VERTICAL IMBALANCE
VERTICAL IMBALANCE
⚫The condition caused by the difference in the prismatic
effect of lenses of unequal power occurring when the wearer
looks at a point below the optical center of the lens, in
anisometropic patients.
⚫suppose
OD -7.00 DS
OS -3.000 DS
⚫And patient looks 1cm below the OCs the prismatic effect
will be 7prism OD and 3PRISM OS. So net result will be
4prism before the right eye.
WHO IS RESPONSIBLE FOR
CORRECTING VI?
Vertical imbalance goes unnoticed throughout the
dispensing procedure. this may happen for variety of
reasons . One major reason is that unless segment and
MRP height are known, the amount of vertical
imbalance cannot be determined. and these
measurements are not known until after frame selection
has occurred.
WHEN IA S CORRECTION FOR VI
IS NEEDED?
1) SHIFTING TO MULTIFOAL:
⚫Need for a VI correction should be questioned when an anisometropic wearer
progresses from a single vision lenses into multifocal. Because when a person is
using single vision lenses, pt. will drop the head , not the eye.
2)TOLERANCE:
⚫tolerance may vary from person to person. Generally a vertical meridian
difference of 1.50 is acceptable. but greater then 2-3 requires correction or
compensation .
3) RECENT ONSET:
⚫ this occurs when a person has had either cataract surgery or refractive surgery
on only one eye. both cause anisomteropia causing a VI at near for which a
multifocal wearer is unable to compensate.
LETS TEST THE NEED FOR VI CORRECTION
To determine if a VI correction may be needed , hand
the person a reading card and ask him to read
something. NOTICE what the person does when handed
the card. If he drops the eyes to read, he is accustomed
to reading with VI and no special compensation may be
needed. if a person drops head to read, reading is done
through the distance OCs to prevent prism imbalance in
the lower part of the glasses.
POTENTIAL NEAR PROBLEMS
. eye strain
⚫headache
⚫double vision
⚫sublimated vision
CORRECTION FOR VI
There are several methods for compensation. Which may
include methods to AVOID the problems of VI( first 4) as
well as methods to CORRECT the problem( last 4)
⚫1. contact lens
⚫2.two pair of glasses
⚫3.dropping the MRP height.
⚫4.Raising the sag height
⚫5.fresnel press on prism
⚫6. dissimilar sags
⚫7.comensated R segs
1) CONTACT LENS
⚫Best option for correcting VI
⚫The OC of CL moves with the eye
⚫lens induced prismatic difference disappears and the VI
problem with it
2)TWO PAIR OF GLASSES
⚫Two pair of single vision glasses, one for distance, one
for near
⚫Option of droping the head , looking through the lens
OCs. inetead of dropping the eyes,
⚫Pair of half eye frame may be used.
⚫It is advisable to position the OCs for the near
prescription must be 5mm below vertical center of
frame.
3)DROPPING THE MRP HEIGHT
⚫Drop the OC or MRP of a multifocal lens pair
⚫Distance to reading level is decreased
⚫An option for border line cases
4) RAISSING THE SEG. HEIGHT
⚫Raising the seg height without simultaneously raising
the height of distance OC (i.e MRP) , the wearer will not
have to look as far down into the kens at near.
5)FRESNEL PRESS ON PRISM
⚫A Fresnel press on prism is made from "thin
transparent flexible plastic material which adheres to the
surface of an ophthalmic lens when pressed in place.
⚫thus it is possible to cut a Fresnel press on prism to fit
the lower half of one lens to counteract a VI.
⚫not a permanent solution.
6)DISSIMILAR SAGS
⚫in this ,method we use the prismatic effect induced by the
sagment of bifocal lens.
⚫suppose
OD -3.00DS
DS -6.00DS
⚫With near add +2.00 DS
⚫so use its prismatic effect
OD 3 * 2cm= 6prism
OS 6 * 1cm= 6prism
7) Compensated R SAGMENT
Compensated R segment is 22mm wide and 14mm deep,
being flat at both top and bottom. when resurfacing to
create prism in the seg, the lenses are able to
compensate for VI. this resurfacing process moves the
sag OC up in one lens and down in other.
⚫For VI less then 1.50prism.
