|Alcon’s Air Optix Aqua Multifocal lens is approved for both daily or extended wear.|
|Bausch + Lomb’s PureVision Multi-Focal is replaced monthly and is available in two add powers.|
|ACUVUE OASYS for Presbyopia by VISTAKON features a center-distance aspheric zone surrounded by alternating aspheric zones on its front surface.|
|C-Vue Advanced HydraVUE Multifocal by Unilens, a monthly silicone hydrogel lens, is completely customizable.|
Reduce myopia progression and digital Eyestrain with multifocal contact lenses.
As practitioners, we’re used to speaking with our patients about the inevitable focusing changes that occur when patients are in their forties. Fitting presbyopic patients with multifocal contact lenses is commonplace, yet not the only opportunity that exists. If we look at multifocal lenses from a different perspective, patients that have accommodative disorders, experience digital eyestrain, or are interested in reducing myopia progression can benefit greatly.
Patients who are working on computers for hours and hours each day””and let’s face it, who isn’t””often present as symptomatic blurred near vision, with difficulty switching or maintaining focus, as well as blurred distance vision at the end of a work day. Eyestrain and headaches are potential signs that a patient’s focusing can be improved. With such a high percentage of your patients using computers and mobile devices, asking a few specific questions when taking their history can prove valuable in uncovering digital eyestrain.
Performing near point tests and evaluating a patient’s accommodation can reveal why they have focusing problems. This information will help guide the conversation about how multifocal contact lenses can assist. While vision therapy may help reduce or eliminate the symptoms, patients may not have the time for therapy. Properly prescribing multifocal contact lenses as an alternative to reading glasses may be a good solution.
Remember to push plus during the refraction and consider the amount of time a person works on the computer. Correcting to “20/happy” may be better than a perfect 20/20 depending on the patient. Discuss the idea of modifying your patient’s prescription based on their visual complaints. Choose the new lenses and assess their fit. The most important thing may not be how clear the eyechart looks in the exam room, but how clear and comfortable your patient’s day-to-day vision seems, especially in the workplace.
The American Optometric Association’s Think About Your Eyes campaign is helping bring additional attention to digital eyestrain. Its ads emphasize the message from The Vision Council that proves 70% of those who use computers and mobile devices experience problems such as eyestrain and headaches.
As eyecare professionals (ECPs), we have the opportunity to help patients with these symptoms and improve their vision and quality of life. Prescribing multifocal contact lenses to patients who are not yet presbyopic may be an effective way to reduce symptoms of strain and fatigue.
THE MULTIFOCAL FAMILY
Familiarity with the various design features of each company’s multifocal lenses is important to achieving successful fits. A patient’s eye dominance, pupil size, visual demands, and typical lighting conditions they work in are important to consider when evaluating which multifocal lens would be best. Fortunately, contact lens manufacturers provide easy-to-understand fitting guides to assist ECPs with initial lens selection and trouble-shooting.
With silicone hydrogel lens material continuing to grow in popularity, there are a number of available lenses to achieve success with your patients.
- Alcon’s Air Optix‘ Aqua Multifocal lens, for example, is made of silicone hydrogel material and has three available add powers. It is approved for both daily wear or extended wear (up to six nights) and is a monthly replacement lens. It has a center-near design to provide clear vision at every range.
- Alcon also offers DAILIES‘ AquaComfort Plus‘ in both multifocal and toric with three add powers for clear binocular vision near through far.
- Biofinity Multifocal (CooperVision) uses a proprietary Balanced Progressive Technology. With separate “D” and “N” designs, a wide array of visual needs can be met by using various lenses. Four add powers are available. Patients can wear these lenses as either daily or extended wear, and monthly replacement is recommended.
- ACUVUE‘ OASYS‘ Brand Contact Lenses for Presbyopia (VISTAKON) has three add powers and can be worn as either daily or extended wear. Replacement is every two weeks. It features a center-distance aspheric zone surrounded by alternating aspheric zones on its front surface.
- PureVision‘ Multi-Focal (Bausch + Lomb) is a center-near, anterior aspheric multifocal that can be worn as daily or continuous wear for up to 30 days. The lens is replaced monthly and is available in two add powers.
- B+L also offers PureVision‘2 Multi-Focal contact lenses for presbyopia, another center-near, anterior aspheric multifocal. This one, however, is indicated for patients with presbyopia for daily or extended wear up to 30 days. The lens is replaced monthly and is available from +6.00D to -10.00D powers in either high or low add powers.
- C-Vue Advanced HydraVUE Multifocal (Unilens Corp), a monthly silicone hydrogel lens, has the widest range of power availability (+20.00D to -20.00D) and add powers up to +3.00D. Thanks to an extensive range of base curves, this monthly disposable lens can fit most presbyopic patients and is completely customizable.
DEALING WITH CHILDREN
For years, optometry has been studying methods to slow myopia progression in children. While there’s been evidence that multifocal lenses can slow myopia, the studies generally had a duration of one year.
Last year, a small study (27 children) by researchers at Ohio State University found that wearing multifocal contact lenses reduced the rate of myopia progression over a two-year period. Multifocal lens wear resulted in a 50% reduction in the progression of myopia and a 29% reduction in axial elongation compared to a historical control group that wore single vision soft contact lenses.
Children aged 8 through 11 were fit with Proclear Multifocal “D” lenses (CooperVision) in each eye. The peripheral defocus is believed to create a signal to stop further growth. Further studies are needed to learn more, but the results are meaningful and, in my opinion, are an important topic to discuss with young patients and their parents in the exam room. Think how appealing it is from a parent’s perspective to know they can make a decision, with your guidance that may prevent their child from becoming significantly nearsighted.
If parents see their child become more nearsighted over the years, and they went through this process themselves younger, it creates a wonderful opportunity to discuss myopia progression and methods to slow it. Most patients haven’t heard of the use of multifocal lenses with children or the benefits of orthokeratology lenses. By discussing these choices with your patients and their parents, you offer them a chance to take control of the future of their vision. While not as aggressive as orthokeratology lenses, soft multifocal lenses may offer a potential alternative to myopia control. They may be appropriate for those patients who are not ready to take the plunge, either from a commitment standpoint or cost perspective.
While I recommend discussing ortho-k early on, you can also talk about how multifocal lenses may achieve the desired results as well. There are many successes within the multifocal family so continue to keep your patients informed.
Eric L. Bran, Professional Editor of Optometric Office, is in a private group practice in Ridgefield, CT.
WHERE TO FIND IT:
Alcon Laboratories, Inc.
Bausch + Lomb
Unilens Vision Inc.
VISTAKON Division of Johnson & Johnson Vision Care, Inc.