Case story 2 by Stephanie Woo
Translating GP Mutifocals are still in the game!
In the past, translating gas permeable multifocals were used frequently for presbyopic patients. With the new technology of soft multifocals and advancement in aspheric-near gas permeable multifocals, translating GP lenses are not utilized as often. When fit properly, translating GP multifocals allow patients to achieve very clear distance, intermediate, and near vision.
A new translating multifocal was recently launched, the Expert Progressive. This lens is a translating 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 is truncated inferiorly to allow for translation during down gaze.
ET, 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 OU with no corneal staining with lenses removed. Currently, 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 OS: 44.0@166, 43.5@076
(MRx: -4.75+1.25x175) 20/25 (MRx: -4.75+2.00x176) 20/25
Add was +2.50 OU
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 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
DVA OD: 20/30, OS 20/40, OU: 20/30
NVA OD: 20/30, OS 20/30 OU: 20/30
The lens centered inferiorly with truncation above the lower lid OU. The patient felt the lenses were comfortable and that the vision was acceptable. Patient instruction was given to ET on how to use eye movements instead of head movements when focusing on near items.
Three week follow up:
ET 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 it took a few days to get used to moving his eyes instead of
his head while reading, but now it was second nature.
DVA OD: 20/25, OS 20/25, OU: 20/20
NVA OD: 20/25, OS 20/25 OU: 20/20
Lens fit: Both lenses decentered inferiorly (fig 1), however, both
lenses translated during downgaze (Fig 2). Lenses both exhibited apical
alignment, average edge clearance, and moved about 1 mm with blink.
With lenses removed, corneas were clear with no epithelial defects.
Since 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 the back of our mind!