Article Date: 5/1/2006

contact lens management
Beat Monovision's Challenges
New lens offers clear optics and biocompatibilty for presbyopes.
MICHAEL A. SLUSKY, O.D.

Meeting presbyopic patients' vision needs with soft contact lenses has always been challenging. The typical presbyope who's been wearing glasses is accustomed to crisp distance vision and full correction of any astigmatism. It's been difficult to duplicate that quality of vision, even for distance, and is even more difficult when we disrupt their binocularity for monovision. Finally, many presbyopic patients have stopped wearing contact lenses due to discomfort.

In my opinion, Acuvue Oasys with Hydraclear Plus is the first contact lens that successfully addresses both the optics and comfort concerns in monovision patients with its polymer technology.

Vistakon's Acuvue Oasys with Hydraclear Plus

Getting Monovision Right

START with a distance lens for the dominant eye 0.25D weaker than normal. Give the non-dominant eye a near lens with 50-75% of patient's suggested add power.

SWITCH the nondominant eye to a lens with 025-0.50D more plus power after four days.

SCHEDULE a follow-up visit to fine-tune the distance lens for better driving and near vision.

Monovision in stages

This lens has remarkably clear and consistent optics; because the tear film is minimally disrupted, visual clarity is maintained all day. Thus we can offer monovision to patients who don't want to sacrifice distance vision. It also has worked very nicely with the staged approach I take to monovision.

After the initial visit, I send the patient home with a distance lens for the dominant eye that is 0.25D weaker than converted distance spectacle prescription pertaining to the newly established refractive error. (Existing monovision patients will continue with their regular full prescriptive power based on the spectacle refraction conversion.) This reduces the disparity between the two eyes and helps them adjust to monovision. For the non-dominant eye, I give the patient a near lens with 50-75% of the suggested add power for their age for the first three to four days and a second lens with 0.25-0.50D more power. I instruct them to begin wearing the stronger, near lens on day four.

At the first follow-up visit we explore the need to modify the distance lens for better driving vision. I've found that even though I under-corrected the patient by 0.25D, most patients are satisfied with this distance vision when they're wearing the lens. The optics are so clear we can tip the balance a little towards near to give the patient good functional near and intermediate vision without adversely affecting distance vision.

Dealing with dryness

Age-related dryness and environmental factors contribute to contact lens intolerance in many presbyopes. After a few hours of lens wear, the tear film typically becomes dry and destabilized, the lens grows uncomfortable and the quality of vision declines. But compared with other silicone hydrogel lenses, this lens is very biocompatible and seems to promote a stable tear film throughout the day. I believe this is due to the polymer technology as well as an excellent balance of base curve, diameter and modulus.

It meets their needs

I prescribe Acuvue Oasys for 98% of my patients and have been especially pleased with the results in monovision cases. It provides presbyopes with a lens that's comfortable even in dry environments, and meets their functional needs while maintaining clarity of vision and corneal health.

DR. SLUSKY IS IN PRIVATE GROUP PRACTICE IN CHICAGO. HE SITS ON THE VISTAKON ADVISORY BOARD AND IS A MEMBER OF THE ACUVUE OASYS LEADERSHIP TEAM.



Optometric Management, Issue: May 2006