Abstract
Objectives
By presenting 2 cases, this study aimed to discuss the utility of multifocal rigid gas permeable contact lenses in the low vision patient population, and their ability to decrease reliance on low vision aids and to increase quality of life.
Methods
A retrospective case series of 2 patients receiving care from two specialty practice locations was performed. Both patients were visually impaired presbyopic myopes, and sought care from both contact lens and low vision specialties in order to improve visual function and enhance their ability to perform activities of daily living. They were each fit with multifocal gas permeable contact lenses to be used in conjunction with low vision devices. The Visual Functioning Questionnaire – 25 was administered to both patients in order to quantify improvement to quality of life with the new contact lenses.
Results
Both patients were successfully fit with multifocal gas permeable contact lenses and reported decreased reliance on low vision aids as well as significant improvement in quality of life when wearing the contact lenses.
Conclusion
The use of multifocal rigid gas permeable contact lenses in the low vision patient population may be an effective tool to make visually impaired patients, particularly presbyopic degenerative myopes, less reliant on low vision aids, thereby improving their quality of life.
1
Introduction
Multifocal rigid gas permeable (MF RGP) contact lenses are an effective option for correcting presbyopic patients for distance and near [ , ]. One particular subset of patients for whom multifocal RGPs might provide substantial benefit are patients with low vision and a high refractive error that require an add. The currently available options for near correction in low vision patients include the use of low vision aids, such as magnifiers, prisms, colored filters and talking books, as well as telescopic contact lenses [ ]. Although current low vision devices are associated with increased patient satisfaction, visual impairment correlates with the capacity to perform activities of daily living, and patients suffering from low vision do report the perception of impaired functional status and quality of life [ , ].
The use of contact lens correction for visually impaired patients has been described, including by means of monovision contact lens microscopes, in which a high powered near addition is prescribed for one eye in order to aid in near tasks [ ]. There is, however, limited documentation available on the use of contact lenses in the presbyopic low vision population. Although multifocal RGPs with maximized adds may be a useful tool for visually impaired patients, to date, there are no reports of such lenses being utilized for near tasks in conjunction with low vision devices. This study reports on a case series of two visually impaired patients who were successfully fitted with multifocal RGP lenses and highlight the potential utility of such lenses in decreasing reliance on low vision aids, as well as in promoting increased quality of life in the low vision patient population.
2
Case reports
2.1
Patient 1
A 65-year-old female with a significant ocular history of high myopia and primary open angle glaucoma presented with poor vision in both eyes after multiple surgeries. In the left eye, the patient had a history of multiple retinal detachment repairs, a macular hole repair, a vitrectomy and cataract extraction. Current medications included 1 drop of Xalatan nightly and Timoptic twice daily in both eyes. The patient reported discontinuing treatment with Rhopressa several weeks prior in the right eye due to chronic conjunctivitis, but was using Tacrolimus ointment at the present visit to treat irritation of the ocular adnexa. Pertinent anterior segment findings were unremarkable in the left eye. On central 10-2 visual field testing, a complete superior temporal defect and partial inferior temporal defect were noted in the right eye, and a complete superior defect was noted in the left eye.
At the present visit, the patient expressed interest in trying alternative contact lenses. Refractive error was -20.00 -0.75 × 30 in the right eye and +0.50 -2.50 × 180 post-cataract extraction in the left eye. She was currently wearing a monofocal RGP contact lens in the right eye which left her significantly under-corrected, and no lens in the left eye. In this system, distance visual acuities were 20/125 in the right eye, which improved to 20/80 on pinhole, and 20/300 in the left eye, with no improvement on pinhole. Near visual acuities were 20/60 in both eyes. She was then fit into an International Contact Lens (ICL) aspheric gas permeable multifocal lens in her right eye, with parameters of: -16.25D, +4.00 add, 9.4 mm diameter, 8.4 mm optic zone and 0.13 mm center thickness. Initial lens selection was based on the adequate fit of her previous monofocal RGP contact lenses. The newly fit lens was observed to have a centered, lid attachment fit with adequate movement. Fluorescein staining revealed an evenly distributed alignment pattern. The BCVA obtained improved to 20/50 +2 at distance in the right eye, and 20/30 in both eyes at near. Several low vision devices were fitted to be used in conjunction with the high add multifocal RGP, including a typoscope for general reading tasks, a +10D/3.5x illuminated hand magnifier for reading small labels and mail, a +8D/3x illuminated stand magnifier for reading poorly contrasted continuous text, +4.00D prism half eyes low vision spectacles for reading well contrasted continuous text, and a 2.8x hand held telescope for spotting street signs in the distance ( Fig. 1 ).
