This is the first of many optometry clinical encounters where I learned something.
1. Very first patient ever in my life. (I don’t count seeing classmates/friends as first time experiences). 66 year old male contact lens patient who wants multifocals CLs. But he’s doing a modified monovision of sorts where he has a multifocal in one eye and a distance toric lens in the other. I fit him with the CIBA Air Optix Aqua Multifocals in his non-dominant eye and the CIBA Air Optix Toric Lens distance contact lens in his dominant. He LOVES the vision, reads happily and can see distance great and the over-refraction (loose lens in multifocal eye, and the distance I did a sphero- cyl OR through the phoropter) was about plano-ish in both eyes.
The clinical pearl is that modified monovision can be an excellent option for patients with a little bit of astigmatism (he had 1.25 D of cyl.) Especially if the patient loves the feel of a particular contact lens multifocal but a toric multifocal option isn’t available.
2. Very first primary care patient ever in my life . 83-year old Spanish speaking only patient comes in with one eye barely open. Chief complaint from his son (translator) is that his left eye is always nearly closed. 20/30 in his open (OD) eye, and light perception only (OS) in the eye that he barely keeps open.
Turns out he has a full-blown retinal detachment secondary to diabetic retinopathy that my partner Chad and I spot which our staff doctor confirms and congratulates us on. So what about the eyelids closing? The patient was able to lift that eye when he desired.
The retinal disparity caused by the retinal detachment between each eye made him voluntarily (and then just out of habit) close his non-seeing eye. This was not a case of ptosis.
3. Second contact lens patient ever. Female keratoconus in her 20s who has lost one gas permeable lens and needs a new one. Chad and I are at it again. Getting a crazy cover test of 20 exotropia in entrance testing. our staff doctor comments when we first meet with him with this clinical pearl:
“Don’t do a binocular test on an essentially monocular patient” (at this point she had just one CL on, and she can see hand motion only in the eye without the RGP.
Other clinical pearls was the patient was getting inferior dimple veiling on the cornea. To fix this we steepened the lens.
We steepened it to allow for better centration so that the lens would not slide down and we also reduced the optic zone diameter to decrease chances of air bubbles.
That’s it for now!
It’s nice to see students getting so good at multifocals. Personally, I need to get better at them myself as I’ve had numerous failed attempts over the years.
I definitely love the new CIBA multifocals. The best multifocal contact lens to use by far.
Gone are the times when heavy glasses marred the beauty of the face. Thanks to the invention and growing use of contact lens; now one can accentuate one’s beauty and enjoy a clear vision too without much of hassle.
Air Optix Contact Lenses are extremely popular, especially among young men and women since they not only serve almost the same corrective purpose as that of glasses, but also have many cosmetic benefits. Being lightweight and virtually invisible, “contacts” as contact lenses are popularly called, have steadily grabbed an enormous market share. In fact, colored contact lenses have now become a style statement for many!