but not at near? I.e. have an alternating Tropia so she would use her right eye for near as it was myopic & therefore reduces the need for accom?

As it is on N cover test her LE fixated so I don't think this is likely but it made me think.

yes she possibly does have. After discussing the options with the px - you can ask what she would prefer. Some people prefer full whack in the right eye as that way they have good monoc side vision.

others, as you say, have a dominance that changes with position - and prefer the myopic eye corrected for near.

You can check for this by putting the whole Rx in the trial fframe and both eyes open. Put a + 1.00 or + 0.75 infront of each eye in turn, notice the reactions. Do same for near.

The px notices the blur-up when you blur the dominant eye and ignores the blur-up on the non-dom eye. Not very scientific - but can clarify matters.

i ended up just putting the full whack in front and then removing it. She didn't notice a change so a balance lens it is.

It does get complicated though.

well done Homer - you are a good optom ! I would have done the same.

As you say:

-go cautiously, only change what you have too

-keep ocular comfort for the px in mind

-keep thinking laterally

(for example: you could have given odd reading adds)

-expect to modify, after all you are not an auto-refractor.

-keep the discussion going.

To add to the list, I have noticed that it is the more myopic eye than is usually the 'near dominance' one, but there is no rule (so break them all!)

Some times, although I have taken every care - I have come to grief on this way of care for anisometropia - they complain on wearing the glasses. Still - can't win 'em all!

I hope you finished yr notes and advice with a few health and safety warnings, and a word abt adaption before driving and stairs. Remember Murphy's Law!

Well done!

Palfi

hey - if you want I can write something abt how to write notes to create a discussion.