A Successful Switch From Monovision to Multifocal Toric Contacts

Introduction

KC, a 53 year old administrative assistant wearing monovision, came in for her annual exam. During the exam, the practitioner asked her if she was happy with her current contact lenses and if she would be interested in trying multifocal contact lenses. Her response was simply, “It’s not great, but I have astigmatism so I’m not sure I can wear multifocal contact lenses.” During a brief conversation, the practitioner explained that there are designs out there that could work for her. After presenting the benefits, limitations, and cost associated with each of his recommendations, they both agreed that she would be a great candidate for SpecialEyes’ 54 Multifocal Toric design.

Upon ordering with SpecialEyes the practitioner provided consultation with the following information:

Keratometry Readings
OD: 43.5/45.00
OS: 43.4/44.3

HVID
OU: 11.4mm

Manifest Refraction
OD: -5.00 -1.75 x010 (+2.00 add)
OS: -4.25 -1.75 x170 (+2.00 add)
(OS dominant)

Pupil Size
Photopic Measurements from Oculus Pentacam®
OD: 2.15mm
OS: 2.08mm
Used 2.7mm effective pupil size in regular room illumination

Other Notes
Currently wearing monovision (Acuvue Oasys for Astigmatism®)
Hoping multifocal contacts will provide her more comfortable vision for work and driving
Administrative assistant & heavy computer user

Lens Design
Using the information provided, the consultant designed the initial trial as follows:
OD: 8.2 BC/14.5 Diam. -4.75 -1.5 x010 (+2.00 add) 1.8 N/C, 3.0 I/Z
OS: 8.2 BC/14.4 Diam. -4.25 -1.75 x170 (+2.00 add) 2.1 D/C, 3.0 I/Z

Notice anything different about the above designs? Typically, we recommend that patients start with center-near designs in both eyes. However, due to the patient’s small pupil size, history of successful monovision wear, and desire for intermediate vision, the consultant recommended placing a center-near design over the non-dominant eye and a center-distance design over the dominant eye. Additionally, the consultant suggested a slightly larger distance center zone size on the dominant to ensure that enough area of distance optics was placed in front of the pupil across various light conditions. Also, the customization of the multifocal optics to the patient's smaller pupil size helped to ensure good vision was obtained at all distances. 

Results
Upon initial dispense, the practitioner evaluated the lenses for good fit (centration, movement, limbal coverage, and rotation) and assessed the binocular visual acuity at distance and near. Due to the optimal lens fit, patient comfort and acceptable visual acuity (20/20 (-)@D, J2+@N) the practitioner instructed the patient to wear the lenses into the real world and follow up in one week.

During the one week follow up, the patient reported great vision and comfort and decided to finalize her year supply. No remakes needed. So what led to this success story? We believe that the secret to success is the practitioner’s process. In fact, his approach aligns perfectly with the SpecialEyes Multifocal Fitting Strategy. Let’s break it down.

1. Select & Measure
   • Selected a patient with high motivation to wear multifocal contact lenses.
   • Presented multiple options and clearly communicated benefits, limitations, and cost associated with each design. Ultimately, the practitioner empowered the patient to make the best decision for her needs.
   • Obtained solid measurements (Ks, HVID, pupil size, recent manifest refraction at distance and near)
2. Design & Evaluate
   • Provided the consultant with solid measurements along with prior lens wear history and visual requirements based on the patient’s daily activities and lifestyle.
   • Allowed SpecialEyes to design and optimize trial lenses based on the patient’s precise measurements and specific needs
   • Thorough evaluation of lens fit and visual acuity
   • Due to the acceptable fit and vision, the practitioner waited to make changes and encouraged the patient to take time to adapt.

In conclusion, this case highlights the importance of taking a strategic approach to multifocal toric contact lens fittings and prescribing with science. In fact, we have found that practitioners that follow a similar process usually achieve success within 1-2 trial lenses. If you find fitting multifocal toric contact lenses to be a frustrating experience that takes too many office visits with poor results, consider implementing the SpecialEyes Multifocal Fitting Strategy and prescribing one of our custom multifocal designs.

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