As we gear up to return to in-person meetings, it is easy to get excited about connecting with friends and colleagues. It’s also very exciting to experience the newest technology in a hands-on, rather than virtual, way with our industry partners in the exhibit halls. As we evaluate the newest instrumentation, our minds often go to our most complicated cases. Let’s not forget how the newest technology can support one of the largest demographics in our practices—presbyopes.

Perhaps the most impactful improvement in contact lens technology for presbyopes is the availability of toric multifocal lenses in frequent replacement, wettable, silicone hydrogel materials. These multifocal optics have been added to single-vision toric platforms that have already provided excellent stability and lens comfort, and they significantly outperform the previous options in the category. For patients who are already wearing the single-vision toric lenses successfully, adding the multifocal optics should be similar to fitting a multifocal spherical lens, which will decrease chair time and enhance the patient experience.

Using Topography

Basic Topography For patients who need a little boost in vision performance, such as those who have rotational instability with a soft toric lens or poor centering of multifocal optics, a topographer can be a valuable instrument. Many modern topographers can now improve our ability to prescribe custom soft and corneal GP lenses.

We can better center a soft lens and enhance the stability over the visual axis by using the horizontal visible iris diameter (HVID) and eccentricity measurements. HVID can help us specify an overall diameter for custom soft lenses, and eccentricity can help design custom base curves when used in addition to the central keratometry readings for soft and GP lenses.

The latest topographers also include excellent cameras to capture both still images and videos of the lens fit in both white and cobalt blue light. When lens troubleshooting becomes particularly difficult, being able to forward images of the lens fit to the laboratory consultant is an excellent learning and time-saving tool (Figure 1).

Topography for Sclerals For our scleral lens-wearing population, technology in scleral topography has exploded in the last few years. Scleral topography helps predict the desired landing curves of a scleral contact lens, which can decrease chair time and the number of follow-up visits. Some instruments can send scans directly to a manufacturing laboratory for the lathing of a free-form scleral lens. As scleral lens shapes become more customizable and a better fit to the ocular surface, multifocal optics will perform better as a result of centered and stable optics.

Optical Decentering Taking the technology one step further, many topographers can also measure angle kappa (i.e., the difference between the pupillary and visual axes) to determine whether decentering the multifocal optics in a custom soft or scleral lens would be beneficial for a patient. It’s well known that due to gravity and scleral shape, contact lenses decenter inferiorly and temporally; this takes the center of the lens optics away from the visual axis, which is superior-nasal to the pupil center. After achieving a stable lens fit, the angle and distance of optical decentering can be specified to the lab based on angle kappa measurements. From there, the add power and zone size can be specified in most designs to match visual demands and pupil size.

Continued Use of Technology

The recent surge in contact lens technologies is impressive and exciting. So, be sure to take advantage of it for the benefit of your presbyopic patients. CLS