UNDERSTAND YOUR OPTIONS WHEN TREATING THIS PATIENT BASE

A 49-YEAR-OLD MALE engineer presented reporting blurred vision at distance and at near (“loss of crispness”) with his spherical daily disposable lenses. A new patient, he considered switching to full-time spectacle wear due to his dissatisfaction with the vision provided by his contact lenses. The patient’s refraction: OD: -0.50-1.00x174 D: 20/15 OS: -0.75-1.00x018 D: 20/15 with a +1.75 near add 20/20 OU.

Fitting the moderate to high astigmatic patient who develops presbyopia is a big contact lens challenge for most eye care providers. Here are some tips.

IDENTIFY PATIENT PRIORITIES

Let the patient’s desires guide your offerings. If he really wants to stay in daily disposable contact lenses, monovision is his only option. That said, most studies show patients prefer multifocal contact lenses vs. monovision, including those reported in Contact Lens Spectrum (a sister publication of Optometric Management) and Optometry Vision Science. If the patient wants to consider a re-usable contact lens, a multifocal toric lens is a good starting point. And, due to his engineering background (a critically observant patient), any uncorrected astigmatism will result in an overall loss of visual sharpness. Therefore, a spherical multifocal lens is not an option. So, other options outside the tried-and-true (see above) must be considered.

INVESTIGATE OTHER OPTIONS

Custom contact lenses. A few manufacturers could offer a custom, soft, toric multifocal design. By combining the toric technology with the multifocal technology, it allows the doctor to treat both conditions more accurately than each individually. (The multifocal alone would not correct the astigmatism well, and the toric alone would not correct the presbyopia well.)

Multifocal RGP lens. This option can often provide sharper vision at distance and near when compared with soft multifocal lens designs. These lenses can be customized to the patient’s cornea and his specific visual needs. A mild amount of lens movement is necessary, but patients will most often have difficulties if this lens moves too much.

Hybrid lens. The hybrid technology platform combines comfort similar to soft lenses and vision of RGPs. The soft skirt surrounding the RGP creates less lens awareness. The second generation Duette multifocal (Synergeyes) provides the only hybrid contact lens with a silicone hydrogel skirt (Dk = 84).

Scleral lens. Some designs for “normal corneas” have the ability to correct astigmatism or presbyopia individually and in combination.

All these contact lens options offer a unique platform and design, which allows the practitioner to provide a customized product to your patients.

I fit the patient mentioned above in a monthly multifocal toric that satisfied both his vision and comfort demands. OM

DR. MILLER is a partner/owner at Eye care Professionals of Powell, in Powell, Ohio. He is past president of the Ohio Optometric Association and assistant professor of clinical practice at The Ohio State University College of Optometry. Dr. Miller has received honoraria for consulting, lecturing, research or acting in an advisory capacity from: Alcon, Allergan, Bausch + Lomb, J&J Vision Care, Revolution EHR and Shire.