The Unorthodox Prescribing of Prism in the Orthodox Community

Several years ago I blogged about the pilgrimage of people to England to receive “special prism glasses” for reading.  Rather than abating, the concept has intensified.  It is both interesting and insightful to see some of the discussions around this on forums in the public domain.  Here is one thread that began in 2012 with more active discussion in 2017, as well as a parallel thread addressing the same topic.  Social media is progressively fueling interest in visual issues, particularly among populations who place a premium on reading and learning.

A parent recently acquainted me with a book written this year by reading specialist Sara Shain, a member of the Orthodox Jewish Community in the metro New York region.  From Zero to Hero has a brief section mentioning the possible help that struggling students can derive from prism glasses or vision therapy, and I particualrly like the header of this section noting that the persistence of these problems poses emotional health risks:

Because we are seeing progressively increasing numbers of Orthodox patients, I thought it might be of interest to add an historical footnote to the discussion.  I was raised in an Orthodox home in the Logan section of Philadelphia, a ten block radius encompassing nearly as many houses of worship as there are Starbucks stores in Manhattan.  My father was an optometrist who had his office in our house, and I attended the Pennsylvania College of Optometry located only a mile from his office.  This afforded a unique opportunity to incorporate what I was learning into the flow of a private practice.

At the same time there was an ophthalmologist practicing nearby by the name of Samuel I. Askovitz.  Naturally in a small neighborhood with only two ophthalmic practices, there were times when Dr. Askovitz would examine our patients and vice-versa.  I noticed that we were consistently seeing patients of Dr. Askovitz who had small amounts of prism in their glasses.  The prisms were in interesting combinations, both in direction and magnitude that I was at a loss to explain based on anything that I was learning in school which focused on prescribing prism only to compensate for double vision or eye strain.  I asked my father about it, who scratched his head and said with dry wit that perhaps Dr. Askovitz’s phoropter was miscalibrated.

It turned out that Dr. Askovitz had an unorthodox intuition that he was successfully applying to his orthodox population over fifty years ago.  Nor was this a coincidence.  In the bio of an article that he authored for the Journal of the American Statistical Association in 1959, Dr. Askovitz listed his main fields of interest in this order:

• The Bible, Talmud and Rabbinic Law
• Graphic Methods in Pure Mathematics and Statistics
• Geometric and Visual Optics
• Application of Electronic and Optical Instruments in Medical Research
• General Medicine and Ophthalmology
• Tumor Statistics

Around this same time, in the 1950s, optometrists working in the field of learning issues actively promoted the prescribing of low power plus lenses for near, in single vision or bifocal form.  The prescribing of analogous low power prisms was generally frowned upon, with the concern about “prism adaptation”.  Dr. Askovitz favored low power prisms, which had the advantage of being incorporable into a single vision lens (or multifocal) without any concern for distance vision blur.  The type of adaptation that might occur for patients using prism to offset double vision did not occur with this population.  To insure against this, patients would return to his practice to have the power, direction, and symmetry between right and left eyes fine tuned.  With a nod to the pioneering principles of Dr. Askovitz, we have come full circle in combining all the modern means at our disposal: creative prescribing of lens and prism power and orientation including lens coatings and tints (and speciality considerations such as the Shaw Lens), as well as optometric vision therapy.