Tom, there are more soft bifocal choices now. Some of my patients do
quite well with them, others not. I find it impossible to predict
without doing a trial fitting. I've had the greatest success lately
with the Proclear Multifocal. For those who can tolerate them, RGP's
probably result in crisper vision. There are a number of tricks, such
as using a single vision lens on one eye and a bifocal on the other,
etc.

DrG

In article <1138893037.200038.158690[at]o13g2000cwo.googlegroups.com> ,
drfrank21[at]gmail.com wrote:

- quote -

Do take into account that refits from low DK lenses (and pts who wear
lenses past their useful like expectancy!) tend to accept more plus as
the cornea adapts to the increased oxygen. That increase is quite
variable and is often .25 and as much as .62 over a period of two or
three weeks post new fitting.

I am not at all a fan of monovision (except those lucky few who are
naturally mono and/or with little or no stereoscopic vision). But over-
plussing the non-dom eye by .25 is a very reasonably thing to do if the
near vision is substantially improved,

- quote -

Indeed. The cheap-o multipacks are often not nearly as good as the
longer term lenses. But sometimes they are!

- quote -

Torics are certainly a challenge! Chair time, chair time, chair
time.............


LB, O.D.

Dr. Leukoma wrote:
- quote -

Dr Leukoma,

Dry eyes was the reason I'd like to try Oasys.

My interest in aspheric lenses was in hopes it might help with
presbyopia, so I wouldn't have to do monovision. I *should* have made
it clear that I was interested in SILICONE aspherics, not just any
aspheric (because of the occasional dry eye issue).

My OD also agrees that multifocals would not benefit me. He literally
said, "The suck for very mild myopics." I know people who wear them and
they all say that they're OK, but not all that great. I have no
interest in them at this point.

Thanks...
-Tom

TomMonger wrote:
- quote -

If the problem is dryness, what do you think would be accomplished by
using different optics? The underlying problem is your tear film, in
which case you treat the tear film. In lieu of treating the tear film,
you can try various polymers that resist on-eye dehydration, or whose
optics are less affected by dehydration. The ideal lens for that would
be low water, i.e. 38% or less. This includes most of the silicone
hydrogels, except Acuvue Advance. The one exception is the Proclear
Compatible, whose polymeric structure causes the surface of the lens to
stay hydrated. Personally, of all the silicone-hydrogels, I have found
the Acuvue Oasys to be the most comfortable on my own eyes. But, some
don't do well with any silicone-hydrogel because of an altered tear
lipid profile.

I have seen patients endorse various kinds of lenses on the internet,
including the aspheric Definition AC. In reality, this is a
methafilcon material with a mid-water content similar to the AV2,
Biomedics 55, and many, many others, with the exception that it is
thicker. The thicker lens contributes to the ability of the lens to
mask low amounts of astigmatism as well as less on-eye dryness, but at
the expense of oxygen permeability. The aspheric design helps to
reduce the inducement of additional spherical aberration.

DrG

- quote -

Larry, it's interesting the different experiences providers have with
contact
lenses. I've haven't had much luck counting on any meaningful plus on
early presbyopes with the spherical hydrogel silicone aspherics. I will
try undercutting the minus (or add more plus) by +.25 on the
non-dominant
eye which helps but that's getting closer to more a monovision fit.

And it seems that those patients with a low distance correction (+/- 75
)
with fairly decent unaided visual acuities don't fare well with the
multiple-
packaged soft multifocals. Invariably they state their distance vision
is
worse off compared to unaided. The success rate seems much higher
with those who have a higher distance correction.

I recently tried the ciba toric multifocal on a patient with limited
success; I
refit him to a gas perm multifocal and it was a night and day
difference. He
stated that the gas perms were much clearer even though the va's of
both
the soft and rgps were the same.

frank

Thank you, all, for the very prompt and informative responses! I now
have some great information to discuss with my OD on my next visit.

Since monovision seems to work really well for me, I'm probably going
to try Oasys lenses and hope I don't have the same negative reaction as
I did with Advance. If that doesn't work, I will give N&D or O2 Optix.
Perhaps I will take Dick's advice and get a pair of Zennis to wear OVER
my monovision lenses for any night driving (which is uncomfortable for
me in monovision).

I wanted to mention that I DO wear progressive bifocals. They're OK for
most of my vision needs, but when I am in front of a computer, I can
actually see BETTER with them off (no correction). I was told I may
need to have my next pair adjusted so the add portion begins earlier?

I also wanted to mention that I *did* try RGPs two years ago. My
previous OD tried a pair on me, but I couldn't keep them in my eyes
more than a few moments. Then she tried a second pair, and I
encountered the same problem. It felt like something was cutting into
my eyes and I couldn't keep my eyes open more than a split second at a
time. I tried for days to try and adapt, but it was impossible.


Thanks again
-Tom in Scranton, PA

In article <1138815705.616300.248660[at]z14g2000cwz.googlegroups.com> ,
drfrank21[at]gmail.com wrote:

- quote -

I beg to differ with you, doc. I've quite a few patients in silicone
hydrogel aspherics getting .75 to 1.00 add and some for whom it doesn't
do a darn thing. Depends, I think, upon residual astig, how evenly the
lens vaults the central cornea and pupil size.

I also have a fair number of folks who absolutely love their apsheric
multifocals. I just dispensed today two pts with toric multis with
excellent distance and midrange acuity (as good or bette than specs!)
and very good (perhaps not excellent!) near point vision. Up to 1.50
add works great, beyond that it gets iffy but is often ok.

Just tried a soft toric multi on me. As my patients, awesome distance
and mid range vision and quite acceptable near. (I may simply over-plus
the near eye .25 or so for *perfect* near.) I still, however, prefer my
RGPs and am waiting for the sil-hydro multi's.

LB, O.D.

otisbrown[at]pa.net wrote:
- quote -

So ya think that a monovision cl correction with the distance eye of
-75 in an
early presbyope will lead to a destructive "stair-step" myopic
posture?? And
the sad (scary) thing is that you're not joking.

frank

In article <1138815088.746051.211460[at]g43g2000cwa.googlegroups.com> ,
drfrank21[at]gmail.com wrote:

- quote -


I'm wondering if he knows that? Maybe that's what his remark means?

- quote -


I tried monovision with glasses. My OD told me it wouldn't work. I
explained to him why it didn't matter. He said it was worth a try.

--
Dan Abel
dabel[at]sonic.net
Petaluma, California, USA

Dear Dicky,

I agree with you, but Tom is on a roll, and
wants that "sharpness" of that minus lens.

Who are you and I to argue with that?

(I loved that extreme sharpness as a kid also -- but
I learned, oh how I learned.)

But Tom should have what he wants -- and support
from the "experts" and not us.

Best,

Otis