contact lens case reports
Managing Complex Optics with Soft Toric Multifocals
BY PATRICK J. CAROLINE, FAAO, & MARK P. ANDRé, FAAO

We've got an idea. Let's take two of our more challenging clinical modalities (toric soft lens optics and soft lens multifocal optics) and put them together in the same contact lens. Let's face it, this can only be trouble in a bottle — or perhaps not.

A Natural Transition

Various iterations of toric multifocal soft lenses have existed for years, but enjoy limited use and marginal success. The reasons are multifactorial and obvious to practitioners familiar with the complexities of astigmatism and presbyopia. Yet many presbyopes who successfully wear toric soft lenses are seeking alternatives to wearing reading glasses over their contact lenses. While GP multifocals are an alternative, many prefer to continue with their habitual soft lenses. For them, a successful soft toric multifocal modality is a natural transition.

In our hands, one of the more successful toric multifocal designs is the CooperVision Ultravue 2000T. It incorporates a fitting philosophy similar to the Proclear and Frequency 55 Multifocals (both CooperVision). You fit the dominant eye with a design to optimize distance vision and the non- dominant eye with a design to optimize near vision (Figure 1). This provides an improved form of monovision with each eye seeing at distance and near.

Pleased Presbyope

Patient SM, a 49-year-old female, has successfully worn toric soft lenses for 20 years. She was experiencing problems with near and intermediate distances and was unhappy with her growing dependence on reading glasses. We discussed her options and she favored the toric multifocal modality.

We fit SM with Ultravue 2000T lenses, her dominant right eye with the "D" lens –3.75 –1.75 x 170 (Figure 2), and non-dominant left eye with the "N" lens –3.50 –2.25 x 0.10 (Figure 3). Add power for both lenses was +1.50D. Her ultimate visual acuities were OD 20/20 at distance and 20/40 at near and OS 20/20 at near and 20/40 +2 at distance. With both eyes VA was 20/20 at distance and 20/20 at near. She was very pleased with the result.

This case illustrates that astigmatism and presbyopia can be successfully managed in patients willing to make some minor compromises at distance and near.

Figure 2. Patient's right eye with the toric multifocal lens.	Figure 3. Patient's left eye with the toric multifocal lens.

Patrick Caroline is an associate professor of optometry at Pacific University and is an assistant professor of ophthalmology at the Oregon Health Sciences University. He is also a consultant to Paragon Vision Sciences and SynergEyes, Inc. Mark André is director of contact lens services at the Oregon Health Sciences University and serves as an assistant professor of optometry at Pacific University. He is also a consultant for Alcon Labs, CooperVision and SynergEyes, Inc.