When my practice was fairly new, about 5 years old, my contact lens distributor dropped by, and had some usual stats, as well as new stats, for me. I was surprised to find that my practice was the number one practice in the state, at that time, in fitting and selling multifocal contact lenses. I was shocked, because at that point in my practice history, I was only seeing patients three days per week, and even then, was not totally full. How was it possible that clinics, literally seeing 20 times more patients than I was, were not surpassing my multifocal fits and sales?
After discussing for a bit, and talking to a few other practices, their staff and doctors, I found that the key for me was implementing three main steps. Let me detail those steps here:
1. Actually bringing up the option of a multifocal contact lens. I say “actually” because many doctors think they are doing this, but in reality, less than ten percent of all optometrists are mentioning multifocal contact lens options to their patients. I can already hear the objection in your minds. “But they don’t work! Patients aren’t satisfied with their vision…” to which I direct you to #2:
2. You must set REALISTIC expectations for your patients when fitting these lenses. This is the most vital of all the steps, as this will help self-select the patients who are the best, and worst, candidates for these lenses. Here is what I say, verbatim, to patients:
Multifocal contact lenses work differently than glasses. Your eyes and your brain figure it out, but understand the quality of your vision may not be the same as your glasses. The key is in the flexibility these lenses give you in not depending on glasses full time.
A realistic goal is that you are free from having to reach for reading glasses 75% of the time. Some patients need them more than this, some less, but this varies on what you are doing with your eyes every day and what your prescription is. (Every patient’s goals are different, and you may have someone who is thrilled to have great near vision 50% of the time). There are certain situations that are still going to be difficult: dimly lit restaurants, small print, and when your eyes are tired.
You must give yourself time to adjust to these lenses, as there is neural adaptation over the first week you wear them. Adjusting the powers may be necessary, and that’s normal and expected (so when and if you don’t have to adjust them, everyone is surprised and delighted). After wearing them for many days, you will figure out what your goals with these lenses are, and we can work with that to finalize the prescription.
3. Follow up is key. After telling the patient all I have listed out in #2, many will determine that this is (or isn’t) for them. If fitting does proceed, follow-up, whether in the exam lane, or via email/phone call check in, is important. Much of my troubleshooting can be figured out without an office visit. Educate your patients that these lenses can be prescribed along with other contact lens prescriptions, such as a distance-only Rx. I find that most are much more amenable to having multifocal contact lenses if they understand it’s not the “only” contact lens they will have on hand to use.
In regards to other practicalities, be sure to follow the fit guides of your multifocal lens options. Much time and energy have been put in to creating these, so don’t assume one multifocal lens fits like another. Ask your reps for support as well. The variety of lens options that are on the market, and have most recently hit the market, make it so almost any patient can be fit in multifocal lens technology. In the world of vastly growing arenas of competition, expertise in fitting multifocal lenses is a hard space to replace or automate. Do yourself and your patients a favor and lean in.
Gina M. Wesley OD, MS, FAAO owns and practices at Complete Eye Care in Medina, MN. Accolades include Minnesota's Young Optometrist of the Year in 2011 and the Early Professional Achievement Award from The Ohio State University College of Optometry in 2013. She is a member of the American Optometric Association, a fellow in the American Academy of Optometry and enjoys practicing, writing and lecturing in the industry. For questions or comments about this article, please contact firstname.lastname@example.org.