Article Date: 1/1/2013

The Multifocal Discussion
multifocal discussion

How to Start the Multifocal Contact Lens Discussion

The initial discussion can make a huge difference in your patients’ CL success. Here are some tips on how to make the most of it.


The obvious candidate for multifocal contact lenses is your presbyopic patient who is motivated to give up glasses or readers. But because so many patients are computer users these days, even younger patients may be good candidates, so don’t be too quick to rule anyone out.

As you determine the best candidate for these lenses, the education factor becomes critical as to whether he/she will be ready and willing to give them a try. We spoke to the contact lens specialists who gave us tips on how to start this discussion.

Plant the seed.

Many optometrists agree that the most critical discussion points about multifocal contact lenses are made while the patient is in the chair. But that doesn’t mean the conversation can’t start sooner. Jennifer Stewart Ellison, O.D., who practices in Norwalk, Conn., says the discussion starts even before the patient gets to the office.

“We ask them [the patient] to bring any contact lenses, glasses or even sunglasses that they [the patient] wear so that already gets into their minds that there are multiple solutions and opportunities,” says Dr. Stewart Ellison. “Then when the patient checks in, we ask on the form ‘Are you interested in trying contact lenses today?’ You’d be surprised how many patients have never been asked. They’ve worn glasses for 40 years, and nobody has ever asked them about changing.”

Multifocal contact lenses can also be discussed during appointment scheduling and through on-hold messaging, say those interviewed.

Adds Patricia V. Gelner, O.D., F.A.A.O., who practices in St. Louis: “When a patient calls to make an appointment, the receptionist makes the patient aware that we offer many vision correction options, and that includes multifocal lenses. That gets the idea planted in their head before they come in.”

Christine Sindt, O.D., F.A.A.O., practicing in Iowa City, Iowa, recommends that when you introduce patients to new technology, such as multifocals, you do so in layers.

“It’s like putting on perfume,” she says. “You want several subtle layers because all at once is too strong. So the discussion about multifocals comes from point-of-purchase materials in the waiting room, educational information playing on the television and staff discussion.”

Also, take advantage of testimonials and multifocal wearers’ firsthand experiences, she says.

“I’ve found it’s very helpful when a staff member actually wears multifocals and can have a genuine discussion about them with the patient before I come into the room,” says Dr. Sindt. “It sets the tone very well.”

Discuss “doughnuts.”

While the idea may be planted early on, the real meat of the discussion typically takes place in the chair. Dr. Gelner starts out by describing multifocal lenses and explaining how they have various circular zones.

“I talk about the bull’s eye in the middle that provides near vision and explain that it has a ‘doughnut of power’ around it to address intermediate vision, while the outer most ‘doughnut’ will address further distance,” she says. “Patients can relate to those terms. As I’m describing it, I provide a handout that actually shows the different zones and what they’re used for. Patients respond well to the combination of the doughnut explanation while looking at the physical handout.”

Set realistic expectations.

It’s also important to set realistic expectations as part of the discussion, says David L. Kading, O.D., F.A.A.O., who practices in Seattle. He says he tells his patients they will still see well, but there will be some differences in their vision. He says he uses the term “range of vision” and also re-emphasizes many times that “80% of vision” is a success — that is, if multifocals can get a patient through the majority of their activities, and most patients do not need any additional correction. However, if patients struggle, they may need readers for certain tasks like intense upclose reading or possibly having some low-powered correction for distance vision, such as driving. The key: Set realistic expectations before the patient tries the lenses.

Pick up the phone.

“Once I get the patient in lenses, the very next thing I do is ask [him/her] to pull out their phone, and take a look,” says Dr. Kading. “This is important because I think a lot of practitioners immediately show the patient a distance chart, which can be displeasing [for the patient]. They came in with complaints about their reading vision and needing to wear readers — not their distance vision.” Dr. Kading says it is best to give them a “win” by correcting the vision that the patient is struggling with first.

“So now a patient who is used to having perfect distance vision is looking at a chart and seeing it differently. That makes for a potential negative first reaction to multifocals. But when they look at their cell phone first, they say, ‘Wow. I can see it.’”

Create the “Aha” moment.

For many patients, seeing their cell phone for the first time without readers is the typical “Aha” moment. They get why multifocals may be a great new option for them. In fact, that “Aha” moment can be so powerful to first-time contact lens wearers that Dr. Stewart Ellison says she capitalizes on it with her exclusive spectacle-wearing patients. She says she asks them to wear a pair of lenses in the dispensary so that they can see themselves in the mirror wearing new glasses.

Set realistic expectations before the patient tries the lenses.

“I’ve had so many patients who never tried them before be blown away by the comfort and the fact they can actually see their watch or their cell phone, that they end up wanting to try lenses right then and there — in the middle of the dispensary search for new eyewear.”

Because so many patients use the computer, Jerome M. Kramer, O.D., F.A.A.O., practicing in Westbury, N.Y., says he has patients sit at his own desk and take a look at the screen.

“The first word out of patients’ mouths is usually ‘Wow,’” he says. “They can’t believe they can see the computer so sharply without a reader. That’s usually the ‘Aha’ moment that convinces the patient lenses will work for their lifestyle.”

Overcome objections.

As when introducing any new technology, be prepared for objections. Cost may be an initial objection, however, in many cases, contact lenses can be cheaper if spectacle replacement was annual or even bi-annual. Dr. Kramer says patients respond well when he uses the analogy of a cell phone:

“Many patients have no problem paying $200 a month for a cell phone for the convenience factor, so we talk about multifocals in terms of convenience, and they [patients] become much more willing to pay that $400 or $500 multifocal contact lens bill each year.”

Dr. Gelner says the majority of other objections can really be “nipped in the bud” before the patient leaves the office. Most initial complaints have to do with clarity of vision, so she says she has patients wear the lenses for 15 minutes to a half hour in the office, allowing them to adjust. Then she sees the patient.

“Don’t let them walk out the door already unhappy,” says Dr. Gelner. “… make adjustments on the spot, and try to get them as happy as possible before they go out and experience real-life vision. Spending that extra time with the patient before they leave can make all the difference in determining whether they come back happy or not.” OM

Ms. Getz is a Philadelphia-area-based freelance writer and a former editor of Eyecare Business magazine (a sister publication of OM). E-mail her at, or send comments to

Optometric Management, Volume: 48 , Issue: January 2013, page(s): 16 18