Case One

Patient: MP

History:
49-year-old WF teacher has worn contact lenses (PMMA- GP SV and multifocal aspheric) for 30+ years
Healthy, hypothyroidism, on synthroid and welbrutin (antidepressant) with seasonal environmental allergies usually under control with OTCs
Ocular Health History: neg

Refraction:

• OD -2.50 + .50 x 80 = + 2.00 D Add 20/20+
• OS -1.00 +.25 x 90 = + 2.00 D Add 20/20+

Ocular measurements:
Pupils: Mesopic OD and OS 5.0 mm Scotopic OD and OS 5.5 mm
VID: 12.0 mm OU
Palpebral Aperture : 10.0 mm OU

Auto Ks and Sim Ks:

• OD 45.50/ 47.12 @ 71
• OS 45.25/ 46.87 @ 89 (80% conf)

Symptoms and Needs:
Wearing VFL 3 multifocal CLs with complaint of not seeing well for reading in the normal classroom lighting.

What do you do???

Case Two

Patient : CP

History:
30-year-old WF housewife, mother and nurse has worn PMMA and GP CLs for 20+ years
History of esotopia corrected by VT, lenses (bif) and eventually CLs (SV)

CLs:

• OD 785 -5.25 9.0 / 7.6 Polycon II design
• OS 780 -3.75 9.0 / 7.6 Polycon II design

Med History : unremarkable with allergies to sulfa
Med: vitamins

Ocular measurements:
VID: 12.0 mm OU
Pupils: Mesopic 5.0 mm OU and 6.0 mm Scotopic OU
Normal: CC and adnexa

Auto Ks and Sim Ks:

• OD 42.50/ 42.87 @ 76
• OS 42.75/ 43.62 @ 108

Subj Refraction:

• OD -5.50 D 1 1/2 prism DN = +2.00D 20/20
• OS -4.00 D 1 1/2 prism UP = +2.00D 20/20

Acuity with CLs:

• OD 20/25
• OS 20/25

Over refraction of CLs (SV):

• OD -.50 20/20
• OS -.50 20/20

Analytical :
Dist. phoria : 3 eso
Dist. horizontal phoria: 3 prism RH
Near phoria : 1 eso
Near horizontal phoria: 3 prism RH
Near Ductions (remember these?) BO 30+/ BI 6/4

Additional History: Wears Oph. Rx over CLs to correct for near asthenopia and
wants to get rid of the glasses for convenience!

What do you do??? Which lens and why??

Case Three

Patient: TM

History:
52-year-old WF teacher/school administrator has worn Rap’s for 15 years.
Activities: Computer use 2 hours/ day. Hobby: Reading
General Health: Inderal for tremors. No allergies to drugs or pollens.
Ocular Health: Unremarkable. Grandmother had glaucoma.

Current Contact Lens Parameters:

• OD 7.40 BC -1.00 DS 9.0 Polycon II
• OS. 7.40 BC -0.75 DS 9.0 Polycon II

Refraction:

• OD –1.75 DS +2.25 Add
• OS –1.25 DS +2.25 Add

Ocular Measurements:
Corneal diameter (VID): 12.0 mm, OU
Pupil Size: Normal 4.50 mm, OU Low Illumination. 5.5+ mm, OU
Palpebral Appearance: 10.5 mm, OU (lower lid at limbus)

Keratometry / Sim K’s:

• OD 45.62 / 46.50 @ 101 (Do)
• OS 45.50 / 46.87 @ 87 (Do)

Chief Complaint:
Difficulty reading with contact lenses and needs to remove CLs to read; does not wish to continue using reading glasses over contact lenses.

Treatment:
What approach would you take to solve her chief complaint?


Case Four

Patient: ML

History:
62-year-old WF banker has worn rigid contact lenses for 23 years ( PMMA, SV GPs & translating bifocal GPs). Her activities include use of computer (significantly more) and her hobbies include exercise and reading.
General Health: Hormone Replacement Therapy.
Ocular Health: Occasional dry eye symptoms. No allergies

Current Contact Lens Parameters:

• OD 7.56 BC -2.00 DS 9.4 x 9.0 Diam. 2.25 BD Prism +2.25 Add 3.5 mm Seg. Ht. Paraperm O2
• OS 7.56 BC -3.00 DS 9.4 x 9.0 Diam. 2.25 BD Prism +2.25 Add 3.5 mm Seg. Ht. Paraperm O2

Refraction:

• OD –2.25 DS + 2.25 Add
• OS –3.50 DS +2.25 Add

Ocular Measurements:
Corneal diameter (VID): 12.0+ mm, OU
Pupil Size: Normal 3.50 mm Low Illumination 4.0 mm
Palpebral Appearance: 9.20 mm, OU. (Lower 1.0 mm below limbus)

Keratometry / Sim K’s:

• OD 45.12 / 45.37 @ 33 (Do)
• OS 44.87 / 45.37 @ 81 (Do)

Chief Complaint:
Difficulty looking at computer screen since office expanded use of computers.

Treatment
What would you do to solve the problem? Which type of lens would you use? What material would you consider and why?