CHILDREN AND athletes are often great candidates for hybrid lenses. Not only do hybrid lenses provide excellent vision due to the GP lens center, they also consistently center well and provide good comfort due to the soft skirt. They can be especially useful for patients who have astigmatism and those who can’t wear soft toric lens designs.

A 14-year-old male presented wearing his habitual spectacles. He reported “distortion.” He had not worn his contact lenses for the last few weeks, hampering his participation in competitive soccer. Prior to discontinuation, his average lens wear time was 14 hours per day. He reported occasional recurrent redness and pain OD that resolved without intervention. He applied the lenses with a compatible multipurpose soft contact lens solution.

The patient’s keratometry values were 42.25/44.25 @ 095 OD and 42.50/44.25 @ 096 OS. The refraction was +1.50 –2.00 x 180 OD and +0.50 –0.75 x 180 OS, and he had 20/20 vision in both eyes. He was previously unsuccessful with several daily disposable soft toric lens designs due to poor stability of vision. The final hybrid lens parameters were 7.9/14.5/+0.25/Flat OD and 7.9/14.5/PL/Flat OS and the patient achieved 20/15⁺¹ vision in each eye.

This acuity achievement is remarkable considering that at age 5, he was diagnosed with refractive amblyopia OD and his best-corrected visual acuity was 20/70 in that eye. Following 3 months of wearing prescription spectacles full time, his vision improved to 20/30. His vision then plateaued and occlusion therapy was initiated, which improved his vision to 20/20^-3 over the course of the next 6 months.

At the most recent visit, the patient wore his replacement hybrid lenses and brought the “distorted” lenses in for inspection. He reported going on vacation and leaving the lenses in the barrel case for about a week. When he returned, there was very little solution in the bottom of the case and the lenses had adhered to the sides of the barrel case, causing indentations to form on the soft skirt (Figure 1). The indentations remained following a round of repeat disinfection, so he did not resume lens wear. 

The patient’s guardian requested a replacement set of lenses, and the patient wore them when he came in for follow-up (Figure 2). He reported excellent vision and the lenses fit well with full coverage, good centration, and movement of approximately 1.0 mm on the blink.

Keep the following in mind when seeing hybrid lens patients. First, it is critical to review the proper use of solutions at each visit. In this case, there was insufficient coverage of the lenses with peroxide solution, which could have been caused by insufficient filling or rinsing, interaction with another solution, or improper closing or storing of the case. This can affect the efficacy of the disinfection as well as the integrity of the lens itself.

Second, through targeted questioning, we were able to determine that the patient’s intermittent redness and irritation were probably caused by hand soap residue. We recommended using a different hand soap and rinsing the lenses with preservative-free saline prior to handling.

Finally, with the new pair of lenses, the patient noted excellent vision and comfort. We commended him for inspecting the lenses thoroughly prior to application to prevent wearing damaged lenses. We also recommended purchasing a backup pair of lenses and stressed the 6-month replacement window for these lenses. He was very happy to resume playing soccer without spectacles!

Acknowledgments: I would like to thank Drs. Stephen Beckerman and Valerie Kattouf for managing this patient and allowing me to consult on the specialty lens aspect of this case.