Prior publications have demonstrated that prism in contact lenses is an option for spectacle lenses or occlusion of an eye for some individuals.¹ Prism can be incorporated into contact lenses to correct small-angle deviations. A case report illustrated the correction of vertical heterophoria due to surgery with a base-down prism into a bitoric rigid GP lens.²

In one study, the elimination of horizontal diplopia secondary to head trauma with a 4 prism diopter (PD) base out (BO) right eye and 2 PD BO left eye, equaling 6 PD BO prism was reported.³ In another, Lee and colleagues treated decompensated esotropia with 4 PD BO per lens, for a total of 8 PD BO prism.⁴ Good vision (20/20) and binocular fusion were accomplished with impression-based scleral lenses.

A 2026 study described the efficacy of prism-incorporated impression-based scleral lenses (pibSL) to manage binocular diplopia.¹ Seven patients with assorted etiologies of binocular diplopia, including congenital and acquired conditions, were included in this case series. Two of the 7 patients included had corneal irregularity. Individuals were fit with pibSL that can include up to 5 D of prism in each lens (10 D in total) in any direction. Ocular impressions of the globe were obtained from each eye. 

Visual acuity (VA), the resolution of diplopia, and subjective reports on cosmesis and comfort were evaluated. If poor quality of vision was reported, wavefront-guided (WFG) optics were incorporated into the scleral lens.

Every individual in this study achieved 20/20 or better and the resolution of diplopia with pibSLs. When WFG optics were included, residual higher-order aberrations were decreased, thus resulting in subjective improvement in vision quality and balanced VA. Additionally, individuals reported great levels of satisfaction with pibSL.

PibSLs are a successful and well-tolerated substitute to traditional prism spectacles for the management of binocular diplopia and can alleviate symptoms of anisometropia, asthenopia, and physical discomfort associated with spectacle prism. All individuals were satisfied with cosmesis. Additionally, in eyes with multifaceted necessities, the addition of WFG optics also improved the quality of vision. Additional studies of pibSL are needed to more objectively explore visual quality and limitations.

References

1. Gelles JD, Weng A, Vought V, et al. Management of Binocular Diplopia With Prism Incorporated Ocular Impression-Based Scleral Lenses With and Without Wavefront-Guided Optics. Eye Contact Lens. 2026 Jun 1;52(6):245-251. doi: 10.1097/ICL.0000000000001275

2. Lindsay RG, Crock GW. A bitoric rigid contact lens with base down prism to eliminate binocular vertical diplopia. Clin Exp Optom. 2005;88:55-57. doi: 10.1111/j.1444-0938.2005.tb06665.x

3. Frogozo M, ed. Treatment of Horizontal Diplopia with Prism Correction in Scleral Gas Permeable Prosthetic Device. Poster Presented at: 2016 Global Specialty Lens Symposium; 2016. Las Vegas.

4. Lee SK, Zabrowski C, McClelland CM, Lee MS. Treatment of horizontal binocular diplopia with prismatic contact lenses. J Neuro Ophthalmol. 2021;41:e81-e82. doi: 10.1097/WNO.0000000000000936

Melissa Barnett, OD, FAAO, FSLS, practices at Baker Optometry. She is also an International Coaching Federation (ICF) associate certified coach. She has received remuneration from ABB, AbbVie, Alcon, Azura, Bausch + Lomb, BCLA, Bruder, Cloudbreak Pharma, Dompé, Epion, OCuSOFT, ScienceBased Health, STAPLE Program, Tarsus, Tenpoint Pharmaceuticals, and Théa Pharma.

This content is sponsored by Contamac.