Question
QUESTION:
I have been wearing prisms for about 40 years. My initial physician speculated the double-vision and lack of depth perception was experiencing was due to a head injury in childhood, but this isn't for sure. He said the injury was near the optic nerve.
Every doctor I've seen since followed through with prisms after seeing the double vision in their exams.
The current prism is a 3.
In my most recent exam. with new doctor, I mentioned I was experiencing sporadic double vision, so imagine my surprise when he didn't seem to detect my double vision, nor did the prescription call for prisms. When I mentioned this, he had the eyeglass maker next door check my glasses, then he added the prism.
I can't help but feel something went wrong. It seems to me that 40 years of prisms shouldn't be eliminated without mentioning it to the patient.
Did the doctor miss something, or have I miraculously been cured?
I intend to dispute his bill, but I'd like to know if it's just my imagination and lack of expertise.
As an update, I have telephoned and written to this doctor and he has not replied to my inquiries. I did pay half his bill of $170.00.
ANSWER: Actually the need for prism is easy to miss in a routine exam. I don't believe most doctors do all the available eye muscle functioning tests on every patient every time because such testing rarely turns up anything that is relevant to the handling of the case. It becomes much more important to check everything related to possible eye disease or dangerous conditions that could need immediate referral. The need for prism is much less definite and prescribing prism is more an art than a science.
In fact, if you don't specifically point out that you have needed prism in the past, you may easily wind up not getting it. It is even hard to miss prism in an existing pair of glasses when reading the prescription off them.
I would not be too hard on the doctor for not picking up the need for prism. It did get added back to your glasses, right? So no harm was done.
---------- FOLLOW-UP ----------
QUESTION: When I made the original appointment, I mentioned I was having double vision episodes, and I replied "yes" when the assistant asked me if I were having double vision during the Pre-exam.
I appreciate what you're saying, as I have lived long enough to make a lot of mistakes. This incident had made me lose faith in the doctor, however, and I admit to being annoyed that he hasn't replied to my inquiries.
Yes, I got the prisms, but how do know it's the correct amount since he didn't do that part of the exam?
Thank you for your time.
Answer
Well, of course it is annoying that the doctor has not taken the time to respond to your inquiries. It sounds like you just had an overall bad experience in that office, so I assume you will not go back there next time.
However, still trying to defend the probable validity of your prescription, when I said prescribing prism is more of an art than a science, I meant that even when the doctor knows a patient needs prism, the amount he prescribes is not so much an exactly scientific result of the testing as it is a more "seat of the pants" decision. Oh, there are rules we all learned in Optometry school, but in practice I think most eye doctors wind up throwing the rules about prescribing prism out the window and just go with what works for each individual patient. Sometimes it is a trial and error situation at best.
If the glasses you got seem to be working, I would not worry about the prism amount any longer. In most cases, if the prism amount is not right, the patient will have problems and can tell there is a problem much more accurately than the doctor could.
