Multifocal RGP CL

**Rockstargazer** · 01-30-2007, 03:36 PM

I need some opinions from my fellow optiboarders about the best multi-focal RGP CL's out there today. Here's my readers digest version history:
Started wearing PMMA CL at 13, successfully switched to Boston Equalens RGP's in early 80's. Wore them full time with very little Rx and/or radius changes until 2003-ish. Did try monovision fit mid-90's with minimal success- Went back to distance correction until presbyopia won the battle and I started wearing glasses (PAL's) full time since 2003. I absolutely cannot deal w/ monofit. I suspect is has to do w/ being cross dominate due to Duane's Syndrome early childhood. Ophthalmologist surgical shortened muscle in OD and became OS dominate. So I would very much like to try some type of CL multifocal again, but because I've been out of the loop with that end of the industry don't know what I should try. Side note: Went to new OD for my new Rx she wanted me to see the senior OD because he was fitting a new CL design that was part soft/ part rigid CL. AND the fitting fee alone would be over $700. SURE I'm gonna pay that much for a fitting that no one is sure will even work? I tried soft CL's before with zero luck, too much astig.

Latest Rx:
OD -4.50 -1.00 x 08
OS -4.25 -1.25 x 23
+2.00

I don't mind paying an OD a fitting fee but hey, I used to train CL wearers, and I know how to insert & remove those little ******s. Been there done that. $700? Whew, maybe I should go back into the dispening world. Any thoughts or comments to help guide me here?

Thank you very much for your input.

**Dave Nelson** · 01-30-2007, 04:43 PM

You neglected to say whether your astigmatism is corneal, lenticular, or mixed. Eyelids can play a major role in determining suitability as well, both tension and position playing a role. A translating seg RGP is likely your best bet, but they are limited in toric configuration. If your astigmatism is all, or nearly all, corneal, no toricity is needed. A very experienced translating seg fitter is needed, since these can be tricky to fit, and would not be cheap, although a $700 fitting fee sounds pretty steep. Find another fitter willing to return at least a portion of a chair fee if unsucessfull.

**chip anderson** · 01-30-2007, 04:45 PM

Depends on the individual case, what is best for that patient. You really can't beat a good PMMA crescent fused bifocal if properly fitted, edged and supervised. After that probably an excutive type HGP, aspheric bifocals are good to if you can get enough effective add power and excellent centration. I have had good results with effort, on Danker's
Asphro-F (front aspheric bifocals) but a lot of trial and error here.

Chip

**allanon** · 01-30-2007, 05:15 PM

I'd go with a Tangent Streak no-line.. less than $350/pr typically. Fit in our office is betwn 100 and 200 (trying to avoid collusion).

Great lens. 100% success rate in my office.

**mpowers** · 01-31-2007, 05:51 PM

Dave,
I have had excellent success with wave cl's www.wavecontactlenses.com. Its a custom lens designed from topographer. If you look into it, make sure the prescriber is experienced. There is a learning curve.

Dr. P
no financial interest

**Floridaopti33** · 02-01-2007, 12:01 PM

700 sounds a bit steep. Should be around 250-300 ish for the lens'. Another 200 max for exam IMO, although there may be a topography(sp) charge added in too. We've been using Boston lens through TruForm, great results so far.

Paula

**chip anderson** · 02-01-2007, 06:21 PM

It's not what brand, type, etc. you use, it's who you see. And all of the other decisions should be the fitter's.

**ziggy** · 02-01-2007, 08:21 PM

Marcie, If you are going to vist your family in the Cincy area anytime soon, give me a call and I'll hook you up. I use several designs from Diversified Opth. As long as you'll be here for 3-4 days I have plenty of time to get it right.

**sharon m./ aboc** · 02-01-2007, 09:14 PM

Has anybody had any experience with those hybrid contacts? They're RGP in the center and soft all around the edges. I can't remember what they're called.

**Dave Nelson** · 02-01-2007, 09:38 PM

Softperm. Very low DK, better initial comfort than RGPs, but hard to get tear exchange. Niche lens, limited use, hard to care for. Probably best for high corneal toricity if Ks and spec cyl are equal.

**mpowers** · 02-01-2007, 09:56 PM

Synergeyes are the new hybrid. I haven't fit any personally, but I hear they are a good problem solver. Good comfort, but difficult removal. And difficult to evaluate fit. It sounds like a good lens for certain patients, but definitely not a first choice lens.

Mike

**sharon m./ aboc** · 02-01-2007, 10:42 PM

It sounds less attractive now. I hadn't considered the removal factor. Sounds like it would be hard not to tear it. If you can't blink it out and you can't pinch it out. How do you get it out?

**ziggy** · 02-02-2007, 11:37 AM

Originally Posted by sharon m./ aboc

How do you get it out?

plunger?

**chip anderson** · 02-02-2007, 11:58 AM

Can be removed by manupilating lids. Can be removed by carefully pinching flexible edge of lens. Problem is edge separates from rigid center at a rate too often for most patients to tolerate or afford. Have never done so but probably can be removed with a suction cup.

The longest I have ever seen one last in patient use was 3 years. Most patients were lucky to get 3 months out of them.

Every bit as much of a pain as a piggy-back system.

Chip

**mpowers** · 02-02-2007, 12:10 PM

Initial reports are that the junction with synergeyes holds up much better than previous hybrids. I spoke with a doctor that has fit several hundred patients (many referred by corneal specialist) and has only had several tear. Hopefully it will come out with a silicone hydrogel skirt soon. I personally only see use for them at this point in highly distored corneas with poor traditional GP comfort or poor centration issues.

Mike