Margaret has been my patient for the last seven years. She is a lovely 72-year-young lady. Having lost her husband two years ago, she has decided to move on with her life by enjoying time with her friends and family and by meeting new people. She has a youthful spirit and, recently, a look that I have not seen in her before. She told me that her daughter wears multifocal contact lenses and that she would like to wear them as well. She recently had cataract surgery, so her distance vision is nearly plano with 0.50D of cylinder. Additionally, she requires a strong add power. She carries around reading glasses when she is not wearing full-time vision correction. I shared with Margaret the obstacles that switching to multifocals would pose for her, but she insisted that she was up for the challenge and had all the time in the world to work with me to adapt to them. Not being someone who says no to a young lady like Margaret, we got to work.
In my experience, the biggest challenge that someone like Margaret will face when transitioning to multifocal vision is cortical adaptation. We initially tried using some standard soft multifocals by following the fitting guides, but she complained about distance vision and shadows. We then attempted to shift one eye for distance and one for near, but she complained that her depth perception wasn’t the same, and she was unwilling to continue. At this point, I reminded Margaret about our prior discussions; she looked at me and said “try something else.”
So, I decided to work through the cortical adaptation at a slower pace. I fit her with very low-add lenses that only slightly changed her vision in the distance. I explained that she was not to go even a single day without wearing the lenses and that she should wear reading glasses over her lenses to improve her near vision. She came back to the office and shared that she was able to see the computer just fine and could even make out the menu during her lunch dates with slightly better clarity. Over the next couple of weeks, I slowly increased the add power in her lenses.
Through this process, we were able to help her adapt to lens wear, but not with a sudden change. Margaret was overjoyed with our final outcome and said that she could not wait to wear the lenses on her upcoming date.
READ MORE: https://www.clspectrum.com/newsletters/contact-lenses-today/october-27,-2019
