Article Date: 12/1/2006

contact lens management
Multifocals That Multitask

This family of lenses offers something for all your hard-to-please patients.

DAVID A. WOLF, O.D.

Two years ago, I was offered the opportunity to fit the PolyVue High Definition line of products, and my successful multifocal soft lens fits have sky-rocketed. The aspheric design allows for good distance vision, and the two different add designs offer excellent near vision. The addition of the astigmatic design has also increased my success with this lens. These cases illustrate how I use the lenses to achieve excellent results.

Jumpy vision

A 53-year-old female, soft lens wearer for many years struggled once presbyopia set in. I fit her with a daily progressive soft lens for social situations; her best vision was 20/30 O.D. and J2. She was bothered by "jumpy vision" and experienced some nausea, but tolerated the lenses. Her vision, however, was not adequate for her to wear them at work. I then tried a two-week disposable soft multifocal, which improved vision to 20/20 O.D. and J1. Despite this, she continued to struggle with comfort and needed reading glasses over her lenses. When she wore the lenses all day, she awoke with sore eyes. At her next exam, I recommended we refit her. I used Polyvue HDX progressive -2.50D O.D. and -3.00D O.S. The aspheric design masked the cylinder of the right eye, and she was able to see 20/20 O.D. at distance and J1 at near.

PolyVue High Definition

MATERIAL: Polymacon
BASE CURVE: 8.6mm
DIAMETER: 14mm
POWERS: +5.00D to -7.00D
ADD POWER: HD and HD Toric: up to +1.25; HDX Progressive and HDX
TORIC PROGRESSIVE: +1.25D to +2.25D
CYLINDER AND AXIS - TORICS ONLY: -0.75, -1.50; 90� and 180�
PRICE: $24 single, $72 multipack (3 plus one)

CL neophyte

Approaching age 50, this patient was tired of taking his glasses off and on and noticed that his near vision was not adequate, especially in low light. We discussed his options and decided to order PolyVue HDX torics. I originally ordered a pair of lenses with an Rx of -0.75D -0.75 x 180 O.D. and -1.25D -0.75 x 180 O.S. Not having worn contact lenses before made insertion and removal a challenge for this patient, but the lenses worked well due to their stable handling. The patient's vision was 20/20 O.D. at distance and J1+ at near, but he had slight blurring at distance. I ordered a second lens for the dominant right eye: PolyVue HD toric -1.25D -0.75 x 180. The lower add allowed for better distance vision, yet maintained good near vision.

Increasing CL wear

This patient alternated between monovision contact lenses and glasses, but wanted to wear contact lenses more often. We discussed her options, and she chose the PolyVue HD lenses with an Rx of 0.50D O.D. and 1.75 O.S. Her distance vision was 20/20 O.D., but her near was only J2. After a few weeks, the patient returned for follow-up. She was struggling at near with J2 vision. Loose lens refraction over the lenses showed she could accept +0.50D over each eye with no decreased distance vision. We changed her Rx to +1.00D O.D. and +2.25D O.S. The aspheric design allows for additional plus without decreasing distance vision. This level of vision was a definite upgrade from monovision.

Many multifocal patients drop out of contact lenses after struggling with the quality of vision, but my PolyVue patients consistently re-order at their annual exam.

DR. WOLF IS THE OWNER OF LAKE OSWEGO VISION CLINIC IN ORE. HE IS A MEMBER OF THE AMERICAN OPTOMETRIC ASSOCIATION. E-MAIL INFO@LAKEOSWEGOVISION.COM.



Optometric Management, Issue: December 2006