CASE ONE MH (Dr. Hansen)

Case History

• 61 WF 40+ years with PMMA and GP contact lenses
   
• Occupation: optometric assistant for nine years
   
• Hx: I originally fit her with De Centered Decarle Bif CLs. Successfully worn for many years.

New Information

• OD -5.50 + .25 x 170 20/20- = +2.50 add
  OS -5.25 +.50 x 75 20/20- = +2.50 add
   
• K's: OD 42.50/41.87 @ 88
          OS 42.87/42.37 @ 103
   
• HHx: Meds Ca ++ plus vitamins

Physical Measurements

• Mesopic = 4.0 mm
  Scotopic = 4.5 mm
   
• Corneal Diam = 11.5mm
   
• Palpebral Aperture = 9.0mm
   
• Dominant Eye = OD
   
• CT: orthogonal astigmatism highest peak in superior quadrant

Reasons to Refit: Needs better intermediate range and needs higher add power.

What Was Done?

• Refit her with a VFL 3 high add Aspheric design (Conforma CL Lab)
   
• OD 756 -6.50 9.2 Diam 8.0 OZ = +2.50 add with +1.25 on front surface
  with 3.5mm zone HDS material
  OS 760 -6.00 9.2 Diam 8.0 OZ = +2.50 add with +1.25 on front surface
  with 3.5mm zone HDS material
   
• Fit the zone .5mm - 1.0 mm less than the mesopic pupil size

CASE TWO MS (Dr. Hansen)

Case History

• 61 WM with 40+ years of PMMA and GP experience
   
• Occupation: CPA
   
• Hx: I originally fit him with an Aspheric Multifocal CL but over the years has developed a need for more add power

New Information

• OD -5.50 +1.50 x 100 = +2.50 add
   
• OS -5.50 +1.75 x 70 = +2.50 add
   
• K's OD 45.37/46.00 @ 89
          OS 45.00/46.12 @ 78
   
• HHx: Recent heart surgery (successful)
   
• Meds: Zocor, Beta Blocker, Toprol XL, allegra, Nasonex, Multivitamins, Niaspan aspirin, Cimetidine
   
• Allergies: sulfa , pollen, dust and dogs

Physical Measurements

• Mesopic = 4.5mm
  Scotopic = 5.0mm
   
• Corneal Diam = 11.0mm
   
• Palpebral Aperture = 8.0mm
   
• Dominant Eye = OD
   
• CT highest peak in central zone

Reasons to Refit: Needs stronger add.

What Was Done?

• Refit with Multifocal CD contact lenses (Universal CL in JAX)
   
• OD 677 BC -8.00 9.4 Diam 8.2 OZ 11.50 /.4 9.00/blend .17 ct +3.25 add
  no front add FL 30 lenticular design
  OS 6.83 BC -8.50 9.4 Diam 8.2 OZ 11.50/.4 9.00/ blend .19 ct +3.25 add
  no front add FL 30 lenticular design
   
• Changed from a 9.0 mm design to 9.4 for better centration and stabilization

CASE THREE NC (Dr. Baker)

Case History

• 50 WF 30 years wearing PMMA and GP contact lenses
   
• Occupation: business analyst; uses computer 8 hours a day
   
• Hx: Has successfuly worn single vision rigid lenses and has worn monovision for past 6 years. Needs to use single vision specs over contact lenses for near vision tasks.

Current Data

• OD Plano -2.50 x 180 20/20 = +1.75 add
   
• OS +0.75 -2.00 x 010 20/25 = +1.75 add
   
• K’s OD 40.37/43.25 @ 82
          OS 40.25/42.50 @ 93
   
• Health Hx: unremarkable

Ocular Measurements

• Mesopic = 4.0mm
  Scotopic = 5.0mm
   
• Corneal Diam = 12.50mm
   
• Palpebral Aperture = 9.80mm
   
• Dominant Eye = OS
   
• CT = W/R astigmatism

Indications to Refit: Patient needs better intermediate and near range. She is currently wearing bitoric GP lenses and enjoys comfort and centering provided by this design.

Treatment

• Patient was refit with a bitoric designed Mandell Seamless Multifocal GP (Con-Cise Lens, Inc.)
   
• OD 8.40 / 7.89 = +.25 / -2.25 = 9.50 Diam / 8.0 OZ 10.20 / .25SC,
  11.50/0.3PC +2.00 add, 3.40 zone (Dist), HDS material
  OS 8.39 / 7.99 = -0.25 / -1.75 = 9.50 Diam / 8.0 OZ , 10.20 / .25SC,
  12.00/.30PC +2.00 add, 3.40 zone (Dist), HDS material
   
• Changes made to improve performance
   
• OD Changed BC to 8.39 / 7.99 to stabilize lens and increase comfort
   
• OS Changed Distance Zone to 3.80 to improve distance vision

CASE FOUR MM (Dr. Baker)

Case History

• 56 WF with 30+ years of rigid contact lens wear
   
• Occupation: art director
   
• Hx: originally fitted with Back Aspheric Multifocal contact lens 12 years ago. She now needs additional reading adds, great than the +1.50 effect obtained with present lenses.

Current Data

• OD -3.00 -0.75 x 165 20/20 = +2.25 add
   
• OS -2.75 -1.00 x 175 20/20 = +2.25 add
   
• K’s OD 44.12 / 45.50 @ 83
          OS 44.00 / 45.75 @ 90
   
• Health Hx: thyroid dysfunction and menopause changes
   
• Meds: HRT and thyroid extract
   
• Allergies: pollen, dust and animals
   
• Chronic low grade Marginal Blepharitis

Ocular Measurements

• Mesopic = 4.50mm
  Scotopic = 5.50mm
   
• Corneal Diam = 11.50mm, OU
   
• Palpebral Aperture = 9.80mm, OU
   
• Dominant Eye = OD
   
• CT = W/R astigmatism and small amount of corneal distortion

Reason to Refit: Patient needs higher reading add than current +1.75.

Treatment

• Patient was refit with a high add Essentials III Aspheric Multifocal by Blanchard Contact Lens Co., giving improved reading vision needed to perform near vision tasks.
   
• OD 7.50BC -3.50DS 9.50Dia., .15ct, +2.25 add (SeriesIII), Boston EO
  OS 7.40BC -4.00DS 9.50Dia., .15ct, +2.25 add (SeriesIII), Boston EO
   
• This lens design incorporates both back and front aspheric surfaces to obtain the higher add powers. This patient was well adapted to the aspheric design and demonstrated a good corneal response to the higher dk (58) Boston EO versus the previous lenses made of F-30 material.
   
• Patient has been placed on a regimen of routine lid soaks and scrubs to control the dry eye problems caused by the chronic lid margin condition. She reports improved comfort and reduced dry eye symptoms.