Monthly replacement provides option for presbyopic astigmatic patients

Please describe the lens and what makes it unique.

Bausch + Lomb Ultra Multifocal for Astigmatism is built on the Ultra family platform, combining the stable toric lens design from Ultra for Astigmatism with the 3-Zone Progressive multifocal design from the Ultra for Presbyopia lens. It addresses astigmatism, yields binocular distance and near vision and provides all-day comfort, due to the company’s MoistureSeal technology. One of the most exciting things about this monthly replacement lens is that we now have a readily available contact lens option for our presbyopic astigmatic patients.

What is your capture rate?

I have been fitting this lens since we received the fitting set in summer 2019. Within the first week of its availability, I fit about 40 people. Additionally, I regularly fit the lens once or twice a day, on average.

How do you present the lens?

I think presbyopic astigmatic patients find the combination of binocularity and successful multifocal design most exciting; every suitable patient seems willing to try it, especially since I can do so right at the time of their initial appointment. My patients can see my enthusiasm for this lens and its success in my practice. They can read my excitement when I present this new option for them, sharing that I am confident in its performance to provide them with clear vision at all distances.

It also has been helpful to show new wearers the three zones of the lens. I literally take the near point card from the patient and hold it at reading distance, then move it to the intermediate zone. Finally, I point to the acuity chart. Because monovision patients are often used to pushing an object away when they are struggling to read, I have found that showing patients how this lens works is a helpful reminder that they might need to actually pull objects closer to get things into focus. Finally, this lens has incredible stability, which is a must for a toric lens.

How would you describe the fitting process for this lens?

One of my favorite things about this lens is the ease of the fitting process. Simply stated, I fit it as I would a standard toric lens, then select the proper add power. Following the fitting guide simplifies the process and the steps work well to get the patients to a happy visual outcome that meets their needs. It is important to determine the proper distance power initially; this ensures I am setting the patient on the track for successful vision and decreased follow-up visits. I always perform an over-refraction after the lenses have settled for a few minutes, as even the myopic emerging presbyope will have little tolerance for being over-minused in this lens.

Please share a related case study

“Judy,” a 65-year-old astigmat, was fit with a monovision soft toric contact lens prescription. OD -2.25-1.25x090, OS -0.50-1.25x110, with VA at 20/20, distance and 20/30, near. Her spectacle prescription was OD -2.25-1.25x082, Add 2.50 20/20 D & N’, OS -1.75-1.75x 113, Add 2.50 20/20 D & N’. Judy reported being completely happy in monovision, as she had no distance, near or nighttime complaints. She reported that she sometimes used readers on top of her contact lenses. I refit her into the Ultra Multifocal for Astigmatism lens. Her prescription, -2.25-1.25 x 080 high add OD and -1.50-1.25 x 110 high add OS. Binocular acuity in the lens: 20/20 D, 20/25 N’.

Judy reacted favorably to the lens on insertion, astonished at the improvement of her distance vision. She said it felt about the same at near. On follow-up, she reported that she didn’t need to use her readers anymore, and that she had clearer distance vision, especially when driving. OM

DR. SMITH is a 2004 graduate of Indiana University School of Optometry. He established his practice in Fishers, Ind. in 2006. Originally from Laramie, Wyoming, he enjoys being a father first and foremost and loves to spend his free time outdoors. Dr. Smith has been a Bausch + Lomb contact lens expert since early 2019.