Translating (R)GP Mutifocals are still in the game!
Stephanie L. Woo OD FAAO FSLS
In the past, translating gas permeable multifocals were used frequently for presbyopic patients. With new soft multifocal technology and advancements in aspheric-near gas permeable multifocals, translating (R)GP lenses are not utilized as often. But when fit properly, translating (R)GP multifocals allow patients to achieve very clear distance, intermediate and near vision.
A new translating multifocal, the Expert Progressive (Precilens, Créteil Cedex (Paris) France), was recently launched. This lens is a translating (R)GP multifocal, but there are no lines demarcating the different distance and near zones. Essentially, this lens acts as a “no line bifocal” or progressive contact lens. The lens has a reverse curve and in addition a small amount of prism ballast inferiorly to hold in place. The lens is 360 degrees round, which dramatically helps in comfort versus a truncated lens.
A 58-year-old male presented to the clinic for his annual comprehensive exam and gas permeable lens fit. He was currently wearing:
OD: Boston ES/ 7.99/ -3.50/ 9.20
OS: Boston ES/ 7.85/ -3.50/ 9.20
With these lenses, he achieved 20/30 distance vision OD and OS with no significant over-refraction. The lens fit was acceptable OD and OS with no corneal staining after lens removal. He was wearing reading glasses of an unknown power over his contact lenses for near tasks.
Keratometry and refraction:
OD: 44.0@014, 43.2@104 S-4.75+1.25x175 VA 20/25
OS: 44.0@166, 43.5@076 S-4.75+2.00x176 VA 20/25
Near add was +2.50 OD and OS
Ocular health was unremarkable. At this time, a gas permeable multifocal was discussed. The benefits included the ability to attain functional distance, intermediate and near vision and also to reduce dependency on reading glasses. He was very interested in trying a (R)GP multifocal.
The Expert Progressive lens was ordered empirically using keratometry values, refraction and add power.
OD: Expert Progressive/ 7.75/9.0/-4.25/+2.50add/ Boston ES
OD: Expert Progressive/ 7.70/ 9.0/ -3.75/ +2.50 add/ Boston ES
Distance VA OD: 20/30, OS 20/40 (OU: 20/30)
Near VA OD: 20/30, OS 20/30 (OU: 20/30)
The lenses centered slightly inferiorly on primary gaze. The patient felt that the lenses were comfortable and that the vision was acceptable. Patient instruction was provided on how to use eye movements instead of head movements when focusing on near items.
Fig 1 Fig 2
Three week follow up:
The patient returned 3 weeks later for a contact lens follow up. He had been wearing the lenses about 12 hours per day and was very pleased with his vision. He reported great distance, intermediate and near vision. He stated that it took a few days to get used to moving his eyes rather than his head while reading, but now it was second nature.
Distance VA OD: 20/25, OS 20/20 (OU: 20/20)
Near VA OD: 20/25, OS 20/25 (OU: 20/20)
Both lenses decentered somewhat inferiorly on primary gaze (fig 1); however, both lenses translated during downgaze (Fig 2). Both lenses exhibited apical alignment, average edge clearance, and moved about 1 mm with blink. After lens removal, the corneas were clear with no epithelial defects. Because the vision was very crisp in each eye and the lenses were comfortable, these lenses were finalized.
Translating multifocals offer our presbyopic patients a great option for crisp, clear distance and near vision. For patients with demanding vision needs, we should keep these lens designs in mind!
Dr. Stephanie L. Woo graduated from the Southern California College of Optometry and completed a Cornea/Contact Lens residency at the University of Missouri - St. Louis.
She is a Fellow of the American Academy of Optometry and a Fellow of the Scleral Lens Education Society.
She is a contributing author for the American Optometric Association Contact Lens and Cornea section, and she is the author of the "GP Expert" column for Review of Contact Lenses.
She is also the Public Education Chair for the Scleral Lens Education society and is an Advisory Board member for GPLI. She currently practices at Havasu Eye Center in Lake Havasu, AZ.