Hi all, I’m hoping someone can give me guidance (as I’ve exhausted my IRL brains trust on this one).

I have a px, an late 50s investment advisor who sits on his PC all week, goes acrobatic aircraft flying on weekends, and does photography in his spare time.

He has been wearing 2 SV pairs (SVD and SVI) for the past year.

Given Rx (old SVD): R -525/-100×129 L -400/125×067
Given Rx (old SVI): R -350/-100×129 L -225/-125×067
Our PAL: R -450/-100×130 L -400/-125×073 Add +175

The old SVs were completed without heights accounted for. A vertical decentration of approx 10-11mm exists in both lenses.

Verting his SVD at actual pupil as worn showed prisms of R 6.0D BU and L 3.6D BU, with some horizontal prism of about 0.40D BO.

He’s become used to these despite the prism and, what I assume would’ve been initial slight distortion with being off-centre.

We ended up making him a pair of PALs non too dissimilar to the Varilux X, in a frame shape almost identical to his SVD pair (base curves match, oval/rectangular shaped, next to no decentration). He is not adapting and is complaining of swim effects to the point of vomiting. POW parameters, etc have all been checked and cleared.

Can’t seem to troubleshoot this one. Would his VI on his old pairs be ‘throwing off’ the numbers so to speak?

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