Multifocal Case Study: GP Intolerance and Custom Soft Aspheric Multifocal Contact Lenses

by Moshe Schwartz, OD, FAAO
Dr. Moshe Schwartz, OD

Case Study Report: A patient unsuccessful in stock disposable multifocal contact lenses and intolerant to GP multifocal contact lenses finds success in customized soft aspheric multifocal contact lenses.

A 45-year-old presbyopic male patient presented to my practice for a contact lens examination. His chief complaint was blurred vision at distance with his presenting multifocal contact lenses. After a thorough examination and discussion of my clinical findings and recommendations, we collaboratively decided to order gas permeable (GP) multifocal contact lenses.

Manifest Refraction:
OD: -1.75 -0.50 x107 Add: +1.75 DVA: 20/20 NVA: 20/20
OS: -1.75 -0.25 x069 Add: +1.75 DVA: 20/20 NVA: 20/20
OU: DVA:20/20 NVA: 20/20

Presenting Multifocal Contact Lenses:
OD: Proclear Multifocal D Lens -1.75 Base Curve: 8.7 Diameter: 14.4 Add: +1.00 DVA: 20/25 unstable NVA: J4
OS: Proclear Multifocal N Lens -1.75 Base Curve: 8.7 Diameter: 14.4 Add: +1.00 DVA: 20/25 unstable NVA: J4
DVA OU: 20/20-2 Unstable

New GP Multifocal Contact Lenses:
OD: Boston XO2 Gas Permeable Lens -1.85 Base Curve: 7.65 Diameter: 11.0 mm Add: +1.75
DVA: 20/20+ Stable NVA: 20/20 Stable

OS: Boston XO2 Gas Permeable Lens -1.83 Base Curve: 7.49 Diameter: 11.0 mm Add: +1.75
DVA: 20/20+ Stable NVA: 20/20 Stable

OU: DVA: 20/20 Stable
NVA: 20/20 Stable

During the GP contact lens dispensing appointment, the fitting characteristics and fluorescein pattern of the lenses was optimal. Visual performance was good and proper lens movement was noted. The contact lenses were dispensed.

The patient requested a follow up visit after eight weeks complaining that he could not adapt to the gas permeable lenses. He stated, “I love my vision but cannot stand the lens sensation in my eyes”. I inquired about his lens wear time and cleaning system, and he informed me that he had been wearing the lenses at least 8 hours per day. The patient was thrilled with his vision at all ranges in the GP multifocal contact lenses, but had a difficult time adapting to them due to constant lens sensation and dryness that he deemed uncomfortable and intolerable. An alternative material and design of multifocal contact lenses had to be sought in order to address his chief complaint of not being able to tolerate the GP lenses in his eyes, coupled with his high motivation to wear a multifocal contact lenses, and considering his past failure in stock multifocal contact lenses.

I decided to trial custom soft aspheric multifocal contact lenses and ordered the SpecialEyes 54 Multifocal due to its improved posterior lens-corneal alignment that increases comfort and hydration, in particular for patients with susceptibility to dry eyes.

New Trial SpecialEyes 54 Aspheric Multifocal Contact Lenses:
OD: -1.50 -0.50 x107   Base Curve: 8.1 Diameter 14.5 Add: +1.75 2.0mm Near Center Zone
DVA: 20/20 stable NVA @14 inches: J1 Stable

OS: -1.75                    Base Curve 8.1 Diameter 14.5 Add: +1.75 2.0mm Near Center Zone
DVA: 20/20 Stable NVA @14 inches: J1 Stable

The contact lens fitting and evaluation revealed that the near center 54 Multifocal lenses were well centered, had proper movement, and exhibited a clear lens surface with appropriate wettability. Vision was optimal at all ranges: near, intermediate, and distance. The lenses were dispensed and the patient was encouraged to wear the lenses regularly for adaptation.

Revision & Final Outcome:
On a 2 week contact lens follow up exam, the patient presented wearing his trial customized soft multifocal contact lenses for 8 hours. The patient was experiencing contact lens comfort and vision from his custom soft multifocal lenses, and was wearing them for 15 hours a day. However, he did express a desire to improve his distance vision if possible.

Via slit lamp examination, an optimal contact lens fit was observed with good centration, rotation and movement. Snellen chart visual acuity revealed 20/20 at distance and near but as previously stated the patient subjectively described a desire to improve the quality of his distance vision, even though objective distance visual acuity measurement taken at the Snellen chart was acceptable.

The right eye was the patient’s dominant eye so I decreased the near center zone size in the OD lens from 2.0mm to 1.8mm to address the patient’s subjective distance vision complaint. This decrease in the near center zone size enhanced the patient’s distance vision by reducing the area of near optics within the central near zone while concurrently decreasing the rate at which the power progressed from near power in the center to full distance power in the periphery. This change also increased the area over the pupil that was dedicated to distance and intermediate vision. The patient was satisfied with this small change as it improved his distance vision. We ordered the patient a year’s supply of the custom soft aspheric multifocal contact lenses. The patient was instructed to continue with his current wearing schedule as long as he continues to experience symptom-free contact lens wear.

My patient, who had distance visual acuity issues in stock multifocal contact lenses and intolerance to GP multifocal contact lenses, has now experienced a victory in custom soft aspheric multifocal contact lenses. He remains successful in these lenses and my staff and I have gained a loyal and happy contact lens patient.

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

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

Moshe Schwartz, OD, FAAO

Dr. Schwartz earned his Doctor of Optometry degree from Nova Southeastern University in Florida, and has been in private practice since 1997. He is a Diplomate in Cornea, Contact Lenses and Refractive Technologies of the American Academy of Optometry, and a member of the College of Vision Development (C.O.V.D.)

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