Bausch + Lomb (B+L) recently launched in the United States its Bausch + Lomb Ultra Multifocal for Astigmatism contact lens, a monthly silicone hydrogel lens that was designed to address the lifestyle and vision needs of patients who have both astigmatism and presbyopia. It combines the company’s 3-Zone Progressive multifocal design with the stability of its Optic-Align toric design to provide an advanced lens technology that offers the convenience of same-day fitting during the initial lens exam, according to B+L. B+L Ultra Multifocal for Astigmatism lenses are manufactured in samfilcon A (46% water) with MoistureSeal Technology. Parameters include 8.6mm base curve, 14.5mm diameter, spherical powers from +4.00D to –6.00D in 0.25D steps, cylinders of –0.75D, –1.25D, –1.75D, –2.25D, and –2.75D in axes of 10° to 180° in 10° steps, and add powers of +0.75D to +1.50D (Low) and +1.75D to +2.50D (High). The center thickness is 0.10mm for a –3.00D lens.
I recently talked with practitioners who are actively fitting the B+L Ultra Multifocal for Astigmatism contact lens in their practices. Here we share their clinical experiences.
Please tell us about your general experience with B+L’s Ultra Multifocal for Astigmatism lens.
Mark Schaeffer, OD, works at one of the first practices to receive the lenses when they launched. His Alabama-based locations had even created a list of patients who would be good candidates when the lenses were available. “Usually when we get a new product, there are mixed reviews, but we have seen very positive results from our patients who have worn the lens,” he says, “We find that our doctors and staff proactively discuss this lens technology. Patients are telling us that they are able to see far away, up close, and in between, with easy transitioning between all three areas of focus.”
Katie Chu, OD, who practices in Rosemead, CA, was also among the first practitioners to receive the fitting set, and she immediately began to introduce it to her patients. She is currently discussing it with 100% of her patients who are presbyopic and is now fitting about one a day. “Bausch + Lomb’s technology has made this lens very predictable, and predictability is key in the fitting process of any specialty lens,” she says. “Every practitioner’s goal is patient satisfaction, and when you have a product that gives you immediate positive feedback on the initial visit, it’s a great feeling for you and the patient.”
Rachael Wruble, OD, who practices in North Carolina, also sees the benefit of giving patients what they need. “I tell my patients that I am a magician who can pull a contact lens out of my fitting room that has nearsighted/farsighted, astigmatic, and multifocal power,” she notes. “It is amazing to be able to give patients an option that they have never had before.”
Who are the best candidates for this lens and why?
Ryan Corte, OD, who practices in Concord, NC explains that any patient who is interested in contact lenses and who has presbyopia and astigmatism is a good candidate for this lens. “The easiest patients to transition into this lens are distance-only soft toric wearers and those who are masking their astigmatism with multifocals,” he says.
“The best candidates are every presbyopic astigmatic patient whom you previously thought would not be a good candidate,” says Dr. Chu. “If they have never considered lenses before, I ask them how happy they are with their current progressive glasses.
“I then say that I have an option for them now and that this contact lens will give them a smooth transition from distance to near so that they no longer have to move their head vertically to get clear intermediate vision on the computer,” she continues.
Dr. Schaeffer concurs. “My personal favorite candidates are previous contact lens wearers who now wear only glasses or patients who never knew that they could wear contact lenses,” he says. “They are more motivated and seem happier that we can correct both the astigmatism and their near vision.”
Dr. Wruble notes that another target group is current monovision toric contact lens wearers who could not be fitted successfully in the past with multifocal lenses. “For any patient who wears monovision or distance-only contact lenses, I offer this option. Many patients have been told for years that there are no options or that they have to choose distance or near. Well, not anymore,” she says.
Tell us about the fitting process for this lens and what has worked best for you.
All of the practitioners to whom we spoke rely heavily on the fitting guide. Dr. Corte notes that this fitting guide is very similar to the one for B+L Ultra for Presbyopia except that you need to account for patients’ astigmatism. “Honestly, just follow the fitting guide,” he says. “In cases in which I don’t have the particular lens that I need in office, I put the corresponding Ultra for Astigmatism lens on their eye to evaluate how the lens settles. This helps streamline the lenses that I need to order for maximum success.”
Dr. Schaeffer agrees that the fitting process is very similar to the other B+L Ultra lenses. “The fitting process is very straightforward, with small tweaks to the lens making a big difference for our patient outcomes,” he says. “Only rarely do we need to use more than two lens changes from the original selection when following the fit guide.”
Dr. Wruble says that she fits the lens straight from refraction. “Distance is pretty spot on, and for near, I usually bump up to the high add for patients +1.75D and over,” she says. “I find that patients also experience less glare while driving at night with the astigmatism corrected.”
How has the B+L Ultra Multifocal for Astigmatism lens helped with troubleshooting for particular patients? Tell us about any success stories in that regard.
Setting proper expectations is half the battle when fitting patients into the B+L Ultra Multifocal for Astigmatism contact lens. “We like to tell our patients who are wearing the lens for the first time that today will be the worst that their vision should be in the lenses,” says Dr. Schaeffer.
One of his patients had monovision contact lenses but wasn’t thrilled with his vision. “We had attempted several different lenses trying to get his prescription right over the years, but we had to settle where we were,” he said. “We put on the [B+L Ultra Multifocal for Astigmatism] lenses in the office, and he was floored. He was beyond thrilled to be able to see his computer, his phone, and in the distance within a few minutes of the lenses settling.”
Personal experience helps Dr. Chu realistically set patients’ expectations. “I am currently wearing the product myself, so I am able to tell my patients what to expect during the initial fitting and what to expect during their trial period,” she says. “The success rate will increase simply because potential issues become non-issues to patients when they are discussed at the initial visit.”
Dr. Chu tells of a patient who is a mechanic and a long-time toric contact lens wearer. When presbyopia set in a few years ago, he struggled with the idea of putting readers over his contact lenses and having them made into safety glasses. And because binocular vision was of great importance, a monovision fit was not an option. So, she introduced this lens at his annual exam. “He appeared slightly hesitant, but when I brought him back into my exam room after he sat in my waiting room for 10 minutes with the initial pair of lenses, I was greeted with a big smile—a smile that I have come to know well from other patients fitted in the same lens,” she says. “Not only did the patient report good physical comfort, but the vision was outstanding. He was able to achieve 20/20 at distance and 20/20 at near without needing any readers.
“A week later at his follow-up visit, the patient was excited to report that the contact lenses made him feel young again. He was able to freely position his head at work and not feel compromised as he was by previous options that were constant reminders that he was aging,” Dr. Chu continued. “This success story is just one example of many at our office, because you can replace ‘mechanic’ with ‘dentist,’ ‘engineer,’ ‘retiree,’ ‘homemaker,’ ‘teacher,’ etc.”
According to Dr. Wruble, her best patient thus far is a hyperopic esotropic patient who wears glasses the majority of the time because she struggles with depth perception. “She has worn part-time monovision contact lenses for years, but admits that she has hit her garage with her car because she could not judge the distance. We had her in distance-only contact lenses for a while, and she would ask people to read the menu for her at restaurants when she forgot her readers,” recounts Dr. Wruble. “These lenses allow her to wear contact lenses full time and to have great depth perception,” she continues. “She can now park her car and see her food when she eats.” CLS