Presbyopes in Your Practice

Properly fitting multifocal contact lenses is important for a successful patient experience. To maximize success with multifocal lenses, practitioners need to select a lens with an effective design, choose patients who will be motivated to try the lens, and communicate with these patients to help them get the most from the lens. Here are some tips to help you deliver incredible vision to your patients:

Step 1: Patient Evaluation

• Ensure that the patient has good motivation for selecting multifocal contact lenses.
• Set realistic expectations for the patient.
• The patient should have no more than -1.00D cylinder corneal astigmatism.

Pre-Fitting Evaluation

• Measure spectacle Rx, including ADD power.
• Establish baseline binocular visual acuities at distance and near.
• Determine dominant eye at distance.

 

Step 2: Initial Lens Selection

Sphere Power

Choose the lens with the patient's full distance spectacle sphere.

• If cylinder, present adjust sphere power appropriately.
• Vertexed, spherical equivalent power for vertex distance. Click here to download a vertex chart.

 

Step 3: Initial Lens Evaluation

• Allow lens to equilibrate on each eye (may take up to 10 minutes for new wearers).
• Lenses should center well and provide adequate movement.
• Vision evaluation should always be done in normal room illumination.
• All testing should be out-of-the-phoropter. Hand-held ophthalmic lenses work best.
• Check distance acuity binocularly. Over-refract if necessary in 0.25D steps to best visual acuity with both eyes open.
• Check near acuity binocularly, with distance over-refraction still in place.

 

Step 4: Symptom Resolution

Unacceptable Visual Acuity

• 0.25D can make a significant difference in visual acuity. Re-check near and distance visual acuities with over-refraction in place.

Distance Visual Acuity Unacceptable

• If patient is wearing two low ADD lenses, add -0.25D to the dominant eye.
• If patient is wearing two high ADD lenses, add -0.25D to the dominant eye. If problem persists, then use a low ADD in the dominant eye and a high ADD in the non-dominant eye.
• If patient is wearing mixed ADDs, add -0.25D to the dominant eye. If problem persists, then use a low ADD OU.

Near Visual Acuity Unacceptable

• If patient is wearing two low ADD lenses, use a low ADD in dominant eye and high ADD in non-dominant eye. If problem persists, then add +0.25D to the non-dominant eye. If near vision is still not acceptable, use high ADD OU.
• If patient is wearing two high ADD lenses, add +0.25D to non-dominant eye.
• If patient is wearing mixed ADDs, add +0.25D to the non-dominant eye. If problem persists, then use a high ADD OU.

 

Other Tips From Your Peers

• Consider using two low ADDs for those with +1.50 ADD or less and two high ADDs for those with +1.50 ADD or more.
• Use "mixed" ADDs as a backup in case of initial rejection.
• To transfer patient easily from monovision to multifocal, use two low ADDs and overplus the non-dominant eye (about half the amount of the habitual monovision Rx).
• When evaluating visual quality, focus on the functional range of vision.
• Use a reading card with paragraphs in different font sizes, or use a computer to simulate a patient's real-world environment. Ask whether they're experiencing smooth transitions and clarity in the intermediate range.
• Be patient with the adaptation. Allow your patient to wear their lenses for one to two weeks, and then re-evaluate.
• Counsel patient to have adequate lighting when reading or doing close work.

For full prescribing information, refer to the package insert/fitting guide.

*Richard Durocher OD, Rhonda Robinson OD, Jennifer Smythe OD, Mike Pier OD