TROUBLESHOOTING MULTIFOCAL CL PROBLEMS

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Find out which products help solve common multifocal cl fitting issues.

CooperVision’s Proclear Multifocal includes phosphorylcholine to minimize dryness symptoms and provide better end-day comfort.

Advances in materials, designs, and disposal and planned replacement modalities have brought multifocal contact lenses into the mainstream. Although the latest technology has provided patients with lenses that fit well and maintain good ocular health, new multifocal wearers may have some apprehensions. Fortunately, there are multiple lens options that enable optome-trists to offer up solutions and present the best modality.

COMFORT CONCERNS
Dryness, especially among menopausal and peri-menopausal women, is the most common complaint of contact lens wearers. Many presbyopic patients also have arthritis, thyroid disease, and other systemic health problems, or are taking medications that contribute to dry eye symptoms. The phosphorylcholine in CooperVision, Inc.’s Proclear® Multifocal and the HYDRACLEAR® PLUS technology in ACUVUE® OASYS® for PRESBYOPIA from VISTAKON, Division of Johnson & Johnson Vision Care, Inc., can help to minimize dryness symptoms and provide better end-day comfort.

INADEQUATE NEAR VISION
With spectacles, the eyes rotate through various zones on the lenses in

Bausch + Lomb’s SofLens and PureVision can resolve patient concerns over ‘starbursts’ and ‘halos’ when driving at night.

order to achieve acuity at all ranges. With contact lenses, rays of light from all distances enter the pupil simultaneously. Adapting to multifocal contact lenses may take time, even two or more weeks. The brain must learn to process and resolve simultaneous images and choose the image at a distance at which one needs to see and filter out competing images from other distances. Good communication and reassurance will help patients persist with their multifocals until maximum near vision is achieved.

Patients with small pupils in particular may have difficulty with near vision when wearing multifocal lenses—especially with a center-distance design. Center-near multifocals, such as Bausch + Lomb’s SofLens® and PureVision® Multi-Focals and Unilens Vision Inc.’s C-VUE® Multifocals work best for these patients, as well as CIBA VISION’s AIR OPTIX® AQUA MULTIFOCAL, which offsets loss of accommodation by increasing depth of focus.

UNWANTED 3D  Patients fit with center-near multifocals sometimes remark that “print seems to stand off the page like it’s in 3D” or “there’s a shadow under the letters.” This is referred to as the “3D” effect. It’s related to the initial inability of the brain to determine simultaneous images and will settle in a week or two as the brain learns to filter out unwanted images. Explanation, reassurance, and time will resolve the 3D effect.

Mature presbyopes may need more close vision than the maximum add in current multifocals. A modified monovision approach often meets their needs. If they are already maxed out, the non-dominant eye can be overplussed, providing better near vision while good distance is maintained in the dominant eye. Alternatively, it is possible to obtain add powers as high as +4.00D on CooperVision’s Proclear Multifocal XR. If distance vision is adversely affected by attempts to improve near vision, “booster” glasses may be needed for intensive close work.

DECREASED DISTANCE VISION
Our pupils constrict significantly in bright light, especially in the southwestern U.S., where there is often little or no cloud cover, or at the seashore. In conditions such as these, the pupils may become so small that it’s difficult for distance rays to be properly imaged on the retina with a center-near multifocal design. Sunglasses allow the pupil to enlarge and improve distance vision, but these patients might do better with a multifocal that has a central distance bias, particularly the ACUVUE OASYS for PRESBYOPIA by VISTAKON, which also has a ultra-violet blocker.

Patients who require very good distance vision or those whose distance

CIBA VISION’s AIR OPTIX AQUA MULTIFOCAL offsets loss of accommodation by increasing depth
of focus.

vision is not good enough with center-near multifocals are good candidates for center-distance lenses. Athletes, especially golfers, find that center distance multifocals meet their needs well. A golfer needs good intermediate vision for teeing off, good distance vision for following the ball, and minimal near vision for seeing the scorecard. Excellent distance vision is also essential for police officers, emergency workers, and pilots.

FLARE AND HALOS
Patients wearing center-distance lenses may have clear distance vision during the day but be bothered by “starbursts” and “halos” around headlights and streetlights when driving at night as the pupil dilates and more light enters through the intermediate and near zones of the lenses. These symptoms may resolve if patients are refit with center-near multifocals, such as Bausch + Lomb’s SofLens and PureVision; Unilens’ C-VUE Multifocals; CIBA’s AIR OPTIX AQUA MULTIFOCAL; or Cooper-
Vision’s Frequency® 55 or Proclear Multifocal “N” (center near) lenses.

MONOVISION TO MULTIFOCALS
Successful monovision lens wearers will lose most of their accommodation when they become mature presbyopes. At this point, they must choose between good vision at the intermediate range and good vision at close range. This is an excellent time to introduce them to multifocal lenses. Most will adapt to the new way of seeing things and can be successfully fit with one or more center-near or center-distance multifocal designs.

Those who don’t adapt to these designs are ideal for CooperVision’s “Balanced Progressive Technology” lenses. Balanced Progressive Technology can be achieved with Frequency 55 or the Proclear Multifocal. The patient’s dominant eye is fit with the “D” lens, which has a 2.3mm spherical central distance zone surrounded by annular aspheric intermediate and spherical near zones. This should provide 20/20 vision for distance and the equivalent of 20/40 vision at near. The non-dominant eye is fit with the “N” lens, which has a 1.7mm central spherical zone for near, surrounded by annular aspheric intermediate and spherical distance zones. This should provide the equivalent of 20/20 vision at near and 20/40 at distance.

Alternatively, using the lowest add of a center-near or center-distance multifocal in the dominant eye and a higher add in the non-dominant eye may simulate monovision and promote adaptation.

Don’t limit your lens fitting in this category with a few multifocal options—using lenses from all manufacturers allows you to ensure the right fit.

Phyllis L. Rakow is Director of Contact Lens Services for The Princeton Eye Group in Princeton, NJ.

WHERE TO FIND IT
Bausch + Lomb
800-828-9030 • bausch.com

CIBA VISION
800-241-5999 • cibavision.com

CooperVision, Inc.
800-341-2020 • coopervision.com

Unilens Vision Inc.
800-446-2020 • unilens.com

VISTAKON,
Division of Johnson & Johnson Vision Care, Inc.
800-843-2020 • jnjvisioncare.com

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