Difficult Patient Easily Satisfied with Custom Soft Toric Multifocal Contact Lenses

by Stephanie Woo, OD, FAAO, FSLS

Soft Toric Multifocal Case Study Report:
LM, a 41 year old male, presented to the office for a full eye exam on April 17, 2014. He had been wearing glasses ever since childhood and bifocals for the past 10 years. He was interested in LASIK surgery.

Habitual Glasses: DVA was 20/30 in the OD and 20/25 in the OS. NVA was 20/20
OD: +7.25 -1.75 x008
OS: +8.00 -2.00 x176
Add: +1.50

Manifest Refraction:
OD: +7.00 -1.50 x010 Add: +1.50 DVA: 20/30
OS: +8.00 -1.50 x179 Add: +1.50 DVA: 20/25
OU NVA: 20/20

Keratometry Values:
OD: 43.25/45.50&097
OS: 43.75/47.00@096

Exam Findings: No significant findings upon dilated fundus exam, however gonioscopy showed very narrow angles OU.

Assessment & Plan: Compound Hyperopic Astigmat with Presbyopia OU. Refer for Clear Lens Exchange.

Revisit: On April 23, the patient presented back to the clinic after his refractive surgery consultation and decided it was too expensive to proceed with the clear lens exchange. At this time, I had mentioned contacts to help with his dependence on glasses. After a thorough discussion of vision needs, he decided distance contacts would be best. Based on keratometry values and refraction the following calculated trial custom soft toric contact lenses were ordered:
SpecialEyes 54 Toric:
OD: Base Curve: 8.2 Diameter 14.7 +7.75 -1.75 x010
OS: Base Curve: 8.1 Diameter: 14.8 +8.75 -1.75 x179

The patient was seeing about 20/30 in each eye at dispense and the stability dots were stable at 3:00 and 9:00 OU. He wore the lenses for 2 weeks, but was disappointed that he could not see up close. At this time, I recommended custom soft toric multifocal contact lenses, which the patient was willing to try. Pupil size of 4.0mm was measured with the topographer and given to the Specialeyes consultant. New lenses were created and dispensed:

SpecialEyes 54 Multifocal:
(aspheric center near custom soft toric multifocal contact lenses)
OD: Base Curve: 8.20 Diameter: 14.70 +7.75-1.75x010 Add: +1.50 Near Center Zone: 2.0mm Distance Zone: 4.0mm
OS: Base Curve: 8.10 Diameter: 14.80 +8.75-1.75x179 Add: +1.50 Near Center Zone 2.0mm Distance Zone: 4.0mm

Dispense & Follow up: At dispense the patient was seeing about 20/30 at distance and near, and the stability dots were stable at 3:00 and 9:00 OU. Upon his return to clinic 2 weeks later, he was seeing 20/25 at distance and near and was thrilled with the vision. He ordered an annual supply of lenses and remains a happy patient.

Conclusion: Hyperopic astigmatic patients can be some of the most visually discriminative people. Despite the patient’s compound hyperopic astigmatism with presbyopia, I was able to successfully fit him in custom soft toric multifocal contact lenses. As revealed above, the adaptation phase of 2 weeks was critical for my patient’s success. Revision of the trial custom soft toric multifocal contact lenses was not needed. If the patient had communicated a chief complaint of needing better near, intermediate, or distance vision, I could have made changes to the zones that house the multifocal optics in an attempt to further improve my patient’s vision. Since my patient was satisfied and happy with his 20/25 vision, so was I. He remains a happy toric multifocal contact lens patient and I found another tool that I can add to my contact lens fitting tool box.

**Enroll in the 54 Multifocal Email Course to learn how to fit and customize this design**  

**For more information visit the 54 Multifocal Page**

Stephanie Woo, OD, FAAO, FSLS

Dr. Woo earned her optometry degree from the Southern California College of Optometry. In addition, she completed a cornea and contact lens residency at the University of Missouri. Dr. Woo is a Fellow of the American Academy of Optometry and a Fellow of the Scleral Lens Education Society. She is an author for the American Optometric Association and the Review of Cornea and Contact Lens, and spends time lecturing around the country on the topic of contact lenses.