NIDEK ID

Name J , p

ExamNo R : 1 i__: ___ 1 __

44.00 Off 41.lt 41.11 II.II 41

4'.11 ., .. 11.ll '110 '550 ,IU O 4UO

44.50 O.ll

"" 11.ll 11.11 II.II

' UJI 1110 J!JO JUO ]ljlJ JI! Q

Horm lndv .!50

= 1 R 1 L

R

'

SIM K's: 44.7617.>lli,l 17' 43.4917.76~107' dk-1.27 ~ .22

• -•

SIM K's: 44.Sl 1758~ 155' 43.55 [7.75, 65' dk .0.98 •0.1

"'" -0 00 • ,:) !(I

R • Date

R: 01/29/2015 11:17

L: 01/29/20151 1:17 Comment ' L:

'

~20\ '

CY< -~.<!i . l.( ),J

Axia l o.~109 A PP 44.03 SO 0.53 @6.0mm

,'ECCP44.04 0@4.50mm ' ., . '

... - - ... - ' - . -

Axial .,

10, I \ > I I 0

; O,

• ,... is

-, • -

' •

' ' . \

0.324@6.00mm / O<d<,r. 8 "'' " 4'1.23 (7.63/ Dist : 0.00@ O'

D.10@253

A PP 44.00 50 0.!7 @6.0mm ,'ECCP44.03 D@4.50mm

' " . ' , (".,

/

•

: ~ '

• •

• • • --. • •·~• .. a..;2,-~ ',_._,.3i) t .l48 @6.00m,n I 0,d<)r: 8

P\1,: 44.19 [1.61/ 11 isl : 0.00@ 0'

A-OS

"' " ~ ;~p .3-.:)@ 17 .:& ~.!{ 1 ~)@1½

44.00 0 .11 1!.lt 11.lf II.II II.II

l!ll lUI 31.;1 lt~I )151

-41.11 11.lt 17.11 ,1.;, ,u,. ,1, t

44.50 ll!t o• 11.lt 11.lf 11.lt ...

ll or m ln d v .50

R

• • ,,.,

3mm2one: 44.2317.63>iil 8' 41.51 /7.94)'.iil 98' dk-1.721•0.31

•

• -•

•

3mmZone: 44.35 /7.61))il166' 41.88 /7.87))il 76' dk.1.41 •0.26 ~ Fi:11

: 1 4:,( i'. i -5)@10-i H.V.,ojl .i :,)G~

Instantaneous

"' ' 7~

' I I ' , ' • ,,. \ .

"',

- - - ' • • •

Instantaneous

'''- ., !' ' I I I '

'

OK . , 1i (.,) 22} .., "3{ .. , 11}

., , •

\

•

Physic ian

Techn ician

Diagno s is

0.36@109

. " / • ....,

• -,, -,

• --

• ' •

Pv, : 44.24 (7.63/ Dist : 0.00@ O'

0.10@253

,

Pv, , 44.JO (7.S11 DiSI, 0.00@ O'

0 4~ ..0.21) 0 ~ .0 ::>1)

R

R • ' L:

CL Lab Map

Placido ima e

Placido ima e

SA~ .Omrn

10/31/2015 11:45

Ver .1.14.01

0.36@109

Dist : 0.00@ 0°

!ilill1!lc~ lmli1!:~

0.10@2-53

o..o.os c..:i.:i, .:_ n ~ -~

comc2 ln,::".;,,c: n=1.:nr :, (A.:<.!~::.). ~ 1.~l',:,.J (R,:,, .1.c POJ Ot:l.~.on-.m ).: '..Si .~

• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

specialeyes - forprecisionvision

Clinical Application of Vertical Prismin a Customized Soft Multifocal Toric Contact Lens

Moshe Schwartz, OD, FAAO

Purpose

This case examinesthe optimization of

multifocal opticsand the integration

of additionalamounts of vertical

prism in a softmultifocal toriccontact lens to

reduce asthenopiaand diplopia and

enhance visualperformance.

Vertical Deviation:

OD: +1.75 prism diopters base down

Patient Measurements Simulated Keratometric (K) Readings:

OD: 43.49 @107/44.76 @017

OS: 43.55 @65/44.53 @155

Manifest Refraction:

OD: -0.25 -2.25 x100 +1.00 add

OS: -1.50 -1.50 x068 +1.00 add

DVA: 20/20 | NVA: 20/20

Pupil Size Measurements (Nidek OPD Scan III):

OD: 4.24mm photopic | 5.65mm mesopic

OS: 4.11mm photopic | 5.86mm mesopic

An effective pupil size of 4.9mm was calculated as the patient’s

pupil size in regular room illumination by taking the average of

the photopic and mesopic pupil-size measurements. This value

was used in designing the multifocal optics.

Methods The subject of this case report is a 41-year-old Caucasian malewho was fitted in simultaneous-design, center-near, custom soft toric multifocal contact lenses in both eyes. The lens designparameters (base curve, diameter, and multifocal optic zones) were customized based on an average horizontal visible irisdiameter (HVID) value and the patient’s simulated keratometricreadings and pupil size.

The base curve and diameter of the lenses were designed usingthe SpecialEyes Arc Length Calculator. Power was determinedbased on the patient’s manifest refraction. The custommultifocal optics (near-center and peripheral zone sizes) wereinitially chosen based on prior experience with this lens design.During the fitting process, the multifocal optics were optimizedaccording to the SpecialEyes Multifocal Simulator results andthe patient’s pupil size measurement. Standard prism ballasting(1.0 prism diopter base down) was used to stabilize the toricmultifocal contact lenses, and the prism was customized toaddress vertical deviation.

Results During the initial trial contact lens dispense and follow-up,the patient expressed a chief complaint of blurred vision atnear and intermediate viewing distances. Near visual acuityof J4 confirmed this issue. A slit-lamp examination revealed that the lens-fi tting characteristics were optimal, proper lensmovement was observed, and the lens surface was cleanand free of defects.

The next trial lens design began with referencing pupil sizemeasurements and redesigning the multifocal optics. Thepatient’s 4.9mm effective pupil size measurement and addpower were input into the SpecialEyes Multifocal Simulator toassist in the redesign of the multifocal optics to improve visualperformance. The Multifocal Simulator suggested a 2.2mmnear-center zone size and a 4.4mm peripheral zone size.The near-center zone was modifi ed to a slightly larger 2.4mmsize since the prior trial lens had a near-center zone size of2.2mm and the patient was seeing J4 at near with that lens.Increasing the near-center zone size provided more near opticsover the patient’s pupil diameter area and improved nearvision. The peripheral zone size was also modifi ed to 4.5mm,which reduced the rate at which the intermediate powersprogressed (decreased eccentricity) and resulted in improvedintermediate vision.

While optimizing the multifocal optics did improve visualperformance for the patient, he still experienced a visualdisturbance. He complained that his eyes were not working welltogether and that “things were floating” at distance and near. A vertical deviation was determined using dissociated phorias,and this finding was successfully integrated in the lens design by customizing prism. The third set of trial lenses increasedbase-down prism in the right lens from 1.0 diopter to a totalof 1.75 diopters to address the vertical deviation. As a resultof the prism customization, the patient experienced improvedbinocularity and enhanced visual performance.

Conclusions 1. Optimizing the near-center zone sizes and peripheral zone

sizes of the multifocal optics based on pupil size provedsuccessful in improving visual acuities for the patient.

2. Incorporating additional base-down prism in the right contactlens addressed the vertical deviation and further improvedbinocularity and visual performance.

Trial Lenses #1

OD: 8.2 Base Curve, 14.7 Diameter | -0.25 -2.25 x100 +1.00 Add

OS: 8.1 Base Curve, 14.7 Diameter | -1.50 -1.50 x068 +1.00 Add

Multifocal Optics:

2.2mm near-center zone | 4.0mm peripheral zone

Prism: 1.0 prism diopter base down

Visual Acuities:

OD: 20/30 at distance not stable | OS: 20/20 – at distance not stable

OU: 20/20 at distance | J4 at near

Trial Lenses #2

Optimization of the multifocal optics

Multifocal Optics:

2.4mm near-center zone | 4.5mm peripheral zone

Visual Acuities:

OD: 20/20 | OS: 20/20 | OU: 20/25 Polyopia

Trial Lenses #3

Customization of prism to reduce asthenopia, resolve diplopia, and

address vertical deviation

Prism: OD: Increase to 1.75 diopters of base-down prism

Visual Acuities:

Distance: OD: 20/20 | OS: 20/20 | OU: 20/20

Near: OD: J1 | OS: J1 | OU: J1+

Discussion A fully customized, soft multifocal contact lens design withcustomizable base-down prism provides encouraging resultsfor patients with vertical deviation. Optimizing the multifocaloptics according to the patient’s pupil size improved near andintermediate vision. This case report demonstrates the successthat is possible with a customized multifocal lens design toachieve a positive outcome for patients.

Special Thanks: To the wonderful people of SpecialEyes for helping me put this poster together.