Avoid dissatisfied multifocal wearers by following a few simple guidelines.

The most common challenges with multifocal contact lenses are compromised vision, difficulty in fitting, and uncomfortable wear. All these issues can be resolved in most cases by following a few guidelines that involve properly educating patients and setting their expectations, learning the design features of various multifocal lenses, and offering “add-ons” to all your presbyopic patients.

One of the most important elements is to have a candid conversation with your patients about their visual needs.When speaking with them, you can gather key information about their near vision difficulties. This allows you to “profile” them and begin to estimate their likely success with lenses. Things to consider when determining a good multifocal lens candidate include: personality, visual demands, age, and computer use; and reading, driving, and sports activities.

Setting realistic expectations about the quality of vision for various activities will lead to a better first impression of these lenses. Letting patients know that additional fine-tuning of the power or fit of the lenses helps to explain how, with determination, they will succeed with multifocal lenses. As doctors, we are aware that fitting this category of lenses can take more chair time, and your fees should reflect the expertise used and time taken with presbyopic patients.

Achieving success with fitting presbyopic patients in contact lenses and doing so proficiently requires being very familiar with the design features of various manufacturers’ multifocal designs (see “Multifocals At-A-Glance”). Variables such as a patient’s eye dominance, pupil size, and typical lighting conditions they work in need to be considered when evaluating which multifocal lens would be most suitable for an individual patient. Of course, the easy-to-understand fitting guides manufacturers provide help with initial lens selection.

There may come a time during a follow-up appointment when a patient might express that her distance vision is not quite clear enough for some activities, such as playing tennis or golf. If the patient is happy with the lenses for work-related activities and almost all other daily needs, consider prescribing a sports-related pair of contact lenses. This would simply be a distance-only prescription, and it can make a big difference in their sports performance.

Doctors have long prescribed more than one pair of eyeglasses based on a patient’s needs. What’s preventing a patient from putting in a different pair of contact lenses when he goes for that weekend bike ride? It’s just that we don’t think in those terms with contact lenses as we do with second pair sales for eyeglasses.

In addition, presbyopic patients as a group experience more problems with dry eye than a younger population. As a result, comfortable contact lens wear can be elusive for some patients. The combination of prescribing artificial tears, recommending specific lens-cleaning solutions, and treating any lid margin disease can be essential for satisfied multifocal lens wearers.

Being prepared about how to correctly present multifocals is crucial because during the next few years a greater number of your patients will be more aware of having the option of contact lenses to correct their presbyopia as opposed to traditional eyeglasses.

Eric L. Bran, Professional Editor of Ophthalmic Office, is in a private group practice in Ridgefield, CT and is co-director of The Institute for Sports Vision. He is also an associate consultant for The Power Practice® .



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