--- title: Custom Multifocal Optics are a Success for Patient with Smaller Pupils description: "Read SpecialEyes Case Study: SpecialEyes' custom multifocal optics satisfies a hyperopic, presbyopic patient with astigmatism and small pupils." image: https://blog.specialeyesqc.com/hubfs/Blog%20Banner%20-%20SPE%20(47).png --- Case Studies: Multifocal # Custom Multifocal Optics are a Success for Patient with Smaller Pupils Read SpecialEyes Case Study: SpecialEyes' custom multifocal optics satisfies a hyperopic, presbyopic patient with astigmatism and small pupils. [ SpecialEyes ](https://blog.specialeyesqc.com/author/specialeyes) Oct 27, 2016 --- A practitioner called to design a pair of the [custom SpecialEyes 54 Multifocal](https://www.specialeyesqc.com/multifocal) Toric contact lenses for a hyperopic astigmatic patient. The practitioner provided HVID, Keratometry (K) readings, manifest refraction, and pupil size to the SpecialEyes consultant, who utilized the [SpecialEyes Arc Length Contact Lens Calculator](https://calculators.specialeyesqc.com/arc-length-calculator.php) to design the base curve and diameter of the lenses and the [SpecialEyes Multifocal Simulator](https://calculators.specialeyesqc.com/multifocal-simulator.php) to design the custom multifocal optics. Patient measurements were as follows: HVID OD: 11.8mm OS: 11.8mm Keratometry Readings OD: 43.75/44.00 OS: 44.50/45.50 Manifest Refraction OD: +2.00 -1.00 x125 OS: +1.25 -1.25 x070 Pupil Size (regular room illumination) OU: 3.3mm The initial trial contact lens parameters were as follows: SpecialEyes 54 Multifocal Toric OD: 8.1/14.6 +2.00 -1.00 x125 +1.75 add OS: 8.0/14.5 +1.25 -1.25 x070 +1.75 add Custom Multifocal Optics: 1.8mm near center zone and 3.0mm peripheral zone Upon initial trial lens evaluation and dispense, the lenses were centered, fitting well, and exhibited optimal movement on blink. The right lens was rotated 8 degrees clockwise, but was stable and not fluctuating. The left lens was rotated 10 degrees counterclockwise and was also very stable. Visual acuities with the trial lenses: OD: 20/30 @ distance and 20/60 @ near OS: 20/25 @ distance and 20/25 @ near Action: Since the lens rotation was very stable, LARS (Left Add, Right Subtract) was implemented to account for the rotation in hopes to improve distance visual acuity. Since the patient was seeing worse at near in the right lens (20/60), it was decided to alter the custom multifocal optics to improve near vision. The near center zone in the right lens was increased from 1.8mm to 2.0mm in hopes to improve near visual acuity for the patient. Since the patient was seeing fairly well at near via the left lens (20/25), no change was made to the near center zone in that lens. The thought was once the lens rotation is compensated for, both near and distance would improve. The parameters for the second pair of trial contact lenses were as follows (changes in bold): OD: 8.1/14.6 +2.00 -1.00 **x133** +1.75 add Multifocal Optics: **2.0mm near center zone** and 3.0mm peripheral zone OS: 8.0/14.5 +1.25 -1.25 **x060** +1.75 add Multifocal optics: 1.8mm near center zone and 3.0mm peripheral zone The new trial lenses were dispensed and the patient wore the lenses for an adaptation period. At follow up, the patient expressed satisfaction with the new trial multifocal toric contact lenses and an annual supply of lenses was ordered. To learn more about designing and prescribing the custom soft SpecialEyes 54 Multifocal Toric contact lens, please sign up for [Dr. Rob Davis’ email course](https://www.specialeyesqc.com/multifocal-course). Or, [submit your ](https://www.specialeyesqc.com/contact)[online request](https://specialeyesqc.com/multifocal-contact.php) and our team would be glad to send you information and pricing. Happy Fitting, The SpecialEyes Consultation Team   [![MF guide](https://blog.specialeyesqc.com/hs-fs/hubfs/MF%20guide.png?width=1727&name=MF%20guide.png)](https://info.specialeyesqc.com/multifocal-download)   [Case Studies: Multifocal](https://blog.specialeyesqc.com/tag/case-studies-custom-multifocals) ## Similar posts Case Studies: Multifocal ### [A Smooth Transition into SpecialEyes’ Multifocal Contact Lenses](https://blog.specialeyesqc.com/a-smooth-transition-into-specialeyes-multifocal-contact-lenses) SpecialEyes' custom designed multifocal contact lenses makes transitioning from the SpecialEyes Single Vision Toric or Sphere Contact Lens easier... SpecialEyes Oct 21, 2015 Toric Design & Prescribing ### [Healthy Habits and Contact Lens Care](https://blog.specialeyesqc.com/healthy-habits-contact-lens-care) In celebration and support of Contact Lens Health Week, SpecialEyes shares tips on contact lens care and healthy habits for your SpecialEyes patients. SpecialEyes Aug 25, 2016 Multifocal Design & Prescribing ### [Toric Multifocal Contact Lenses and Importance of Accurate Pupil Size Measurement](https://blog.specialeyesqc.com/toric-multifocal-contact-lenses-and-importance-of-accurate-pupil-size-measurement) When fitting SpecialEyes' custom toric multifocal contact lenses, it is imperative to provide SpecialEyes with an accurate pupil size measurement.... SpecialEyes Aug 18, 2014 ### Get the latest updates from SpecialEyes Complete the form to get the latest news and updates.