Use soft and hybrid lenses to meet these patients’ needs

When a current or new contact lens (CL) wearer presents with symptoms of presbyopia, such as holding reading materials at a distance, the optometrist’s challenge is to continue to satisfy this patient’s often demanding visual, lifestyle, and physiological needs. This way, these patients can continue to benefit from CL wear. Such patients who also require astigmatic correction add another level of clinical complexity. Remember: Uncorrected astigmatism can result in increased symptoms of ocular discomfort, dry eye, and headaches.

Here, I discuss the currently available soft and hybrid contact lens multifocal options that can meet these patients’ needs, as well as provide my suggested components of a presbyopic CL workup to increase the likelihood of successful CL wear.

CURRENTLY AVAILABLE CLS

• Soft. A variety of soft multifocal toric CLs are available in both hydroxyethyl methacrylate-based and silicone hydrogel materials. These include either concentric or aspheric designs (some with a blend of both), having center near or center-distance optics. These lenses are supplied for monthly replacement. With additional alternatives in made-to-order and custom products, ODs can satisfy an extensive range of refractive needs.

Soft multifocal toric CLs correct virtually any amount of refractive cylinder, making them a good choice for significant residual astigmatism (i.e., when the total refractive cylinder is greater than the corneal cylinder). Current soft CL patients and new wearers, particularly those who wish to wear CLs part-time, are also excellent candidates for these designs because no significant physical adaptation is required.

Patients for whom intermediate/computer distance is most critical will do well with center near aspheric designs. These CLs work well for these tasks, as the pupil size reduces in illumination. This makes them conducive to near work. Brands that offer center-near and center-distance options may be chosen when either or both near and distance needs are more critical. These may also be favored by patients who are currently corrected in a monovision fashion, as the dominant eye can be fit with a center-distance lens.

• Hybrid. Hybrid multifocal CLs are an excellent option for new wearers or current soft lens wearers who need the comfort of a soft CL, but the optical quality of a rigid CL. Multiple designs, including multifocal (single center near-add zone), progressive (distance and near-center optics), as well as a proprietary, made to order, extended-depth-of-field version are available. These lenses can correct 2.5 D or more of corneal toricity.

COMPONENTS OF WORKUP

1. New, up-to-date refraction, pushing plus at distance, not at near.
2. Careful ocular surface, lid, and tear film evaluation.
3. Topography or keratometry.
4. Horizontal visible iris diameter.
5. Mesopic and scotopic pupil diameter.
6. Ocular dominance
7. Assessment of patient’s main ocular and comfort needs. OM

DR. RESNICK is president and managing partner at Drs. Farkas, Kassalow, Resnick, and Associates, a contact lens and anterior segment specialty practice in New York. She is a diplomate in the Cornea, Contact Lens, and Refractive Technology section of the AAO, a diplomate of the ABO, and a fellow of the Scleral Lens Education Society.