Prescribing for Presbyopia

Presbyopia Posters From GSLS

BY CRAIG W. NORMAN, FCLSA

Many interesting topics were presented at January’s Global Specialty Lens Symposium (GSLS) in Las Vegas, including presbyopia. This column will highlight some of the posters on this topic.

Understanding and Advancing Soft Multifocal Contact Lenses

Gerard Cairns, PhD, MCOptom, FAAO, FBCLA, and Tara Vaz, OD, FAAO, evaluated all peer-reviewed literature relating to soft multifocal contact lenses published over the preceding 10 years. Underutilization of soft multifocals was demonstrated, while the literature also supports their recognized limitations. More can be done to model realworld variables in optical development, and clinical research continues to innovate to establish vision performance benchmarks in this category. Greater acceptance of current lenses may occur through careful patient selection, careful patient counseling, and by targeting low adds or by partially correcting presbyopia.

Wavefront-Guided Progressive Multifocal Soft Lenses

Stephen Dunn and Garold Edwards, OD, described a method and process of properly fitting a progressive contact lens that corrects presbyopia using concentric aspheric zones. Also detailed was a process of using a diagnostic test lens that enables relatively unskilled technicians to accurately determine the optimal optic zone and accommodation zone relative to pupil size. Wavefront aberrometry provides the input parameters, guiding software to design the lens accurately.

Use of Daily Multifocal Contact Lenses in the Treatment of Convergence Excess

Erin Kindy, Addie Smith, and William Edmondson, MAT, OD, FAAO, discussed two patients who had convergence excess and showed a marked decrease in near esophoria while wearing daily multifocal contact lenses. Perhaps more importantly, one patient described a substantial relief of near asthenopia, while the other reported less “pulling” of her eyes and resolution of diplopia while studying. The authors concluded that patients may experience relief of near symptoms and improvement in stereopsis through daily wear multifocal lenses.

Variation in Pupil Diameter With Age in Normal Room Illumination

A general assumption has been that pupil diameter decreases in size as we age. Amanda C. Kingston, MS, CCOA; Stephanie Su-Brady, OD; and Ian G. Cox, BOptom, PhD, FAAO, discuss their study showing that there is a wide distribution of pupil diameters across the age range in normal room illumination (360 Lux). Distribution range of pupil diameters did not decrease as a function of age group, indicating that there is not a direct relationship between age and pupil size while viewing a distant object under normal room illumination conditions. Study data indicate that it is important to take into account pupil diameter variation when designing and prescribing a multifocal contact lens since age alone cannot predict pupil size.

Performance Evaluation of the Expert Progressive

Brooke Messer, OD; Catherine Peyre, MD; and Craig W. Norman, FCLSA, discussed 35 patients fit with Precilens’ Expert Progressive GP lens; 29 patients subjectively considered the fitting successful and continuing to wear their lenses full time. For distance acuity, 59 of the 68 eyes saw 20/25 (8/10) or better with their final dispensed lens. For near acuity, 30 patients saw RS25 or better on a reduced Snellen visual acuity chart. Intermediate vision was assessed subjectively as “acceptable” or “not acceptable,” and 29 patients considered their vision acceptable. Comfort was reported as excellent by all habitually adapted GP wearers on the initial dispensing visit, and non-adapted GP wearers noted acceptable comfort by their final dispensing visit. CLS

Craig Norman is Director of Research, Michigan College of Optometry at Ferris State University. He is a fellow of the Contact Lens Society of America and is an advisor to the GP Lens Institute. You can reach him at CraigNorman@ferris.edu.