Retinal Physician Article Submission Guidelines-Prescribing for Astigmatism and Presbyopia


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Article Date: 4/1/2014

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Reader and Industry Forum
Reader and Industry Forum

One Lens Modality Is Not Always Enough

BY CHUCK ALDRIDGE, OD, MBA, FAAO

Recently, my wife and I decided to take a week-long cruise. We made all of the travel arrangements, and before long it was time to pack. Now, I take a number of business trips each year. Such trips involve packing light and moving fast. The luggage is always carry-on and has clothing items that can be easily mixed and matched.

But I soon discovered that packing for this vacation would be very different. I needed a week’s worth of dinner outfits with appropriate shoes and belts. I needed sneakers and several sets of gym clothes so I could use the fitness center. I packed leather sandals for walking around the island, but then also needed flip flops that could get wet at the pool or beach. This was not going to be a carry-on trip, and a mix-and-match wardrobe was not going to work.

This experience reminded me of how many of my contact lens patients had tried to “mix and match” their current contact lens modality to serve all of their vision needs, also finding that it won’t work. You can help such patients succeed by prescribing different modalities for different situations. Let me share with you some of their stories.

The Frequent Flyer

Tina is 35-year-old software programmer. Her spectacle correction is –2.00D sphere in each eye. She currently wears a monthly replacement lens; occasionally, she wears them overnight, but most of the time she removes them before sleeping.

Her job requires her to travel to the Phoenix area every one to two months for a few days. Because these are short trips, Tina prefers carry-on luggage. She has found the four-hour flights in the low-humidity cabin very irritating to her contact lens wear. Additionally, the arid desert area around Phoenix further adds to this contact lens dryness. For her last several trips, Tina has worn her spectacle correction to avoid this contact lens discomfort and the hassle of explaining the 8-ounce bottle of multipurpose solution in her carry-on to TSA.

However, Tina misses having her contact lenses during these trips. We discussed daily disposable lenses, and she agreed to a trial during her next trip.

Tina returned very enthusiastic about how comfortable and convenient her daily disposable lenses were during the trip. When I asked whether she wanted to switch to them, she claimed that she wanted to continue with her monthly replacement lenses but also purchase some daily disposables for her business trips.

The Scuba Diver

Susie is a 27-year-old who has been scuba diving for about four years. She thoroughly enjoys this hobby and travels extensively looking for the “perfect dive site.” She has high myopia with moderate astigmatism in each eye. Susie originally tried toric soft contact lenses, but preferred the sharper vision of GP lenses, which she has worn uneventfully since age 16.

During her certification scuba dive, Susie had to intentionally remove her mask, put it back in place, and then clear the water from the mask at a depth of about 20 feet. During this anxious time, Susie opened her eyes, and away floated one of her GP lenses.

When she came in for a replacement lens, she asked if there were any other lens options for her new hobby. Because I also scuba dive, I had a good understanding of her dilemma.

Prescription face mask inserts were not the best option because Susie has a significant prescription, which would make the reduced peripheral vision that exists in scuba diving even worse. Also, she would be significantly visually handicapped on the boat deck while she was getting geared up and ready for a dive.

Susie finally agreed to a trial of toric daily disposable lenses. This modality was highly successful for her during scuba diving, and she now packs enough lenses for each dive trip.

The Golfer

Gabe is a 49-year-old salesman who has a moderate amount of hyperopia and is presbyopic. Silicone hydrogel monthly replacement multifocal contact lenses have been a real benefit to him during his workday, enabling him to be totally free from glasses for all of his work activities.

However, Gabe is an active weekend golfer and experiences discomfort and dryness when it is windy on the course. He has tried non-prescription sunglasses to block the wind and uses lubricant drops frequently, both with little success.

We first tried spherical daily disposables. Even though Gabe had to put on readers to see his score card, he was pleased with the results. Unfortunately, a monovision trial was not successful.

Gabe is now trying a daily disposable multifocal for his golf outings. Thus far it has been an even more desirable option.

The Swimmer

Sam is a 20-year-old competitive swimmer who has a moderate amount of myopia with mild astigmatism. He currently wears monthly replacement toric lenses.

Sam is fine when he removes his lenses during swim practice. However, when he removes them during competition, he has trouble judging the distance to the wall, which adversely affects the timing of his turn.

When Sam wears his current lenses during competition, the pool water negatively affects the fit and comfort, and he has to discard them prematurely.

We first tried a toric daily disposable design, but soon discovered that a spherical equivalent daily disposable worked just as well for his competitive swims.

Think Beyond One Modality

I hope these examples help demonstrate how we can proactively work with our patients to solve specific vision needs by providing them with contact lens modalities specific to each need. With the many lens options available today, our patients don’t have to mix-and-match. CLS


Dr. Aldridge is a graduate of Southern College of Optometry and practices in Burnsville, NC. He lectures frequently and has written numerous articles on ocular disease, contact lenses, and practice management.



Contact Lens Spectrum, Volume: 29 , Issue: April 2014, page(s): 56, 57

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