|The DAILIES AquaComfort Plus Multifocal combines Alcon’s Precision Profile Design with blink-activated moisture to provide all-day comfort.|
|CooperVision’s Biofinity multifocal offers the ability to choose between the D and N lenses to better fit to a patient’s individual needs.|
Recent technological advancements have led to an increase in patient acceptance.
As patients age and their visual demands continue to affect their ability to properly focus, multifocal contact lenses (MFLs) become an important aspect of maintaining comfortable vision. Finding a balance of good vision and comfort for your presbyotic patients can be challenging, and the wrong prescription could lead to a patient giving up their lenses altogether. Luckily, though, today’s advanced designs and improved lens materials provide excellent options for those of us who fit MFLs, opening up an area of practice growth that should continue to increase. Here are some patient scenarios and comments from doctors about their preferred choice of MFLs.
One patient, a 46-year-old real estate agent, presented for her yearly eye exam. She was wearing glasses for various distance needs, such as driving, television viewing, and watching her kids play sports. She is only mildly nearsighted (-0.75 OU), so not wearing her glasses during most of her day hadn’t been much of an issue. Over the last year, however, maintaining clear near vision for reading small print, such as her real estate listings, had become more challenging. Now that her distance vision isn’t the only issue, she expressed an interest in wearing contacts again, as she’d previously worn them for a number of years in college and into her 30s.
After reviewing her topography measurements and explaining how she’d notice an improvement in her range of focus with MFLs, it was recommended she try daily disposable MFLs and she was fit with CooperVision’s Proclear‘ 1 Day multifocal lenses. The prospect of not having to constantly clean her lenses as she did many years ago was very appealing to her, and she was immediately surprised by their comfort and the improvements she realized in both her distance and near vision. At her one-week follow-up appointment, she confirmed that her near vision was now great and that her distance vision was better than ever, as she had noticed that morning when she’d worn them when playing a tennis match.
Another patient, a 55-year-old computer science teacher at the local middle school, came in for his yearly eye exam. He’d been wearing Alcon’s AIR OPTIX‘ Night & Day‘ CLs (-6.00D OU) throughout the day and using +1.75D readers on top for near work. While helping students at their computers, he found that he couldn’t clearly see their laptops or tablets while standing next to them. For that reason, he’d been wearing his contacts less often and wearing his progressive glasses to work most of the time. After explaining the improvement that MFLs would provide for intermediate distance, he was fit with AIR OPTIX AQUA Multifocal lenses and he found the intermediate vision was exactly what he needed to help him at his job.
I asked some of my colleagues about their favorite MFLs and their top fitting tips. Here’s what they shared with me.
Alicia Telega, OD,
Shadyside Eye Associates,
“Currently, one of my favorites is Alcon’s DAILIES‘ AquaComfort Plus‘ Multifocal lenses. They’re definitely my new “˜go-to’ lens for the majority of my presbyopic patients. They’re easy to fit, and most patients love the comfort and ease of a one-day lens. Since many of my patients are already using one-day lenses, it’s great to allow them to stay with their preferred modality while achieving acceptable vision. I have a large dry-eye practice as well, and I find that most presbyopic patients who have dropped out of their lenses due to comfort issues are able to wear this lens. It’s great for part-time wearers, too. That’s a really big bonus for this group as they may not be able to wear a lens all day, every day, because of the high visual demands at work and on computers, but they love the ease of a daily disposable for social events and vacations so they can still enjoy great vision.
“My other favorite is CooperVision’s Biofinity‘ multifocal. I love the optics of this lens and the ability to choose between the D and N lenses to better fit to a patient’s individual needs””if she needs better computer vision or better distance vision, for example. The center D is really great technology and I’m also fitting it a lot for myopia control in my younger patients. As with all my multifocal contact lens fits, I always educate patients on the limits of the lens and potential side effects, like reduced depth perception and ghosting. Choosing the right patient with the right motivation is also key.”
Scott A. Tomasino, OD,
Iverson-Tomasino-Goerss Eyecare Associates,
“In our practice, we believe daily disposables are the best option for contact lens wearers. Until recently we didn’t have a lot of options for daily disposable multifocals and I feel the designs that were available weren’t up to par compared to what was out there in monthly options, and Biofinity and AIR OPTIX were our preferred designs in the monthly segment.
“For patients who are migrating from monovision (which I find is preferred by most of my presbyopic patients, especially early presbyopes), CooperVision’s Proclear 1 Day multifocal has been well received. It utilizes the principal of less plus on the dominant eye to create a modified monovision concept that enhances performance. This works quite well, particularly in the low add range. My other favorite is Alcon’s DAILIES AquaComfort Plus Multifocal lenses. The company took the successful AIR OPTIX multifocal design and built it into this daily disposable lens, adding the convenience and health benefits of a daily disposable modality. It works well for us in the mid-to-higher add range. There’s no question that careful screening and setting realistic expectations are the keys to success when working with multifocal contact lenses.”
Laurence Lonky, OD,
Cortlandt Eye Care,
Cortlandt Manor, NY
“The most important factor in the successful fitting of presbyopic patients for contact lenses is understanding and managing their needs and expectations. While we shouldn’t be limited by the patient’s stated desires at the start of the evaluation, they need to know that we “˜hear them’ as we move forward with the fitting process. With experienced CL wearers, discussing their satisfaction with their present mode of lens replacement may open the door to changing to daily disposables or staying with a preferred, successful replacement schedule. For lens wearers who are emerging presbyopes, I find almost any design works well, and their familiarity with the brand you’ve fit them with before goes a long way in building confidence and trust. For higher presbyopes, other variables such as pupil size, near vision demands in the workplace, and dry eye come into play. Here, I find that the enhanced combinations available with the Biofinity multifocal is very helpful, especially in offering good vision for the computer.”
Eric L. Bran, Professional Editor of Optometric Office, is in private group practice in Ridgefield, CT.
WHERE TO FIND IT:
Alcon Laboratories, Inc. •800-451-3937 •alcon.com
CooperVision, Inc. •800-341-2020 •coopervision.com