Multifocals in Action
Test these tried-and-true contact
lens fitting tips.
We're all aware that multifocal
contact lenses are booming. The number of multifocal contact
lenses dispensed in 2000 grew by 30%, according to Joe Barr, O.D.,
M.S., F.A.A.O., editor of Contact Lens Spectrum, the leading
contact lens journal. The bifocal disposable category alone grew
by more than 45%.
Each year, 4 million Americans
become presbyopic, and multifocal contact lenses fit their needs.
Multifocal soft lenses alone are expected to grow from a $16
million market in 1998 to a $184 million market in 2003.
To help you hone your skills with
this modality, here are some helpful fitting tips from doctors
all over the country.
Here are three quick tips you
should always keep in mind when fitting multifocal lenses:
- When reaching for a rigid gas
permeable (RGP) multifocal, always use an aspheric design
first. They're easy to fit, have superior visual
performance and are many times more comfortable.
- If you have an existing RGP
wearer entering presbyopia, always prescribe an RGP
multifocal. These patients are the closest thing to a
perfect multifocal contact lens candidate.
- In my experience, the main
area for failure with bifocal contact lenses is distance
vision. This leads me to choose aspheric designs first
and pick up poor reading with an auxiliary spectacle.
Remember, wearing an auxiliary spectacle up to 20% of the
time still signifies a successful fit.
-- Milton Hom, O.D.,
When fitting RGP multifocal and
bifocal designs, it's critical to make this experience as
comfortable and natural as possible. The use of a topical
anesthetic is important because the natural lens awareness they'll
experience will occur gradually. In addition, use diagnostic
lenses in combination with the predicted over-refraction in a
trial frame so that vision will be optimum immediately after lens
-- Edward Bennett, O.D.,
St. Louis, Mo.
One of the most important things
you can do when fitting a patient with a bifocal contact lens is
ask him about his computer use. If set up correctly, the computer
is a different distance (over 20") than "normal"
reading distance (16"), so be sure that whichever lens you
supply covers that viewing distance as well. Most likely you'll
choose an aspheric or concentric design.
-- Jeffrey Anshel, O.D.
fit bifocal contact lenses for many years, I've developed two
simple rules that have worked well in our seven-doctor practice:
- Have a fair no-fault refund
policy that you can explain up front to patients before
they're fit with any bifocal contact lenses. In our
office, we offer a 2-month full satisfaction guarantee.
If for any reason a patient decides not to continue with
his contact lenses, we'll refund the full cost of the
lenses. Examination and fitting fees aren't refundable.
- Never prejudge who's a
candidate for bifocal contact lenses. Of course, it's
imperative not to undertake cases that are medically
contraindicated, and it's absolutely critical that you
fully explain the lower likelihood of success in
difficult cases. I can't tell you how much my contact
lens practice has grown because of this simple philosophy.
Many borderline patients have always wanted to try
bifocal contact lenses but were discouraged by their
previous practitioner. A fair up-front refund policy
gives you the freedom to offer these services to most
-- Robert Bauman, O.D.
Keep in mind that monovision still
has a place. In fact, about half of the successful soft
multifocal fits utilize some degree of modified monovision. With
the Acuvue Bifocal, this often means unequal adds (using a lower
add for the "distance" eye), and with other designs it
can mean over-plusing the "near" eye.
Locking in on the idea that both
eyes need to be equal cuts success rates in half. And, locking in
on the "dominant" eye is another way to be wrong half
the time. Patients who are successful with monovision or modified
monovision are switch-hitters, and determining whether or not a
patient has this flexibility is key to using these techniques.
-- Peter Bergenske,
Middleton Branch, Wis.
The best way I've found to
increase our success with bifocal lenses is to let the patient
try the lens. What I do is spend a little time and talk to the
patient about bifocal contact lenses. I explain our fees and
contact lens fitting policies. I also tell him that he can try
the lens for free. I do this by first placing a pair of lenses on
the patient. I then have him sit in the waiting room for 15 to 20
minutes to allow the lens to settle. Then, I call him back into
my room to check the fit and visual acuity. That's when the
patient must decide if he wants to continue. If he says no, then
he isn't charged for the fit. If he says the lenses are okay but
not perfect, I tell him that it's part of the fitting process.
Depending on his vision, it may get better. But, if he wants to
continue, then he'll be charged.
-- Deepak Gupta, O.D.,
In an imperfect world, multifocal
contact lenses are somewhat of a compromise in the category of
outstanding visual acuity. Therefore, in our practice, where a
larger number of our patients participate in recreational
activities, I always design multifocal contact lenses to suit the
specific needs of my athletic patients. For example, a golfer
must be able to locate his shot when it lands. My inclination is
to slightly increase the distance prescription and underplay the
near component of the lens. By doing this, the golfer can watch
his tee shot in progress, read the green accurately and see the
ball clearly at impact. The only compromise is not being able to
read the scorecard as clearly. With the way many of us play golf,
this may actually be an advantage!
-- Don Teig, O.D., F.A.A.O.
When fitting a bifocal contact
lens patient, trial frame with loose spectacle lenses. This
allows the patient to grasp the concept, while you determine if
it's a viable alternative. Remind the patient that he may need
over-correction for driving, computer use and long-term reading.
Also explain why the lenses may not be appropriate. Honesty and
skill make your patient more receptive to your recommendations.
--Pamela J. Miller,
O.D., J.D., F.A.A.O.
Optometric Management, Issue: February 2001