By: Kevin Chan, OD, MS, FAAO
Treehouse Eyes, Tysons Corner, VA
Fitting multifocal lenses is thought to be largely reserved for baby boomers or patients with presbyopia. In surge of the alarming rate of myopia progression in children, more practitioners are starting to adopt and fit multifocal lenses for the young population. Choosing the right lens design and parameters can sometimes be challenging since the clinical goals and protocols for myopia management in children are uniquely different from that for patients with presbyopia.
The case study below illustrates the importance of finding the right candidate and how customizing multifocal lens design can best deliver the overall treatment goal of myopia management.
A 13-year-old teenager, JK, was first referred to our office by a primary eye care provider for an initial consultation of myopia management two years ago. His mother reported that he has started wearing glasses since age 8. His current Rx was reported to be continuously getting worse by ‘almost 1 diopter each year’. He is an avid soccer player in school, and he found that wearing glasses has been a hindrance for him. His mother, as a -10D high myope herself, said she did not want her son’s vision to deteriorate and become functionally debilitating like her.
JK has previously had a brief history of wearing rigid orthokeratology lenses at night. However, given his active lifestyle and varied sleep hours, he has struggled with fluctuating vision during daytime. Since switching to the SpecialEyes 54 Multifocal lenses, he reported he has been more comfortable with his overall vision and comfort.
43.21 @014/ 43.97 @104
43.34 @179/ 44.34 @089
Manifest Rx (upon cycloplegic refraction)
OD: -5.25 -0.75 x016
OS: -5.00 -0.50 x161
SpecialEyes 54 Multifocal Trial Lenses
OD: 8.2 / 14.7 -5.25 -0.50 x175 (+3.00 add)
OS: 8.2 / 14.7 -5.00 DS (+3.00 add)
Multifocal Optic Zones: 2.8mm distance-centered zone and 5.5mm peripheral zone
Upon the first 3 months -- JK reported his vision has been clear and consistent throughout the whole day. Entrance aided visual acuity: 20/20+2 OD and 20/20 OS. Over-refraction (with lenses): Plano 20/20 OD & OS. Transitions between distance and near has also been clear and smooth with no symptom of halos. Equipment for axial length (AL) measurement was yet to be available at that time.
Upon Year 1 -- JK stated that his corrected vision has remained good and stable with current multifocal toric lenses. He said he could easily wear them with consistent comfort for 12-14 hours daily. Entrance aided visual acuity: 20/20+2 OD and 20/15 OS. Post-cycloplegic refraction: OD -5.50 -1.00 x005; OS -5.25 -1.00 x001. Axial lengths (AL) at baseline (measured by A-scan): OD 26.15mm; OS 25.68mm.
Upon 18 months -- Entrance aided visual acuity: OD 20/15-1; OS 20/15 OS. AL (measured by A-scan): OD 25.84mm; OS 25.55mm -- indicating -0.12mm and -0.04mm as a decrease in AL for OD and OS, respectively, compared to baseline data taken six months ago.
Upon Year 2 -- Entrance aided visual acuity has remained solid and stable as 20/20 OD & OS. Post-cycloplegic refraction: OD -5.25 -1.00 x006; OS -4.75 -0.75 x178. AL (Baseline data by non-contact Pentacam AXL, Oculus): OD 26.49mm; OS 26.13mm.
Note: AL variations can be accounted by different instrumentations and calibrations used.
While fitting multifocal contact lenses for young myopic patients may first seem atypical or time-consuming for some practitioners, it serves an important clinical goal of myopia management for children. In particular, accurate and reliable cycloplegic refraction data, along with reproducible axial length measurements, are key parameters in optimizing treatment outcomes for myopia management. Practitioners should also consider patients’ pupil sizes as a key parameter when it comes to multifocal lens design. I personally like using the SpecialEyes Multifocal Simulator to help optimize vision and perception in patients’ perspective. In sum, the experience of fitting SpecialEyes multifocal lenses for the young population has been made easy, while also transformative for their quality of life.