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"Identifying Good Multifocal Candidates"

“MultiFocal: The New Standard of Care for Presbyopes”

- Kelly Kerksick, OD

The challenge of trying to guess whether or not a patient is interested in multifocal lenses can be very difficult. Many times patients won't verbalize with the doctor their interest or desire for contact lenses. In particular, many patients assume that the doctor will be the one to make the recommendation for contact lenses. Unfortunately, many practitioners aren't always mentioning multifocal and other specialty contact lenses to the patient as often as they should which leaves the patient to assume that they are not candidates for these amazing technologies.

Occupational Considerations

If we think about the reasons for why patients want multifocal contact lenses, the answer is easy. Patients want to be able to see with flexibility. Taking this one step further, flexibility is a key component to maximizing occupational productivity. As a result, multifocal contact lens technology can be an excellent tool to maximize productivity on the job. Multifocal contact lenses can provide more flexibility to individuals, particularly those individuals that work on a computer for many hours per day. There are several occupations where multifocal contact lenses would have the ability to outperform spectacle lenses, especially those occupations that require a lot of near work and computer work.

In addition to those professions that require a lot of computer work and near work, there are a number of other occupations that also reap the benefits of the multifocal contact lens technology. For example, electricians and pilots are perfect examples of occupations that would benefit from the multifocal contact lenses. With the design of the PureVision Multi-Focal, the patient would have the ability to see clearly up over the top of their head at near just like seeing down below. This is a distinct advantage that the multifocal contact lenses offer over traditional spectacle lenses.

Our office recommends new multifocal contact lenses to every patient who we think will benefit from them. We try to present something new to the patient every time they come in for a visit. This makes them look forward to their regular visit and provides justification for a higher evaluation fee for a contact lens analysis.

Promoting the Multifocal Technology in Your Practice

An easy way to channel new patients into multifocal lenses is to offer a brief questionnaire on your practice's welcome forms to determine whether or not they are a candidate for the multifocal contact lens technology. Good questions to include on this form would be:

  • Would you be interested in a contact lens that would allow you to read without glasses?
  • Do you spend any time on the computer?

A questionnaire is an excellent way to pique the patients' interest regarding multifocal lenses. These questions often create discussion about the multifocal contact lens products and whether or not the patient is a good candidate.

In addition to asking patients the right questions to pique their interest and educate them about the technologies that are available, promotional materials displayed in the reception area can also help to trigger an interest or desire in experiencing the new multifocal lens products. Keeping brochures and literature on hand describing the benefits of the lens technologies can prove to be very helpful in finding patients who have an interest in the multifocal lenses.

Clinical Findings to Consider

When trying to identify good multifocal candidates, one of the first factors to consider is the patient's prescription. Unfortunately, one of the biggest misconceptions of multifocal contact lenses is that they take far more time than monovision fits or traditional distance only contact lenses. The actuality of multifocal fitting is that the fitting can be very simple and straightforward if you know what you how to troubleshoot efficiently.

For instance, when considering multifocal lenses for your patient, evaluate the patient's distance prescription first. It is recommended that the patient's prescription does not exceed one diopter of astigmatism. If the patient does have more than one diopter of astigmatism, this does not necessarily make the patient a poor candidate for multifocal lenses.

Other factors that the doctor must consider is the way the multifocal lenses fit. Often times, a patient may have an irregular cornea responsible for poor centration of the contact lens. An imperative factor for a successful multifocal fit is a contact lens that centers well. Doctors should consider these factors when fitting multifocal lenses, as it is just as important to know when to "pull the plug" and go in a different direction such as monovision. So often, practitioners "chase their tail" trying to make prescription adjustments to multifocals when the actual issue is poor centration causing a poor fit and poor vision. A lens that does not center well will most likely never offer good vision. Be sure to be mindful of these factors when recommending multifocals to your patients.

Other Factors to Consider

One of the most important factors that need to be taken into consideration is the motivation of the patient. Attitude is everything and is a key component to the success of a patient in multifocal lenses. When trying to identify good multifocal candidates, it is essential that patients are very motivated and have a good understanding of what their expectations should be with the contact lenses.

An excellent way to determine whether or not a patient is a good candidate for the multifocal contact lens technology is to ask them what they want from the lenses. Getting a patient to state their expectations of the lenses is an excellent way to find good candidates for the technology while educating patients on what is or isn't realistic regarding the performance of the multifocal contact lenses. Doctors that have been very successful upgrading patients into multifocal lenses will often make notes in the chart about the patient's goals with the multifocal lenses. This is an excellent time to confirm with the patient that their expectations are realistic or to educate the patient appropriately if their expectations aren't very realistic. Many multifocal wearers tend to focus on what they can't see rather than what they can see. The microscopic print on the insert for a prescription is a classic example of an unrealistic endpoint. Sure, many of these patients will be able to see this very small font, but an individual with this as their goal is really being set up to fail. Realistic goals include good, functional vision which provides the ability to read a magazine or a newspaper, work at the computer, etc. Many of these patients have expectations that can be somewhat unrealistic so it is always wise to reiterate with the patient the original goals of the contact lenses and doctors will find that the majority of the time, success will have been achieved meeting the patient's expectations as discussed at the original examination.