The College of Optometrists

hello..had a patient 28 years old c/o frontal h/a's and finding she had to wear her distance vision spex all the time since she had a baby 8 months ago. Basically she had an axis of 110 and I found 70 on subjective. She could see 6/5 with her current spex in that eye and with the cyl at 70 she could see 6/4. I placed the cyl at 90 to modify and she did not want it, she definately wanted it at 70. Her last eye test was 7 months ago. What would you have done?

Well done on a good eye examination. The astig axis is not cast in stone and if the cyl is mild it can seem to wander even paradoxically.

This can be due to the px not holding the head upright but tilted over. It can also be due to pupil size - with some people the focus at the mid periphery of the lens being different from central. It can simply be due to adaption. The fact a 40 degree change only made a small visual improvement would tell me the cyl was small. So I think I would have tried different cyl axes and used the one that gave the best vision with least distortion. (A letter F or P is handy as a target for X Cyl) (which side gives least distortion - 1 or 2?). I am not sure if such an axis change would stop headaches = but it is possible. THe wrong cyl axis is frustrating for the wearer, in my view.