Hi @tcokeefe glad you found relief with a prism in your glasses. Something as simple as double vision can be the cause of many health issues such as headaches, motion sickness, and balance. Have you been able to stop the atrophy of the eye muscle from further deterioration? Perhaps eye muscle exercises can help strengthen those muscles again. You can always have an assessment done by a certified eye therapist to determine if eye exercises can help. Your neuro ophthalmologist may not mention an eye therapist. I had a friend who was left with double vision after suffering a concussion as a result of a fall. She went to a neuro ophthalmologist and got a prism in her glasses. It helped but later went to an eye therapist. After a few months of eye exercises she started seeing double again. She was happy to learn her eyes muscles got stronger and no longer needed a prism. I hope this helps. Wish you well.