CLINICAL: Contact Lenses

Cataracts and Contact Lens Wear

A variety of lens options are available to maximize cataract patients’ vision

We are fortunate to practice at a time when a variety of contact lens options enable eye care professionals to maximize their patients’ vision, particularly when other health concerns are present, such as cataracts.

For example, a presbyopic patient presented with complaints of blurred vision in both distance and near out of her current soft, toric multifocal contact lenses.

She told me she was considering dropping out of contact lens wear, due to the loss of clear, crisp vision at both distance and near. Additionally, this patient mentioned her night driving was becoming more difficult.

To help her, I needed to determine her underlying visual restrictions; identify her wants and offer her products for optimal vision.


Her entering VAs were 20/30 OD and OS at both distance and near via her current contact lenses.

Her manifest refraction was:

OD: -4.50  -1.25 x 030    20/20-
OS: -4.50  -1.50 x 005    20/20-
Add +2.25  20/20- OU

Internal ocular examination revealed small “off-center” posterior sub-capsular cataracts in both eyes. (See Picture 1.)

Picture 1: A small, off-center posterior sub-capsular cataract will cause a loss of visual sharpness and a decrease in night driving.
Image courtesy of Dr. Jason Miller


From the original discussion with the patient, I knew that she was concerned about a lack of crisp vision at distance and near with her contact lenses. She also specifically mentioned difficulty driving at night. When asked whether she would like to continue contact lens wear, could these issues be addressed, she said “yes,” so I discussed with her the benefits and challenges of a variety of contact lens options that could work. (This is when it’s important to be knowledgeable and have the tools and skills needed to enable successful contact lens use in a variety of situations. Local society gatherings, state and national meetings, as well as specialty conferences are great places to stay current on the newest tools.)


This patient’s options included a single vision soft toric (monovision or distance with over-readers), a soft toric multifocal, a single vision RGP, a single vision hybrid, a multifocal soft toric, a multifocal RGP and a multifocal hybrid contact lens.

After weighing the pros and cons of the options, we decided on the multifocal hybrid design. (See Picture 2.) This option may provide sharp vision at distance and near, due to less lens rotation. Also, the lens offers the potential comfort linked with soft lenses, a bonus to meeting the patient’s wants and needs.

Picture 2: A successful fit with hybrid multifocal contact lenses with proper centration and fit.
Image courtesy of Dr. Jason Miller


This patient was able to obtain 20/25+ vision with both eyes at both distance and near with the hybrid multifocal lens. Her solution demonstrates a win for both the patient and the practice: She was happy with her improved vision and overall sharpness, and we were able to prevent a contact lens dropout. OM