Presbyopic Correction in Silicone Hydrogels

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MS - 28 Jan 2006 01:34 GMT

I know that currently there are no multifocal silicone hydrogel lenses on
the market. (Anyone know if there are any in the works?) What I am referring
to is something I read here, I think from Larry, to the effect that Focus
Night and Day lenses have some inherent presbyopic correction (I think due
to being aspheric), that someone with a small amount of presbyopia might
find that enough of a correction for that problem.

I am wondering whether that same inherent presbyopia correction also exists
in other silicone hydrogels, in particular Purevision and Oasys?

At 53 I certainly have much more presbyopia than that small amount of
correction mentioned can handle. I am currently wearing N&Ds, but prescribed
monovision. The presbyopia is getting worse, so I think I will need further
correction for it (unfortunately further weakening distance vision) in my
next contacts. I'm wondering though, if that small amount of presbyopia
correction in the N&Ds is a factor, whether the monovision correction would
have to be more severe, if it were not for that presbyopia correction
inherent in the N&D lenses?

Therefore, I'm wondering if I switched to other silicone hydrogels, such as
Purevision or Oasys, whether there would be a loss of that inherent
presbyopia correction in N&Ds,, or whether it would be about the same, or
whether perhaps one of them might even give better presbyopia correction
than N&D?

Please let us know how these different silicone hydrogels stack up in
regards to inherent presbyopia correction. Thank you.

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LarryDoc - 28 Jan 2006 02:56 GMT

> I know that currently there are no multifocal silicone hydrogel lenses on
> the market. (Anyone know if there are any in the works?)

We might see the Purevision Multifocal in March or April.

>What I am referring
> to is something I read here, I think from Larry, to the effect that Focus
[quoted text clipped - 4 lines]
> I am wondering whether that same inherent presbyopia correction also exists
> in other silicone hydrogels, in particular Purevision and Oasys?

O2Optix, yes, as Night&Day
Purevision, yes, but less available plus power than the previously
mentioned.
Oasys, not aspheric.

Remember, there are a number of non-silicone aspheric lenses and true
multifocals currently available. Another unique hybrid multifocal is
due out this Spring, too----high DK rigid center with soft periphery.

LB, OD

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MS - 28 Jan 2006 06:45 GMT

> > I know that currently there are no multifocal silicone hydrogel lenses on
> > the market. (Anyone know if there are any in the works?)
[quoted text clipped - 20 lines]
>
> LB, OD

Thanks for the detailed knowledgeable reply, Larry! :-)

So, do you think if I changed from N&D to Oasys (which has occurred to me,
as I have dry eyes, of course I would need to try them out first) (I have my
eye exam next week), I would need a stronger monovision correction (meaning
a still weaker minus lens in the non-dominant eye, in order to be able to
read with them) than I would if I continued with N&Ds? Would that therefore
contribute to still weaker distance vision (through having a still weaker
distance lens in one eye), than if I continued with N&D? Would you recommend
that presbyopes not use Oasys, but better to go with N&D or O2?

Yes, I know there are several non-silicon multifocals available. In fact, I
wore RGP multifocals for over a year. (I don't recall the brand at the
moment. I remember corresponding with you about it at the time.) Now I have
become accustomed to the comfort of the soft lenses though, and I really
like the convenience of EW, for instance, not having to fumble for glasses
when getting up at night or in the morning. So I'll probably stick with SH
for now. (Did Menicon Z ever come out in a decent multifocal version in the
US?)

The Purevision Multifocal sounds interesting, as well as the unique hybrid
multifocal. (What is the name of the latter?) (Have you been able to test
prototypes of either of these, or heard about clinical trials, etc.?) I
wonder if I should perhaps postpone my eye exam for a few months, order
another six month's supply of N&Ds (I'm on my last lenses from the current
boxes now), as when I get my eyes checked in June or so, there will probably
be more presbyopic alternatives to choose from. Will there be more and
better contact lens choices for presbyopes in the summer than there are now?

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LarryDoc - 28 Jan 2006 20:25 GMT

]

> So, do you think if I changed from N&D to Oasys (which has occurred to me,
> as I have dry eyes, of course I would need to try them out first) (I have my
> eye exam next week), I would need a stronger monovision correction (meaning
> a still weaker minus lens in the non-dominant eye, in order to be able to
> read with them) than I would if I continued with N&Ds?

Likely.

> Would that therefore
> contribute to still weaker distance vision (through having a still weaker
> distance lens in one eye), than if I continued with N&D?

Possibly. You'd have to try it.

> Would you recommend
> that presbyopes not use Oasys, but better to go with N&D or O2?

Early presbyopes, yes, but not always. Later presbyopes---it depends
upon how much over-plus power they can tolerate. Sometimes
non-aspherio lenses provide *better* distance vision than aspherics. And
if a pt was to be using near vision specs over the contacts, the best
combination might well be with a non-aspheric. I often trial fit both
Oasys and Optics/Night&Day to see which works best. You often can't tell
until you actually try it on the eye.

>(Did Menicon Z ever come out in a decent multifocal version in the

The Menifocal is due out shortly. I don't know if it wil be "decent"

:-)

> The Purevision Multifocal sounds interesting, as well as the unique hybrid
> multifocal. (What is the name of the latter?) (Have you been able to test
> prototypes of either of these, or heard about clinical trials, etc.?)

I have great hopes for the Purevision Multi as it is molded based on the
SL66 and trials in other more civilized countries look very good.
Actually, any silicone hydrogel multifocal should be better than any
mushy/spongy HEMMA lens. In theory.

The hybrid is made by Synergeyes. I've not tried either so I withhold
judgement until then.

>Will there be more and
> better contact lens choices for presbyopes in the summer than there are now?

My crystal ball is a bit cloudy these days, but I can see a number of
new products coming in the next six months, including those mentioned
previously and a couple more.

LB, O.D.

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MS - 29 Jan 2006 05:11 GMT

Thanks for all the interesting info, Larry!

Yes, I read (after reading your posts yesterday) that the Multifocal
Purevision will be the exact same multifocal design that B&L has out now
(Soflens 66?), just using the Purevision material. Is that a good multifocal
design? Have many patients had success with it? ("Success" being a relative
term, of course, as it seems that any contact lens fitting trying to
accommodate both myopia and presbyopia without the use of glasses, whether
by multifocal contact lenses or monovision, is a compromise, and will
certainly not provide perfect vision both near and far. It sure would be
great if some day they could create a solution, whether surgical or via
lenses, that would create perfect near and distance vision!) How does the
current B&L soft multifocal compare in visual results with other multifocal
lenses?

Well, now I'm seriously thinking of calling the eye doc's office Monday and
cancelling my appt for an exam this Friday, buy another two boxes (one for
each eye) of N&D in my current prescription, and go for my eye exam in June
or so, when there are these additional possibilities to try out (especially
the Purevision Multifocal).

> ]
> > So, do you think if I changed from N&D to Oasys (which has occurred to me,
[quoted text clipped - 47 lines]
>
> LB, O.D.

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