prescribing for presbyopia
Fitting the Princess and the Pea with Multifocal Contact Lenses
BY MARY JO STIEGEMEIER, OD, FAAO

Once upon a time, patient TC, a 48-year-old female, came to our office as a new patient. She has a 28-year history of soft contact lens wear, but for the last year, reported that she's worn her lenses only sporadically. She's considering wearing spectacles 100 percent of the time because of problems with near vision blur, although she misses lens wear.

A Fairy Tale Patient

TC describes herself as the princess from "The Princess and the Pea." "Everything bugs me," she says, "any slight difference in my eyeglass prescription bothers me." For this reason, her previous eyecare practitioner had prescribed distance contact lenses with reading glasses over them for near. She'd previously tried monovision without success. She'd never even attempted multifocal contact lenses.

Pertinent history includes that she's a healthy women who loves her progressive multifocal eyeglasses. She reported that she had "no trouble" adapting to them and said she appreciated the vision that her multifocals provided. This small piece of information became the inspiration for this contact lens fitting; although seemingly contradictory, this patient was telling me that she was particular about her correction, needed an add and enjoyed simultaneous vision.

Examining the Patient

TC's manifest refraction yielded OD ­3.50 ­0.25 X 065 20/20 +2.25 add J1; OS ­4.00 ­0.50 X 060 20/20 +2.25 add J1. This refraction was essentially the same as her habitual 18-month-old prescription.

Keratometry data included OD 43.25/43.50 @ 090 clear mires; OS: 43.25/43.67 @ 090 clear mires. Over-refraction over TC's current soft contact lenses was plano in each eye, allowing 20/20 vision in each eye, but Jaeger 12 uncorrected.

Fitting TC

I applied a diagnostic pair of Bausch & Lomb SofLens 66 Multifocal contact lenses in the following parameters:

OD: 8.8mm base curve, ­3.25D sphere power, low add, 20/20 distance

OS: 8.8mm base curve, ­3.75D sphere power, high add, 20/30 distance

TC's binocular near vision was Jaeger 3. Her distance vision was good, but her near vision wasn't adequate.

I then applied a second diagnostic pair of SofLens 66 Multifocal lenses in the following parameters:

OD: 8.8mm base curve, ­3.50D sphere power, high add, 20/30^-1 distance

OS: 8.8mm base curve, ­4.00D sphere power, high add, 20/30^-1 distance

TC's binocular near vision with these lenses was Jaeger 1. Her distance vision wasn't adequate, but her near vision was perfect.

I applied a third pair of diagnostic lenses in the following parameters:

OD: 8.8mm base curve, ­3.75D sphere power, high add, 20/25⁺¹

OS: 8.8mm base curve, ­4.25D sphere power, high add, 20/25⁺¹

TC's binocular near vision with these lenses was Jaeger 2+. Her binocular distance vision was 20/20^-1 and her near vision was adequate. I dispensed these lenses to TC.

Happily Ever After

When TC came to her follow-up exam, she stated that I'd changed her life and she felt like a new woman.

I normally would have felt apprehensive to fit the princess from "The Princess and the Pea" with multifocal contact lenses, but I've found that you can become a fairy godmother if you try.

Dr. Stiegemeier is in private practice in Beachwood, Ohio. She lectures throughout the country on the subject of contact lenses and performs clinical research.