Educate Your New
RGP Bifocal Patients

BY DAVID W. HANSEN, O.D.
AUG. 1996

Education is critical to the overall success of bifocal contact lenses. Patients usually know nothing about presbyopia, and are unaware of how bifocal and multifocal contact lenses work. So, we need many educational tools to effectively inform them about their changing vision.

First, we must educate the patient on the process of presbyopia, then we must select an RGP bifocal design, and finally, once we've prescribed for the patient, we must provide him with a new set of parameters for seeing.

The dispensing visit for an RGP bifocal patient involves more than the 'normal' contact lens educational visit. We must demonstrate what the contact lens design looks like, how it translates on the cornea, and where the patient needs to move his eyes and head for maximum visual acuity.

SIMULATING THE REAL WORLD

It may be appropriate to have patients sit in front of a computer or at a desk in your office to simulate their work environment. We use two different settings to help patients understand their bifocal contact lenses.

After an assistant applies the contact lenses, I return to discuss the style of the lens, and how the patient must move his eyes from far to near. This also helps me document initial visual acuity for distance, intermediate and near. If it appears we may need to modify the lenses, we record this on the exam form. We inform the patient about adaptation during the first week or two of bifocal lens wear. We use different training techniques for patients who have never worn contact lenses versus former RGP contact lens wearers.

FIG. 1: DISTANCE VIEWING OF A TRANSLATING BIFOCAL CONTACT LENS.

FIG. 2: POSITIONING OF CONTACT LENS FOR NEAR VISION WITH A TRANSLATING BIFOCAL CONTACT LENS.

THE NEW CONTACT LENS WEARER

Patients who've never worn contact lenses experience a twofold adaptation -- first, becoming accustomed to the lens on the eye, and then getting used to the bifocal or multifocal process. If lens awareness is a problem, we modify the edge immediately to help accelerate adaptation. Be aware, though, that an extreme modification may alter the fit. This is one of the reasons I believe the practitioner should take an active part in a patient's first day of wear. Professional judgment is needed during this critical time.

THE PREVIOUS CONTACT LENS WEARER

Even patients who have worn contact lenses before need education, especially with the translating process of most multifocal or bifocal lenses. They need to know how to hold reading material, where to look and where to guide their eyes. Most patients must be shown how to keep their head still and use eye movement for easy viewing in multiple zones.

HELPFUL EDUCATIONAL MATERIALS

Slide-audio presentations, videos, charts, diagrams and brochures improve the effectiveness of the overall education. Since there are many multifocal and bifocal RGP designs, you can either develop brochures or use existing materials that explain simply the multifocal styles and the viewing areas needed for individual visual tasks.

FOLLOW-UP

Carefully review your instructions during follow-up appointments. If problems develop, it's possible, and often quite probable, that better education is needed, not lens modification. Remember, fitting skills are mandatory with RGP bifocals, but patient education helps determine success. CLS

Dr. Hansen, a cornea and contact lens diplomate and fellow of the American Academy of Optometry, is in private practice in Des Moines, Iowa.

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