A patient with advanced presbyopia and astigmatism can be one of the most challenging to satisfy with a multifocal toric contact lens. As patients age and need higher add powers, you may worry that you won’t be able to deliver what you are promising—functional vision at near, intermediate, and distance. Yet we have found that 70% of successful patient lenses in the SpecialEyes 54 Multifocal had a +2.00 add power or higher.
So, what’s the secret to success? We believe it is multi-faceted. Centration is a critical factor in multifocal contact lens success, so a customized fit is a huge advantage. Additionally, by incorporating a patient’s true refractive add power and using pupil size to determine the size of the multifocal optic zones, you can provide patients with a good balance of distance, near, and intermediate vision.
Though we recognize that patients with advanced presbyopia come with their own set of challenges, the following case is representative of the successes we witness every day.
DM, a 67-year-old male with advanced presbyopia and astigmatism, presented with a desire to try multifocal toric contact lenses. In the past, the patient had worn two different brands of multifocal toric lenses with moderate success. However, as his presbyopia became more advanced, his vision and overall satisfaction began to suffer. His exam findings were as follows:
OD: -7.00 -1.25 x180 (+2.50 add)
OS: -7.00 -1.25 x180 (+2.50 add)
Pupil Size: 4.5mm in regular room illumination
Based on the exam results and previous lens wear history, the practitioner decided to try the fully custom SpecialEyes 54 Multifocal Toric. To provide this patient with a precision fit and balanced vision, the SpecialEyes consultant used the SpecialEyes Arc Length Calculator and Multifocal Simulator to design the following trial lenses:
OD: 8.3 BC/ 15.0 Diam. -6.50 -1.00 x180 (+2.50 add) 2.0 Near Center Zone, 4.0 Peripheral Zone
OS: 8.3 BC/ 15.0 Diam. -6.50 -1.00 x180 (+2.50 add) 2.0 Near Center Zone, 4.0 Peripheral Zone
The practitioner was pleasantly surprised by the patient’s initial response to the multifocal contact lenses. Subjectively, the patient was very happy. He reported good comfort and stated he didn’t believe he would ever be able to see so well out of a multifocal contact lens. His final binocular acuities were 20/20(-) at distance and 20/20 at near. After allowing the patient time to adapt to the lenses, it was determined no remakes were needed and a one-year supply was ordered.
In conclusion, we know that successful multifocal contact lens outcomes are determined by multiple factors. Obtaining a solid refraction and setting realistic expectations are crucial. However, for many advanced presbyopic patients, especially those with astigmatism, reaching success goes beyond the standard approach. So, why limit yourself and your patient to a cookie-cutter multifocal lens design? Take the opportunity to apply your advanced skills as a practitioner and provide your presbyopic and astigmatic presbyopic patients with a multifocal lens customized for their individual needs.
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