T How to Increase fitting Success with Soft Multifocal

cover story
How to Increase
Fitting Success
with Soft Multifocal
Contact Lenses
Patients’ education in and out of the exam room is key.
BY BRIDGITTE SHEN LEE, OD
T
his article will explore the why, how, and what
of success in fitting patients with multifocal
contact lenses.
WHY: TO IMPROVE PATIENTS’
QUALITY OF LIFE
Like most eye care professionals around the world,
we are faced with the daily challenge of meeting the
wishes of our ever-growing presbyopic patients to stay
in contact lenses and to satisfying their demanding
visual needs. The US contact lens market is expected
to increase to 34 million people by 2018. The segment aged 50 years and older is projected to make up
28% of all potential contact lens wearers by this time.1
Furthermore, almost all adults use more than one digital
electronic device for more than 10 hours daily.2
Understanding the challenge of keeping our patients
with presbyopia happily wearing contact lenses and
effectively communicating with them will help us to
have more success fitting soft multifocal lenses. As a
mildly myopic emerging presbyope, a busy working
mom, and a daily user of a smartphone, tablet, laptop,
and desktop myself, I understand what our patients
need. They want eye care and eyewear solutions that
improve their quality of life, reduce eyestrain and fatigue,
as well as allow them to enjoy visual freedom and maintain a more youthful appearance.
“As the technology
used in spectacle lenses
and contact lenses improves,
we have more choices than ever
to help our patients.”
HOW: TEACH PATIENTS “20/HAPPY TO
STAY IN CONTACT LENS VISION”
As the technology used in spectacle lenses and contact lenses improves, we have more choices than ever to
help our patients. For those who are good candidates
for soft multifocal contact lens and who have a desire to
stay in contacts, review the available options. By helping
patients understand the design of soft multifocal contact lens, they develop realistic expectations during their
adaptation, therefore increasing their compliance and
success. At our practice, we tell our patients that the perfect multifocal contact lens that provides perfect 20/20
visual acuity at all distances has yet to make its debut.
There are, however, quite a few products that will give
them the 20/happy vision that allows them to stay in
contact lens without compromising their busy lifestyles.
january/february 2014 Advanced ocular care 59
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WHAT: OUR PATIENTS PREFER AIR OPTIX
AQUA MULTIFOCALS
Selection of the right candidates is essential to success with soft multifocal contact lenses. Patients who
are in their late 30s or older, have a high near demand at
work, a healthy ocular surface with no dry eye disease,
low astigmatic correction (up to 1.00 D), and moderate
to high myopic or hyperopic correction make for ideal
candidates.
The current available silicone hydrogel or daily disposable soft multifocal contact lenses are:
• one center-distance concentric design (Acuvue
Oasys for Presbyopia, Vistakon Division of Johnson &
Johnson Vision Care, Inc.)
• one center-near and center-distance design (Biofinity
Multifocal, CooperVision)
• one center-near single-profile aspheric design
(Proclear 1-Day Multifocal, CooperVision)
• two center-near profile aspheric designs (PureVision
Multi-Focal, Bausch + Lomb [low and high add] and
Clarity 1-Day Multifocal, Sauflon Pharmaceuticals
Limited)
• center-near precision profile biaspheric design (Air
Optix Aqua Multifocal, Alcon Laboratories, Inc. [low,
medium, and high add]
• center-near precision profile aspheric design (Dailies
AquaComfort Plus Multifocal, Alcon Laboratories
[low, medium, and high add])
No one contact lens design works for every patient.
At our practice, we fit different multifocal contact lenses
based on a patient’s lifestyle, visual needs, ocular conditions, and actual prescription. Overall, our patients have
preferred the Air Optix Aqua Multifocal contact lens
because they get true binocular and clearer vision at all
distances.
FITTING PEARLS
The following fitting pearls for use with the centernear, precision profile, biaspheric-design multifocal contact lens have helped us:
• Follow the fitting guide and give equal add on both
eyes. Do not fit this lens as a modified monovision
lens.
• Over-refract/push plus (+0.25 D increments) over
one eye at a time while the patient views binocularly
at a real-life distance target, preferably outside of
the examination room. The aspheric design of this
lens (adaptive minus power profile) allows you to
push more plus at distance without compromising
distance vision, keep add power equal, and maintain
binocular vision.
• Change trials on the initial day of fitting if push
60 Advanced ocular care january/february 2014
“If we take the time to share
with our patients why we believe
that a multifocal contact lens will
improve their lives, our patients
will work with us to make wearing
multifocal lenses successful.”
plus is accepted, and repeat the push plus to start
the troubleshoot at the follow-up appointment if
needed.
• Educate patients on how this lens is designed
(center-near), and ask them to turn on the light
when they read and put on good polarized sunglasses when they go outside while wearing this lens.
CONCLUSION
With the ever changing demand on the aging population’s visual systems and patients’ clearer preference for
binocular vision over monovision, it is important that we
educate our presbyopic patients about their choices and
fit more multifocal contact lenses to match their lifestyle
needs. If we take the time to share with our patients why
we believe that a multifocal contact lens will improve
their lives, our patients will work with us to make wearing multifocal lenses successful.
This statement by Simon Sinek in his book, Start with
Why: How Great Leaders Inspire Everyone to Take Action,
sums it up perfectly: “People don’t buy what you do; they
buy why you do it. And what you do simply proves what
you believe.”
As more single-use daily disposable multifocal lenses
come into the market, we now have even greater opportunities to help improve our patients’ quality of life! n
Bridgitte Shen Lee, OD, is the cofounder of
Vision Optique in Houston, and she also owns
iTravelCE, an optometric continuing education
company that bridges the Asian and American
optical industries. She is a consultant to Alcon
Laboratories, Inc., and Essilor Laboratories and serves on
their advisory boards. Dr. Shen Lee may be reached at
visionoptique@sbcglobal.net.
1. Studebaker J. Soft Multifocals: Practice growth opportunity. Contact Lens Spectrum. 2009;24(6):40-43
2. Vogt A. Innovations in improving contact lens designs. Advanced Ocular Care. January/February 2013;47-48.
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