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    Managing astigmats when they hit presybopia

    Many options allow patients to remain in contact lenses


    Gas permeable (GP) lenses are a forgotten tool that some practitioners today do not want to fit because of the perceived difficulty to fit and discomfort of the lenses. GP lenses provide great clarity in vision and are able to neutralize high amounts of corneal astigmatism with spherical, aspheric, and back surface toric lens designs.

    GPs are a good choice for astigmatic presbyopic patients. The back surface of the lens can adjust for the astigmatism, while the front of the lens can address the reading add required.

    These lenses can be ordered empirically from your lab with just a few pieces of information. If you provide your lab with keratometry (K) readings, current prescription, horizontal visible iris diameter (HVID), pupil size, and eye dominance, your lab of choice will design a lens for your patient and will walk you through the fit.

    Materials, designs, coatings, and size of lenses allow for greater comfort and very crisp optics. Consider theses lenses for your patients, especially if you are unable to achieve clarity with soft toric lenses.

    Scleral lenses are very popular now with their ability to mask high amounts of corneal astigmatism and provide clear, crisp vision to irregular corneas. When I started fitting scleral lenses eight years ago, we had only spherical scleral lenses to work with. We now have front torics and front aspheric multifocal designs, as well as labs that are able to create front toric multifocal scleral lenses. We live in a great time to be able to help our patients achieve better comfort and vision with scleral lenses.

    Distance contact lenses under readers or computer progressive addition lenses (PALs) is a strategy used as a back-up plan when patients fail to adapt to multifocal lenses or when modified monovision or monovision has not been successful. I will also use this option for patients who do not have the time, money, or energy to move forward with a multifocal contact lens fitting. When a patient wants to remain in her daily disposable or biweekly lenses, this may be her only option as well.

    Communication is key

    When making recommendations to our patients, the strength of our recommendation comes from the relationship we have built with them and the level of professionalism we have shown throughout the exam. How we speak and communicate with out patients determines how they perceive our abilities. As a new grad, I had to use my words to create trust. This was done through kindness, empathy, and taking the time to explain things to patients, showing them my knowledge and empowering them to understand their condition.

    Shalu Pal, BSc, OD, FAAO
    Dr. Pal earned her Doctor of Optometry degree from Southern California College of Optometry and completed a cornea, contact lens, and ...


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