Resolving Near Issue with Custom Optics in Toric Multifocal Contact Lenses

by Steve Sandman, OD

Case Study Report: A 54 year old female patient with myopia, astigmatism, and presbyopia presented to the practice complaining of comfort and stability issues with her current multifocal contact lenses. After an eye exam and conversation with the patient, the decision was made to trial the 54 Toric Multifocal contact lenses from SpecialEyes – a custom aspheric near center design.

Keratometry Readings:
OD: 44.75@155/45.50@065
OS: 45.25@021/46.25@111

Spectacle Rx:
OD: -4.00 -1.00 x150
OS: -4.25 -0.75 x025
Add: +2.50

Pupil Size:
2.5mm in bright light
3.5mm in ambient light

The consultation department at SpecialEyes was contacted and custom 54 Toric Multifocal contact lenses were designed and ordered.

Trial SpecialEyes 54 Toric Multifocal Contact Lenses ordered:
(aspheric center near custom soft multifocal contact lens)
OD: Base Curve: 7.9 Diameter 14.5 -3.75 -1.00 x150 Add: +2.50
Near Center Zone: 1.8mm Distance Zone: 4.0mm
OS: Base Curve: 7.9 Diameter 14.5 -4.00 -0.75 x025 Add: +2.50
Near Center Zone: 1.8mm Distance Zone: 4.0mm

Fitting & Dispense Visit: Upon initial dispense the custom toric multifocal contact lenses were well centered and exhibited proper movement. There was slight rotation in the OD lens and no rotation in the OS lens. The patient was seeing 20/30 at distance in the right eye and 20/25 at distance in the left eye. Near visual acuity OU was 20/40. The lenses were dispensed to allow for adaptation.

Follow-up Visit: After the adaptation period, the patient returned to the clinic wearing her new trial custom toric multifocal contact lenses. Visual acuity OD was improved slightly to 20/30+ and OS visual acuity remained stable at 20/25. Near visual acuity was improved to 20/30 OU. The patient expressed a chief complaint with her near vision while reading. She described seeing a 3-D effect at near, as if parts of the letters pulled away.

Slit lamp examination confirmed optimal fit and stability of the toric multifocal contact lenses. The slight rotation in the OD lens was no longer evident. OD over-refraction of -0.25 improved the patient’s distance vision without interfering with near vision.

SpecialEyes’ consultation department was contacted to see if a change in the size of the near center zone would address the 3-D effect at near. Remake exchange trial lenses were redesigned altering the size of the near center zones from 1.8mm to 2.0mm to assist in resolving the 3-D effect at near, as well as, improving the patient’s overall near vision. The over-refraction of -0.25 was applied to the OD lens bringing the sphere power to -4.00. The new trial lenses were ordered and dispensed.

Reorder Trial 54 Toric Multifocal Contact Lenses:
(Changes underlined)
OD: Base Curve: 7.9 Diameter 14.5 -4.00 -1.00 x150 Add: +2.50 Near Center Zone: 2.0mm Distance Zone: 4.0mm
OS: Base Curve: 7.9 Diameter 14.5 -4.00 -0.75 x025 Add: +2.50 Near Center Zone: 2.0mm Distance Zone: 4.0mm

Upon follow up visit the patient said the new lenses resolved a substantial amount of the 3D effect at near. The patient subjectively voiced a desire for even better near vision. A distance over-refraction was performed and the patient took a +0.50 in the right eye and +0.25 in the left eye improving both her distance and near vision.

The distance plus power over-refraction was applied OU and another set of trial lenses was ordered. At dispense, distance visual acuity was 20/20 OD and 20/30 OS and near visual acuity was 20/30 OU. The patient communicated a subjective improvement in her near and distance vision and expressed satisfaction. The patient was instructed to wear the lenses to further facilitate adaptation.

During a follow up phone call, the patient reported satisfaction with the overall comfort and vision with her custom multifocal contact lenses. She expressed intermittent issues with focusing at near with certain size text, but not every day. Overall she was happy with her custom multifocal contact lenses and the manner in which she utilizes them. We ordered her an annual supply and the patient remains a successful multifocal contact lens wearer.

Final SpecialEyes 54 Toric Multifocal Contact Lenses:
OD: Base Curve: 7.9 Diameter 14.5 -3.75 -1.00 x150 Add: +2.50 Near Center Zone: 2.0mm Distance Zone: 4.0mm
OS: Base Curve: 7.9 Diameter 14.5 -3.50 -0.75 x025 Add: +2.50 Near Center Zone: 2.0mm Distance Zone: 4.0mm

Conclusion: My 54 year old myopic astigmatic patient with advanced presbyopia, who experienced stability and comfort issues with her habitual contact lenses, found success in a custom aspheric multifocal contact lens design. I was able to define and customize the multifocal near center zones and alter the prescription to create an optimal near, intermediate, and distance visual experience for her. It was a successful outcome for both my patient and our practice.

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

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

Steve Sandman, OD
Dr. Sandman practices at EyeCare Specialties, a state-of-the-art multiple office eye care practice serving the communities of southeast Nebraska. He has been with EyeCare Specialties since 1995 and is dedicated to providing his patients the latest optometric technologies combined with compassionate care.