Multifocal Contact Lenses
TODAY

BY ROGER F. SHAW, O.D., SHONDA ACHORD, O.D., & CHRISTINE NORRED, O.D.
AUG. 1997

Just as diversification can infuse new life into a corporation, it can energize a contact lens practice. Satisfy more presbyopes with a diverse inventory of multifocal contact lenses.

Bifocal, multifocal and progressive spectacle lenses have been available for years. Today, we have an abundance of bifocal, multifocal and progressive contact lenses that bode well not only for patients committed to continuing their use of contact lenses, but also for practices that want to retain their patient base and boost profitability. Clearly, contact lenses for presbyopes represent the single biggest new market for eyecare professionals.

Now we have the means of meeting the demand of millions of baby boomers approaching or in their early presbyopic years who have worn contact lenses since high school and don't want to stop. Many of these patients are stretching the limits of good vision to continue wearing their contact lenses, unwilling to turn to spectacles, and often uninformed about the new contact lens technologies that could help them see clearly, even as their presbyopia advances.

THERE ARE NO COOKIE-CUTTER SOLUTIONS

Fitting bifocal contact lenses is not without challenges. But you can turn these often time-consuming challenges into added benefits. You also have to recognize that to successfully fit multifocal contact lenses, chair times will vary. While one patient might declare the first bifocal lens a winner, the next may require four or five tries to achieve visual success. No practitioner has ever had the perfect patient who can wear any contact lens made for presbyopia. However, in our office we can generally fit 80 percent of patients in multifocal contact lenses within two visits. Your objective? Be sure your patients find comfort and can see clearly before they leave the office.

Both you and your patients must be open-minded and willing to try various designs. Most bifocal lenses tend to work on no more than 50 percent of the patient population. If you use lenses from 10 different manufacturers, your success rate may approach 90 percent. So, with a full inventory and the availability of new customized RGP bifocal designs, your success rate should easily approach ... well, perhaps not 100 percent, but a very comfortable rate, nonetheless.

We stock bifocal contact lenses from seven different manufacturers. It's an expensive inventory and larger than many other optometric practices, but well worth the investment. It's amazing that optometrists will vie for the disposable or frequent replacement lens patient, but are reluctant to target the bifocal patient. If we fit a patient in disposable lenses, we make $100. If we fit a patient in bifocal contact lenses, we make $400. In other words, we need only one bifocal patient to every four disposable lens patients to generate the same income. Plus, with a bifocal patient, you have a patient for life.

Another advantage: Since multifocal lenses aren't cheap -- and patients can't reorder them through mail-order or buy them at a discount store -- our patient base is generally more upscale. For the most part, our bifocal contact lens patients are leaders in their companies and their communities, they have considerable influence and respect, and they produce a great many referrals among their peers.

KEYS TO SUCCESS WITH MULTIFOCALS Market -- It's simple. Advertise and promote. Use local newspapers for the best return for your investment, and alert patients through regular direct mail communications. Hold seminars -- Patients come to our seminars as a result of newspaper ads. We like the idea of having 10 to 20 strangers sit in our office for two hours while we talk to them about the benefits of multifocal contact lenses. Try various designs -- Don't draw any conclusions about the efficacy of a lens that works on one patient with regard to providing multifocal correction on another patient. Each patient will respond differently. Keep inventory -- You must have abundant inventory so you can select lenses quickly while the patient is in the chair. You should have all types of bifocal/multifocal lenses -- soft and RGP

MATCHING THE LENS TO THE PATIENT

Presbyopic patients can generally be categorized into three age groups:

beginning presbyope (late 30s to mid-50s);

more advanced presbyope (mid-50+);

more severe presbyope (late 50s to 60+).

And, with today's technology, our mothers and fathers, and even grandmothers and grandfathers can now see clearly with contact lenses, a fact that should be encouraging to those who have been dedicated to contact lens wear since the 1970s and want to continue.

The newer multifocal and progressive contact lenses provide good intermediate vision and are the lenses of choice for most of our presbyopic patients. Many of our patients work on computers every day. When they wear a progressive contact lens, there's no perception of bifocal jump, no need to shift the head to see at distance and near. All of the powers are in front of the patient all the time, facilitating what we call selective vision, where the brain selects the appropriate power depending on what the patient needs to see.

We use only soft lenses for emerging presbyopes, especially the new progressive soft lenses. They work well and emerging presbyopes are generally easier to fit and more easily satisfied visually. Patients find planned replacements especially convenient because they are accustomed to this modality and like multi-pair blister packs. A number of my patients, for instance, travel frequently. Some might tear a lens while away from home or need a quick replacement on a weekend or holiday when the office is closed, so this packaging is quite advantageous.

As presbyopia increases, we have found that we can keep these patients in soft progressives by fitting a weaker near-vision, stronger distance-vision in one eye and doing the opposite in the other eye. Unlike conventional monovision, this modified monovision gives patients better vision in all fields, including good peripheral vision. For example, it enables patients to read stock market quotes, work on a computer and see distant objects without changing the correction they're wearing.

TIPS FOR PRESCRIBING TRANSLATING LENSES Have fitting sets in your office. Work with manufacturers and make sure that you have as large a fitting set inventory as the manufacturer is willing to give you and you're willing to use. For small practices, examine the patient, then call the manufacturer. Often, manufacturers will send you four to five lenses in the range that you need. Consider ordering lenses on a warranty basis. Even if this reduces your profit, it gives you and your patient the opportunity to try the lens and make sure it works at no additional cost. Learn basic in-office modification procedures to avoid the inconvenience of having to send lenses back to the lab.

Again, let us emphasize that you cannot rely on a single -- or even two -- multifocal lenses. You really must try them all. While you might have a patient who achieves success on the first fit, it's more likely that a maturing presbyope will require several different lenses from your trial sets to meet his correction requirements.

For more advanced presbyopes, you must turn to more complex lenses, such as aspheric RGP lenses or, eventually, translating lenses. Some lifetime soft lens wearers will wince at the mention of an RGP, but the fact is that the newer RGPs are far more comfortable than ever before, and patients much prefer RGP contact lenses to eyeglasses. Recent, rapid technological advances now give us many aspheric RGPs that provide extraordinary comfort, crisp, clear vision and good eye health beyond what soft aspherics and multifocals can provide. A further advantage is that RGP manufacturers will work with you in designing exactly the lens your patient needs.

The final step as presbyopia advances is the translating lens, such as the Fused Crescent and the Tangent Streak. We'll soon be seeing new aspheric lenses that incorporate a translating element so that they work much like bifocal spectacles, but with far more intermediate power options.

DR. SHAW'S PRESBYOPIC TOOLBOX The following lenses offer a full spectrum of options for presbyopic patients: Progressive soft lenses -- Specialty Progressive (Specialty UltraVision), Sunsoft Multifocal Profile A and Profile B (Sunsoft) K Aspheric RGPs -- Unilens RGP (Unilens), VFL 3 (Conforma) Translating lenses -- Fluoroperm ST Bifocal (Paragon Vision Sciences), SF-P Bifocal (Menicon)

PRACTICE-BUILDERS

Since multifocal contact lenses are still new to most contact lens wearers, the enterprising optometrist has a unique opportunity to build this practice. Start by placing a small, 3" x 5" black and white display advertisement in your local newspaper. You don't have to say anything more than that you now fit bifocal and multifocal contact lenses. We run this type of ad, which costs about $300, twice a month, and we pick up anywhere from 10 to 20 new patients every time it runs. We also send letters to all of our patients over age 50 about contact lens options available for correcting presbyopia. We also conduct free, one-hour seminars for interested people, generally attracting eight to 12 prospective patients every time.

A strong multifocal contact lens practice will be relatively new in many communities and is truly a burgeoning practice opportunity. Contact lenses for presbyopes are getting better every year, and the number of contact lens wearers entering presbyopia is increasing daily. CLS

A frequent lecturer, Dr. Shaw is widely known for his advanced techniques in meeting the vision correction needs of presbyopic patients. He operates Southern Eye Centers, a multi-office private practice in Baton Rouge. Dr. Achord, a graduate of the University of Houston, and Dr. Norred, a graduate of the Illinois College of Optometry, also practice at Southern Eye Centers.