The College of Optometrists

question1: do we have to do binocular balancing on everyone or is it just the under 40's?

question 2: when doing cross cyl and you change the cyl what alteration is required on the spherical part? or can you jus do BSV after you found the required cyl?

you must binocular balance all those who are actually binocular. im sure u knew this but its the way u worded the question. as far as i know the only people on whom you do not do b balancing is amblyopes, strabismic pxs or those pxs with more than a 3 line acuity difference.

also i still always binocular balance most pxs over the age of 40. this is because some pxs do not actually become presbyopic at that age. there accommodation levels can be sufficient to do a b balance. remember that myopic pxs especially the moderate to high myopes delay presbyopia and so you will find that accommodation is still sufficient. if you can look at the previous rx of the px. if there is a previous add then theres no point in b balancing otherwise do it.

q2 - usually for every change in 0.50dc you will go the opposite way for changing the cyl by 0.25ds. i.e. if u increase cyl by 0.50 then u decrease sph by 0.25 etc.