![]() Adding prism for the purpose of diplopic correction is limited by lens thickness and tolerability. As a secondary effect, between two-thirds to the full amount of prism is translated onto the optical axis. Classically, a minimal quantity of prism of approximately one PD is grounded base down into the lens, utilizing gravity to keep the lens rotation base down. One method of rotational stability for CTLs that incorporates cylindrical refractive error is the prism ballast, in which the thinnest portion of the lens is at the apex and the thickest closer to the base. The patient tolerated them well without diplopia for 3 years.ĬTL options for binocular diplopia are an often overlooked potentially viable option for patients. The toric lens design used required one prism base down for fit stability. Thus, for a net sum of two PD vertical diplopia, three prism base down was added to the left lens and one prism base down to the right. She had no interest in hard CTLs and was fitted for soft CTLs. The rest of her ocular examination was unremarkable. Her diplopia was corrected with a two PD base down prism in the left eye. Sensorimotor examination showed an incomitant two-prism dioptre (PD) right hypotropia consistent with a skew deviation and mild excyclotorsion with her nystagmoid movements. Her extraocular motility was full, and she had Bruns nystagmus consistent with peripheral vestibular asymmetry. ![]() On examination, her visual acuity was 20/20 in each eye. While she had successfully utilized prism glasses for many years, she expressed interest in contact lenses (CTLs). Past medical history included a right acoustic neuroma status-post resection and subsequent radiation therapy. ![]() ![]() A 61-year-old woman developed constant vertical binocular diplopia for 6 years. ![]()
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