By Dr. Benoit
Patient CP, 47 y.o. female administrator
Wearing GP single vision lenses in a monovision modality. Notes decreased near ability.
OD: 7.34 BC, -8.50, 8.0 LD
OS: 7.30 BC, -7.25, 8.0 LD
OD: –8.75-1.00×125 – Dominant Eye
OU: Add +1.50
OD: 45.50/46.37 @ 40
OS: 45.50/46.50 @ 30
Calculated values for Essential Xtra:
OD: 7.40 BC, -8.50, 9.5 LD, Series 2
OS: 7.40 BC, -8.00, 9.5 LD, Series 2
Vision was 20/20 OD, OS, OU distance and near.
Position was superior central with lid attachment, movement was ½ mm in all positions of gaze. Fluorescein pattern showed slight apical clearance with good peripheral clearance.
The patient returned in two weeks, and was very happy with her vision and comfort. She noted no spectacle blur. She did note a slight problem with removal of the OS lens at day’s end.
OS lens changed to the Essential design, same parameters. Vision and comfort were the same and there was no removal problem. The fluorescein pattern showed alignment centrally, with slightly increased peripheral clearance.
By Dr. Baker
Patient AS, Age 53 female
Occupation: Wedding Planner
Hobbies: Tennis & Reading
CC: “Eyes sticky and dry at end of day”
Lens wearing history: Worn soft daily wear contact lenses for 15 years. Has worn soft bifocals the past 3 years:
OD 8.50 BC -2.25 DS 14.0 +1.50 Add – A/V Bifocal
OS 8.50 BC -2.25 DS 14.0 +1.50 Add – A/V Bifocal
Distance: 20/20, OD, OS, OU
Near: 20/30, OU
OD: 43.37 / 44.37 @ 90 Do
OS: 43.00 / 43.75 @ 95 Do
OD: -2.50 DS 20/20+
OS: -2.25 DS 20/20+
Reading: Add +1.50 OU 20/20
SLE: Epithelial staining, OU. Epithelial defect located centrally in OD.
Plan: Lens wear was discontinued and preservative tears were started qid. AS returned in one week for SLE follow-up visit. AS was refitted with a group 2 soft bifocal, continue with lubricants qid.
Follow up visit with SCL’s showed a reoccurring epithelial defect on right eye. Patient discontinued lens wear and was instructed to return in two weeks for SLE and evaluation for GP fitting.
Two week follow-up visit showed a clear epithelium with good wetting. AS was fitted with a Mandell Seamless GP Multifocal with the following parameters and performance:
OD: 7.78 BC -2.50 DS 9.80 Diam. / 8.20 OZ +1.50 / 3.60 Seg. Boston XO
OS: 7.85 BC -2.25 DS 9.80 / 8.20 +1.50 / 3.60 Seg. Boston XO
Visual Acuities: Distance OD, OS, & OU: 20/20. Near OD, OS, and OU: 20/20
Lens Performance: Lenses are lid attached with apical alignment and translate well for reading.
Evaluation at follow-up visit showed patient had good comfort, some intermittent glare at distance and fit looked good. Corneal epithelium in both eyes was clear without any staining. Vertical prism was added to stabilize distance vision in both lenses. Follow-up visit confirmed the lenses now performed as planned.
Discussion: This case demonstrates how GP lenses perform well in a dry eye situation and that GP multifocals can be custom fitted to give good comfort to a patient that previously had only worn soft lenses.
By Dr. Baker
Patient MF, 52 y.o. female
Occupation: ER Physician
Wearing EW single vision soft contact lenses in monovision mode. Having difficulty with critical near tasks.
8.70 -4.00 DS A/V 2
8.70 -2.50 DS A/V 2
OD: -3.50 -0.50 x 080 20/20 – Dominant Eye
OS: -3.50 -0.75 x 090 20/20
Add +2.00, OU
OD: 44.50 / 45.00 @ 080 Do
OS: 44.75 / 45.25 @ 090 Do
Initial lens parameters based on diagnostic evaluation:
OD: 7.60 BC -3.50 9.8 / 8.2 / 3.2 Seg / +2.00 Add
OS: 7.54 BC -3.50 9.8 / 8.2 / 3.2 Seg / +2.00 Add
Lens is Mandell Seamless (Distance center with annular, translating design) in Menicon Z material with plasma treatment.
Vision was 20/20 at distance and near.
Lens was fitted lid attached allowing the central distance zone to align with the pupil. The florescein pattern showed apical alignment with adequate mid peripheral alignment and good peripheral pattern to allow good exchange of tear film. The lenses translated adequately upon down gaze to give good near vision.
The patient returned within two weeks of daily wear schedule. Vision was good, comfort was reported to be excellent and SLE showed good corneal integrity.
MF was seen at Day 1 and Day 7 EW visits and demonstrated successful adaptation to EW. Patient was seen at three weeks for a Continuous wear visit. She continued to show good performance, vision and corneal response. The lenses continued to fit safely and effectively.
Discussion: This case demonstrates that GP multifocals can be used safely and effectively in a continuous wear mode.