Exercises

Example 1:
Consider an anisometropic patient with the following Rx:
OD: -6.00 ADD: +1.75
OS: -3.50 ADD: +1.75
Such a prescription would result in 2.50D of vertical imbalance at the NP (Using Prentice Rule:
See Figure 7, Example 1).
A good assumption for the way that patients use bifocals is to look through a point 10mm below
the distance OC for near which is 5mm below the top of the bifocal.
If a FT 28 is used for each eye with its OC located 5mm below the segment top, the patient
would be looking directly through the bifocal OC for near work, thus the vertical imbalance
induced by the distance lens would remain unchanged.

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However, if a different bifocal style is used for each eye, some of the imbalance can be reduced.

Example 2:

A FT 28 with its OC 5mm below the segment top for the right eye and a round 28mm for the
left whose OC is 14mm below.

Both of these are positioned at the same height which is 5mm below the distance OC.

When the patient looks down to read through the bifocal – a position 10mm below the distance
OC (5mm below the top of both segs), the patient is looking through the OC of the FT28, so no
prism is induced by it, and through a position 9mm above the round seg OC, so BD prism will
be induced.

Assuming a +1.75 ADD power OU this would equate to:

OS Prismatic effect from seg at NP = Distance from OC x Power

=1.75 x 0.9cm = 1.58D BD

Combined prismatic effect OS = 3.5D BD from distance + 1.58D BD from seg = 5.08D BD

Prismatic effect at NP OD = 6.00D BD from distance only

Resultant Imbalance OU = 6BD – 5.08BD = 0.92D

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By always using the bifocal style with the highest OC on the lens with the most minus, or least
plus power in the vertical meridian, this method can help offset some, if not all the vertical
imbalance induced by the distance portion of the lens.

In this example, using the combination of the FT28 on the right eye and the round 28mm on the
left, the majority of the vertical imbalance is neutralized.

Although there is still some residual imbalance, this solution may have resolved enough for it to
no longer be problematic.

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Example 3:

By experimenting with other bifocal styles, for example, a round 40mm on the left eye by
Younger - OC is 20mm away from the seg top which is fabricated 7mm below its distance OC,
more of the vertical imbalance can be neutralized.
Again, assuming a +1.75 ADD power OU this would equate to:
OS Prism effect from seg at NP = Distance from OC x Power

= 1.75 x 1.7cm = 2.98D BD.

NOTE: 1.7cm comes from = 17mm = the distance from the point in the bifocal used for near to
its OC = 20mm – 3mm below seg top = 17mm = 1.7cm

Combined prismatic effect OS at NP = 3.50D BD + 2.98D BD = 6.48D BD

OD prismatic effect at NP = 6.00D BD (Same as prior example)

Resultant Imbalance at NP = 0.48D

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So, using this round 40mm for the left lens would actually neutralize a little more of the vertical
imbalance than necessary, but this demonstrates the concept and the residual 0.48 prism diopter
of imbalance will most likely not be problematic.

Cosmetically, this method is not as appealing as a method called Slab-Off, and is somewhat
restricted by the add power and size of the frame being used.

However, for small amounts of imbalance where Slab-Off is not a viable option, or where
affordability is an issue, this could be considered.