This column builds off my last one in which I discussed strategies to increase success with multifocal lenses by listening to our presbyopic patients, discussing the lens technology, and balancing their visual needs. Presbyopic patients can be some of our toughest contact lens-wearing patients, due to their expectations of getting back the vision they had before long-arm syndrome set in, but they can also be our most loyal and rewarding. That said, these patients may dropout out of contact lens wear if their eyecare professional can’t meet their expectations. For this reason, sometimes we need to get creative. Here are a couple creative cases:

1. A 49-year-old male patient who wears daily disposable toric contact lenses recently presented complaining his vision had changed. His spectacle prescription was –0.50 –1.75 x 100 OD and plano –1.75 x 080 OS, with a +1.75 add. He said he loved his daily disposable lenses and was not interested in switching to reusable lenses. After discussing with him various options, such as… that would meet his visual demands, he said he preferred to see whether we could find a good balance, while keeping him in his current brand of daily disposable lenses. After getting creative by trying a couple different combinations of vision, the patient said he could accept a little undercorrection in his astigmatism and a little extra plus in his nondominant eye. His final contact lens correction was –0.50 –1.25 x 100 OD and +0.50 –1.25 x 080 OS. Additionally, the patient’s visual acuity was 20/20 OU at distance and 20/25^-2 OU at near. He ended his visit by noting that he was happy with this balance and the fact that he would not need to carry around reading glasses to place over his contact lenses.

2. A 54-year-old female patient who presented complaining about her near vision in her daily disposable multifocal contact lenses. Her spectacle prescription was –1.25 –0.75 x 065 OD and –2.00 –0.25 x 120 OS, with a +2.25 add, and her current contact lens prescription was–1.75/mid add OD and –2.50/mid add OS. After discussing some of the visual limitations with multifocal contact lenses and the potential loss of distance vision by increasing the near vision, she wanted to try a new prescription. After a couple options, we landed at –1.25/mid add OD and –1.75/mid add OS. She said she was happy with her 20/20 OU at distance and 20/25 OU at near, and loved the fact that she no longer had to carry around readers.

By listening to presbyopic patients, discussing the lens technology, and balancing their visual needs, it is possible to fit presbyopic patients successfully—particularly with some creativity.

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