Advertisement

PentaVision

Contact Lens Spectrum

Article

Multifocal Contact Lens Expections - Be Prepared!

Contact Lens Spectrum January 1, 1999

prescribing for astigmatism

Multifocal Contact Lens Expections - Be Prepared!

While there's still no one contact lens to correct all presbyopic patients, there are many options. We do our best to choose appropriate contact lenses and care systems for our patients, but education atiotvof expectations will help ensure success.

BY DAVID W.HANSEN, OD
JANUARY 1999

The correction of presbyopia with contact lenses resents a formidable challenge for our technical skills, and convey

TABLE 1
WHAT THE PATIENT WANTS
  • good distance acuity
  • good near acuity
  • good intermediate acuity
  • good translation far to near
  • initial comfort
  • disposability
  • long-lasting and durable
  • modification capabilities
  • least cost
WHAT TO DO
  • select RGP translating design
  • select RGP translating design
  • select simultaneous image/aspheric design (either soft or RGP)
  • select aspheric design (either soft or RGP)
  • select soft bifocal
  • select soft bifocal
  • select RGP bifocal
  • select RGP bifocal
  • monovision (either soft or RGP)

of expectations will help ensure success. The correction of presbyopia with contact lenses presents a formidable challenge for our technical skills, and conveying the advantages and disadvantages of each option is critical. Once you've determined how to best meet each patient's needs (Table 1), improve the chance for success with patient education (Table 2). If practitioner and patient expectations are different, then the contact lens experience is not rewarding for anyone.

TABLE 2
Educate the Patient with the Following Information:
  1. Pupil sizes affect acuity positively and negatively with environmental illumination changes (night is difficult). To constrict the pupil while driving, turn on a dome light.
  2. Soft bifocals reduce distance and near acuity. This vision is different than eyeglasses.
  3. Movement of translating RGPs may cause blur due to segment junction -- adaptation is needed.
  4. Aspheric RGPs need small to medium pupil sizes for optimum fit. Aspheric multifocal lenses can cause glare and shadows if the pupils are too large. Some of these symptoms are acceptable.
  5. Aspheric RGPs need small to medium pupil sizes for optimum fit. Aspheric multifocal lenses can cause glare and shadows if the pupils are too large. Some of these symptoms are acceptable.
  6. All RGP bifocals and multifocals should translate. Patients need to adjust reading material distance to allow for the bifocal to work.
  7. Eye dominancy is more important when fitting soft bifocal contact lenses. Enhancement of the dominant eye for distance viewing is a method to improve viewing because the lenses don't translate.
  8. Centration of a simultaneous multifocal contact lens is important. Excessive movement of a simultaneous lens causes irritation, variable acuity and visual discomfort.
  9. Patients with intermediate needs, such as computer users, do better with soft or RGP aspheric multifocals. Distance and near acuity may not have some compromises.

Managing Great Expectations

What do you do when a patient tells you, "All I really want is to see up close," and then after you prescribe a successful bifocal lens, the patient says, "But I can't see in the distance like with my eyeglasses"? Or, have there been times when a patient to whom you prescribed a multifocal RGP lens with measured acuities of 20/20+ in each eye for distance, near and intermediate says, " Everything is blurry!" It happens more than we like to admit.

Understanding our patients' expectations is more difficult than it sounds. Do they know what they really want? Extracting all of our patients' needs is a time-consuming and never-ending process, but it is an extremely important first step toward multifocal success. Remember,we may not be able to read minds, but we can ask questions.

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

What to Read Next