ACCORDING TO A 2014 report from the Centers for Disease Control and Prevention (CDC), the number of people who give birth to their first babies in their 40s has quadrupled since the mid-1980s (Matthews and Hamilton, 2014). If we add new parenthood to the growing list of near vision demands for presbyopes, the natural loss of accommodation is a nuisance when it comes to newborn nail clipping, nose cleaning, and appreciation of fine baby hairs. Once the grasp reflex develops in babies, spectacle lenses worn to correct refractive error don’t stand a chance, as those tiny hands will reach for your frames faster than you can say “peek-a-boo.”

CASE HISTORY TRIGGER POINTS

Patients who present with astigmatism of –0.75DC or greater in at least one eye represent nearly 50% of patients starting contact lens wear (Young et al, 2011). It is important to investigate how well soft toric lenses meet the daily visual demands of people who wear them. For example, a patient who had a myopic, astigmatic, presbyopic spectacle prescription reported that she recently stopped wearing her single-vision soft toric lenses due to an inadequate visual experience for all working distances. Her progressive spectacles were constantly being tugged at and damaged by her nearly 1-year-old baby boy.

She felt hopeless, afraid that there was no contact lens solution that would free her of spectacle lens wear. Baseline topographic mapping was the next step to guide the contact lens decision-making process.

UNDERPROMISE, OVERDELIVER

It can take some convincing to get a previous contact lens wearer to financially invest in your refit services, especially when there is no lens to take home at the end of their consultation visit. Hybrid contact lenses with extended depth of focus technology were empirically ordered for this patient, supplying the manufacturer with only her spectacle prescription, keratometric readings, and horizontal visible iris diameter (Table 1).

The new contact lenses were dispensed a few weeks later. The patient was taught care and handling of hybrid lenses and she obtained 20/20 acuities OD/OS/OU at distance and 20/20 OU at near, measured via a near Snellen acuity card held at 50cm. She was impressed by both the quantity and quality of vision in comparison to what she had with her progressive spectacles; often she needed to hunt for the “sweet spot.”

WEARER EXPERIENCE

At home, the patient built up to wearing her lenses for 10 to 12 hours a day. She loves the freedom from spectacles and appreciates the ability to carry out various real-world tasks (Table 2).

SEIZE THE OPPORTUNITY

There is a market for hybrid multifocal lens wear for new parents who require astigmatic multifocal correction. Even if they represent a small percentage of your specialty lens patient population, it is worth considering this option for them.

REFERENCES

1. Matthews TJ, Hamilton BE. First births to older women continue to rise. Centers for Disease Control and Prevention/National Center for Health Statistics. 2014 May. Available at cdc.gov/nchs/products/databriefs/db152.htm. Accessed 2024 Jan 30.

2. Young G, Sulley A, Hunt C. Prevalence of astigmatism in relation to soft contact lens fitting. Eye Contact Lens. 2011 Jan;37:20-25.