Last month we looked at a fairly complex single vision fit using SynergEyes iD hybrid lenses, empirically fitted which gave a great result for both practitioner and patient alike with very few appointments, saving chair time and money…
This month we will throw some presbyopia into the mix along with the astigmatism. This combination is one of our worst-case scenarios for achieving patient satisfaction. Mix that with the patient being quite particular about their vision –– even with their expectations managed and you have a perfect storm…
OD -6.75/-2.50 x 5 with VA of 6/7.5
HVID: 11.34 Add +1.75 N5. BVD 12mm
OS -8.00/-1.25 x 175 with a VA of 6/7.5
HVID: 11.29 Add +1.75 N5. BVD 12mm
This patient was very keen on contact lenses, not necessarily for full time wear but would prefer it if possible and had tried various soft toric multifocals, monovision and all the other combinations we revert to in practice and was always disappointed and frustrated by the variability in vision along with ghosting, particularly in lower light levels.
This was especially frustrating for him as even when used for social wear in the evenings, the lenses were at their worst…
Once we applied the BVD to the spectacle Rx the astigmatism matched the topography powers very nicely so the lenses were ordered as below.
SynergEyes iD EDOF
OD BOZR / Skirt / Power / EDOF
7.43 / 43 / -7.75 / Mid / EP*
OS BOZR / Skirt / Power / EDOF
7.46 / 43 / -8.50 / Mid
The SynergEyes iD EDOF uses the BHVI design of extended depth of focus which has three designs to cover all spectacle adds and, in this case, we used the mid design which works for adds up to +2.00
*EP is enhanced profile, used for higher levels of astigmatism to stop flexure.
Follow-up & Outcomes
After the follow up appointment the practitioner emailed as below:
A new right lens was made under the guarantee with the BOZR 0.50 steeper to aid the centration. This, of course meant we could leave the power as before to allow for the over-refraction requested giving us:
OD 7.35 / 43 / -7.75 / Mid / EP
This change had the desired effect, centring the lens and improving the distance and near VAs but most importantly for this patient, giving him a stability and consistency of vision that he had not previously experienced.
Apart from the initial sight test where the topography was taken, this relatively complex presbyopic astigmat was fitted with lenses within two appointments and is also benefiting from clearer vision than ever before.
Next month I’ll dig into my case files of some irregular corneal fits that were helped with the empirically fitted UltraHealth lens. The only vaulting hybrid available.
If you have any questions or are keen to introduce these innovative lenses, that are not available on the internet, in your practice or would like some advice, contact us on email@example.com.