This study recruited consecutive patients prescribed prisms during a two-year period, within set criteria of a deviation up to 30 prism diopters, good fusion, willingness to wear prisms and no previous unsuccessful use of prisms. The majority of cases had ground in prisms which were prescribed after an updated refraction. The authors present data from 134 participants; 56 participants were excluded due to loss to follow-up, unable to afford prism glasses, recovery or withdrawal from prism wear. Over half of participants were highly satisfied with their prism glasses and 20% neutral to very dissatisfied. This latter group included more participants with incomitant deviations. Two fifths of participants needed a change in prism prescription at follow-up. Prism satisfaction did not correlate with amount of prism wear, but instead with extent of resolution of diplopia, improvement of depth perception and activities such as driving and reading. The authors also collected data relating to bothersome side-effects from prisms which included altered depth perception, distortion, halos, headaches, dizziness, blurring and eye pain. This study highlights measures which could be taken to optimise patient satisfaction with prisms.