Case Study: Multifocal Contacts for Presbyopia and Astigmatism

Hyperopic Patient with Presbyopia and Astigmatism Achieves Success!

Many practitioners believe that patients with presbyopia and astigmatism, especially those who require high amounts of cylinder correction, are not good candidates for soft multifocal toric contact lenses. The reasons for this vary, but tend to lead back to increased chair time with little success. However, as the industry evolves and more custom options become available, this philosophy could now be a thing of the past. The case study below highlights a hyperopic patient with presbyopia and astigmatism who was easily satisfied in the SpecialEyes 54 Toric Multifocal, a custom aspheric multifocal toric design.

Case Study:

The practitioner provided SpecialEyes with the following measurements to design a pair of trial multifocal toric contact lenses for his hyperopic patient with presbyopia and astigmatism:

Keratometry Readings:
OD: 42.50/45.75
OS: 43.00/45.50

HVID:
OD: 12.00mm
OS: 11.50mm

Manifest Refraction:
OD: +6.75 -4.00 x180 (+2.00 add)
OS: +6.25 -3.50 x177 (+2.00 add)

Pupil Size:
4.0mm in a bright light setting

The SpecialEyes Arc Length Calculator was used to design the custom base curve, diameter and vertexed toric contact lens prescription. SpecialEyes recommends using the add power that is true to the patient’s refraction. Since the multifocal optics are designed based on a patient’s pupil size measurement in regular room illumination, the SpecialEyes consultant referenced the 4.0mm pupil size measurement in a bright light setting, and assumed .50mm pupil dilation for an effective pupil size of 4.5. The effective pupil size of 4.5 was then input into the Multifocal Simulator to design the multifocal optic zones. If you are unfamiliar with the Multifocal Simulator, sign up for the Multifocal Simulator Course or visit the Multifocal Simulator page and check out the video demos.

SpecialEyes 54 Multifocal Toric Trial Lenses:

OD: 8.30 / 14.9 +7.25 -4.50 x180 (+2.00 Add)
OS: 8.20 / 14.5 +6.75 -4.00 x177 (+2.00 Add)
OU Multifocal Optic Zones: 2.0mm near center zone and 4.0mm peripheral zone

Outcome:

After allowing the lenses to settle on the eye, a slit lamp examination revealed the lenses had excellent coverage, centration, and movement on blink. The lenses had no rotation and visual acuity results were acceptable. The practitioner instructed the patient to wear the toric multifocal contact lenses out of the office and adapt to them in a real world environment. After a few weeks of adaptation, no remakes were needed and the practitioner called to order the patient’s supply.

Through the utilization of clinical measures such as a careful manifest refraction, central K values, horizontal visible iris diameter, pupil size, and the SpecialEyes Multifocal simulator, this classically hard to fit multifocal toric patient was easily satisfied. To learn more about our 54 Multifocal Toric Contact Lens, click the Learn More button below. If you would like help designing a custom soft toric multifocal contact lens for your patient with presbyopia and astigmatism, contact the SpecialEyes Consultation Team.