Anisometropia and progressive lenses Author: Irina Jagiloviča E-mail: optometristiem @ gmail.com WWW: www.optometristiem.lv

Definition Ametropia difference >/= 1.00D on spherical equivalent or vertical meridian

Ametropia difference >/= 1.00D on spherical equivalent or vertical meridian

Anisometropia Particularly/ Problematic - Binocular instability, Near prismatic differential - Aniseikonia - Accommodative instability -near acc. demand more convex

Particularly/ Problematic

- Binocular instability, Near prismatic differential

- Aniseikonia

- Accommodative instability

-near acc. demand more convex

OD +1,50-0,50x90 add 1.00 OS +3,50-1,50x100 add 1.00 +1,50 +3,50 15mm 15mm Vertical Anisophoria: 3,00 Δ base up P=d(cm)xD

+1,50

+3,50

Anisometropia Main Therapeutic considerations History - nature of anisometropia - time of correction - level of correction Binocular level - Best VA - Degree of fusion

Main Therapeutic considerations

History

- nature of anisometropia

- time of correction

- level of correction

Binocular level

- Best VA

- Degree of fusion

Anisometropia Main Therapeutic considerations Poor BV - Essentially monocular status - Don’t rock the boat - Usual fitting process PL indicated!

Main Therapeutic considerations

Poor BV

- Essentially monocular status

- Don’t rock the boat

- Usual fitting process

PL indicated!

Anisometropia Main Therapeutic considerations Good BV - Refraction - Acceptable Rx Δ - Avoid under Add - Unequal Adds

Main Therapeutic considerations

Good BV

- Refraction

- Acceptable Rx Δ

- Avoid under Add

- Unequal Adds

Anisometropia Main Therapeutic considerations Good BV - Trial Rx: potential effects of Rx - Comfort at near - Symptoms - Vertical fusion (level and capacity) - Motivation

Main Therapeutic considerations

Good BV

- Trial Rx: potential effects of Rx

- Comfort at near

- Symptoms

- Vertical fusion (level and capacity)

- Motivation

Anisometropia Main Therapeutic considerations Good BV - Lens consideration - Short progression, who has problem dealing with Δ effect - Long progression, who has no problem with Δ effect - Base curves - Degressives (Interviews)

Main Therapeutic considerations

Good BV

- Lens consideration

- Short progression, who has problem dealing with Δ effect

- Long progression, who has no problem with Δ effect

- Base curves

- Degressives (Interviews)

Thinning Prism 15mm 15mm OD Plano ADD 1,25 OS +1,50 ADD 1,25 OD Plano ADD 1,25 OS – 2,75 ADD 1,25 Low Δ differential High Δ differential

Statistics 41 patient: 21 total success 6 PL daily; preferred readers near 7 intolerance 7 failed pre-test

41 patient:

21 total success

6 PL daily; preferred readers near

7 intolerance

7 failed pre-test

References Based on Varilux University course 04.2009. Progressive Lenses Prescribing in Special Cases.

Based on Varilux University course 04.2009. Progressive Lenses Prescribing in Special Cases.

Thank you

Thank you