SpecialEyes Distance Center Multifocal: Case #2 from Treehouse Eyes

Distance Center Multifocal with OptiSync Technology

By: Kevin Chan, OD, MS, FAAO
Treehouse Eyes, Tysons Corner, VA

Case History

A 13-year-old boy, DA, was referred by a primary eye care provider to our office for further evaluation of myopia management in early January 2019. He first began wearing glasses for myopia on full-time basis since age 5. Since then, his parents have noticed that his vision has continuously worsened by almost 1 diopter per eye. As a result, his glasses prescription was increased rapidly every year. His parents, who are also nearsighted, were very concerned about ‘How much worse would his eyes get?’

DA has been active in playing ice hockey after school. His main struggle, though, has always been ‘How to see well without my bulky glasses?’ Upon evaluation, clinical data are shown below:

K readings:
OD 42.09@019/ 42.90@109
OS 42.61@137/ 42.96@047

Cycloplegic Rx:
OD -7.50 -0.75 x173 20/15-1
OS -7.75 -0.25 x044 20/15-1

Pupil sizes:
OD 5.1mm
OS 4.5mm

Axial length at baseline (AL):
OD 27.37mm
OS 27.46mm

In review of DA’s clinical profile and risk factors, along with his active lifestyle, I recommended him to adopt custom soft distance center multifocal contact lenses for daytime wear. He initially preferred daily disposable modality for convenience.

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The patient returned for a one-month follow-up visit since he has started trying out the daily disposable soft multifocal lenses. He reported ‘generally comfortable; yet vision has gotten blurry once in a while’. He also felt ‘the lenses keep moving around quite often during daytime’. At the first follow-up visit, his aided visual acuity was shown to be 20/20-3 OD; and 20/20-1 OS. Topographical map results (Figure 1 & 2), however, revealed unsteady tear film and mires during lens wear, which prompted the patient to blink more frequently than expected.

baseline and over topography maps of right eye

Figure 1. Baseline corneal topography for the right eye (left). Topography with the initial lens fit upon one month of wear (right). The lens shown was noticeably decentered superotemporally in OD.

Baseline and over topography maps of left eye

Figure 2. Baseline corneal topography for the left eye (left). Similar superotemporal decentration pattern was evident upon one month of lens wear in OS.

Three months later, the patient returned for a follow-up visit. He reported he has noticed ‘shadowy figures when seeing things around’. Although he said he has been comfortable with the daily disposable multifocal lenses, he also hoped that ‘the vision and contrast of objects could have been better’.

At that time, his aided visual acuity was shown as 20/20 in each eye. Pt favored over-refraction by -0.25D in each eye. Topographical map comparison between OD and OS was displayed in Figure 3.

Over topography maps using distance center multifocal with optisync technology

Figure 3. Topographical map results taken with daily multifocal lenses OD (left) and OS (right) upon three months of lens wear. Both maps revealed persistent temporal lens decentration in each eye despite relative good status of aided visual acuity.

To address the mediocre perception of vision associated with current daily multifocal lenses, I recommended the patient to be refitted with SpecialEyes Multifocal lens design, particularly customized by the OptiSync® Technology. This unique feature has shown to offset multifocal optics from the center of the lens and develop proper alignment with the patient’s visual axis to enhance their experience when wearing multifocal lenses. For this case, the lens center was particularly customized and shifted by 0.9mm nasally for each eye. The revised lens parameters were shown as followed:

OD 8.4/ 14.8/ -7.25sph/ +3.50add, D/C:2.1, I/Z: 4.2 off set with OptiSync® Technology of 0.9
OS 8.3/ 14.8/ -7.00sph/ +3.50add, D/C 2.0, I/Z: 3.4 off set with OptiSync® Technology of 0.9

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In May 2019, D.A. returned to our office six weeks since he has started wearing the custom multifocal trial lens with the OptiSync® Technology. He reported his aided vision has been good, and also appeared to be more stable with less halos during daytime, as compared to the previous multifocal brand. Current aided visual acuity was shown as 20/20 OD and 20/20-1 OS. An updated axial length measurement revealed a change by -0.21mm and -0.11mm for OD and OS, respectively. Interestingly, the negative sign for the axial length indicated a decrease in physiologic growth. In other words, both eyes have evidently displayed so-called ‘shortening effect’ during the course of myopia treatment!

Summary
Fitting multifocal lenses for children for the goal of myopia management has posted plethora of clinical challenges, especially when patients’ vision and perception are affected by lens misalignment. As a result, visual acuity and symptoms, such as shadows, glare, or halos may develop which can significantly impact the quality of vision. The unique feature of OptiSync® Technology has addressed the anatomical asymmetry of the sclera when fitting distance center multifocal contact lenses, and greatly mitigated the issues of lens misalignment.

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