title: Vertical diplopia onset with first-time bifocal.
abstract: A 39-year-old white female presented with symptoms of constant diplopia onset with a first bifocal correction. The association of these conditions required a careful differential diagnosis and special management considerations. Testing indicated an esotropia with a longstanding nonconcomitant superior oblique paresis which became manifest when she began wearing bifocals. A regimen of horizontal vergence range training in combination with a relieving vertical prism in a near correction were prescribed. An amount of prism which allowed comfortable sensory-motor fusion through both the distance and near portion of a bifocal spectacle correction was eventually ascertained. Information regarding etiology, etiologic incidence, differential diagnosis, and management of superior oblique paresis is also presented.
authors.affiliation: Southern California College of Optometry, Fullerton.
authors.forename: G B
authors.initials: GB
authors.lastname: Erickson
authors.forename: E E
authors.initials: EE
authors.lastname: Caloroso
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D004172:Diplopia / Q000209:etiology* / Q000628:therapy; D004948:Esotropia / Q000175:diagnosis / Q000628:therapy; D005139:Eyeglasses; D005260:Female; D006801:Humans; D009886:Ophthalmoplegia / Q000175:diagnosis; D055095:Optics and Photonics