at all Distances
Brooke Messer OD FSLS
The increased use of computers and handheld electronic devices in the daily routine of our presbyopic patients has created a need in the contact lens market. The presbyopes of today need a multifocal contact lens that can provide excellent visual performance at intermediate distances without degrading distance and near vision. For patients demanding acute vision at all distances, a translating progressive gas permeable ((R)GP) multifocal contact lens with alternating optics can be prescribed.
(R)GP translating progressive lenses provide superior vision quality compared to aspheric and concentric multifocal lens designs due to their optical design and lens positioning. Translating lenses utilize the lower eyelid to correctly position the lens in the patient’s line of sight as the eye moves between working distances. The proper positioning of the lens allows the patient to experience sharper vision by alternating between distance, intermediate and near optics, as opposed to the simultaneous optics of aspheric and concentric lenses that can produce unwanted visual aberrations. Translating (R)GP progressive multifocal lenses are designed for crisp, all-around vision and can be a successful tool for our patients who have high visual demands.
A 59-year-old Caucasian male and new patient presented to our office for a comprehensive eye examination and contact lens fitting. He was currently wearing a spherical, center-near multifocal lens design. The patient is an aerospace engineer and uses several handheld electronic devices along with a computer daily. His chief complaint was poor vision at all distances with his current contact lenses.
Entrance testing was normal with a refraction of -3.75-1.25x135 OD and -3.50-1.00x063 OS. Best-corrected visual acuity was 20/25 OD and 20/20 OS. Topography revealed slightly irregular with-the-rule corneal astigmatism in both eyes. Pupil size was 2.4mm OD and 2.3 mm OS.
Photo 1: Patient’s topography showing slightly irregular with-the-rule astigmatism.
After discussing contact lens options, multifocal scleral lenses with an aspheric design were prescribed because the patient was an avid golfer and wanted a stable lens design with minimal ejection risk. Unfortunately, this option ultimately failed because of dissatisfaction with the quality of his all-around vision, possibly due to his small pupil size.
The Expert Progressive (R)GP progressive multifocal was selected (www.expertprogressive.com) to improve vision quality. As a translating lens, the patient was able to take advantage of the alternating optics, and he instantly noted increased clarity in his all-around vision. He was especially impressed with his improved productivity because he was no longer struggling to read small graphs or charts on his computer
Photo 2: The Expert Progressive utilizes an inferior slab-off design to maintain a thin, consistent diameter to promote lens comfort.
Because a translating progressive multifocal lens has optics similar to those of a progressive spectacle lens, the patient was able to perform all of his intermediate and near tasks without reading glasses, and he experienced good vision while driving. As a habitual soft lens wearer, he did need time to adapt to the gas permeable lenses. This lens was selected to facilitate his adaptation because it positions the lens using a slab-off design, which maintains an even edge thickness around the entire lens diameter, whereas a lens truncation can make the inferior lens edge thick and uncomfortable.
Translating progressive multifocal (R)GP lenses should rest on the lower lid in primary gaze, and the lower pupil margin should be just above the midline of the lens. Patients with larger pupils can also be accommodated in translating lenses, as the optic zone and segment heights are customizable to ensure functional intermediate vision without interrupting distance clarity.
Photo 3: A well fitting translating progressive multifocal (R)GP lens in primary gaze.
When our presbyopic patients’ visual needs demand high-quality optics at all working distances, consider the alternating optics of a translating lens design. Alternating optics can also improve the contact lens wearing experience for presbyopic patients that are unsatisfied with their vision in other multifocal lens designs. In this case, a translating progressive (R)GP multifocal allowed the patient to be free of his spectacle lenses while maintaining good vision quality during his daily tasks.
Brooke Messer is a residency-trained optometrist specializing in contact lenses who practices in Minneapolis, MN, USA.
She has special interests in gas permeable presbyopic and scleral lens designs, and she lectures to other eye care practitioners in classroom and clinical settings.
Brooke is an advisor to the Gas Permeable Lens Institute, a fellow of the Scleral Lens Education Society and adjunct faculty to the Southern California College of Optometry. She is a consultant for Precilens and has lectured for Essilor Contact Lenses.