staffing solutions
Do I Need B-B-Bifocals?
BY MARY JAMESON, BHS, COA, NCLC, CPOT

While canvassing through my desk one ordinary day, I picked up a piece of paper to read. Without even thinking, I extended my arm, pushing the paper further away ever so slightly. I realized what I had just done and immediately thought, "Aaagh!" as Charlie Brown would say. As one of millions of Americans aged 40 or older, I had advanced into a statistic -- I'm borderline for presbyopic correction. (I can't admit to the need for a full-time correction.)

Having spent the past 20 years helping patients choose among options for correcting their presbyopia, I now find myself on the other side of the table having to answer the same questions. How will I be as a patient? I've heard that you should never treat friends or family, so I wouldn't wish myself on my worst enemy with this project.

Let me walk you through the concerns and issues that I'm trying to work out at this time. If you haven't gone through the process yet yourself, then this may provide a better understanding of what your presbyopic patients go through.

Making Mental Adjustments

Coming to terms with what presbyopia represents is quite a hurdle. Intellectually, I can completely understand the reason for the decrease in accommodation. But emotionally (see "Aaagh!" in first paragraph), I can't see myself as being as old as my first grade teacher. Before I can choose my options, I need to understand that this is part of growing up -- not of growing old.

What's My Motivation?

Patient motivation is the key to success with any type of contact lens correction. For presbyopic patients, you need to update their expectations.

I've never worn eyeglasses or contact lenses full time. What am I willing to change in my routine to accommodate (ha ha) correction for presbyopia? Do I want to wear eyeglasses when I've never had to before? Do I want to add contact lens care and handling to my daily routine? Do I want to wear contact lenses full time or part time? Can I succeed with part-time contact lens wear that corrects for presbyopia?

Sifting through Lens Options

I've decided that I don't want to wear eyeglasses full time. What are my contact lens options? I can start with soft or GP contact lenses. Because I'm interested in part-time lens wear, I should start with soft contact lenses. Now what are my options?

Soft multifocal designs include simultaneous, alternating and aspheric. Simultaneous vision corrects both eyes for distance and near at the same time, with the near correction in the center and surrounded by the distance correction or vice versa. In alternating designs, the lower portion of the lens corrects near vision and the upper part corrects distance. This design is more common in GP lenses. Aspheric designs incorporate a gradual flattening and prescription change from the lens center to the periphery.

Some designs work better than others based on pupil size. My pupil diameter is >7mm, and larger pupils are a more challenging size to fit.

Is monovision a good option for me? Monovision corrects one eye (typically the dominant eye) for distance and the other for near. Because monovision uses spherical lenses, I wouldn't have to worry about haloes and ghost images as I would with the simultaneous design. Can I successfully wear monovision part time?

What about modified monovision, in which rather than a full near correction, a slight change in the plus direction provides acceptable near and intermediate vision without negatively affecting distance vision?

Weighing in

I'm still reviewing and trying out all of my options, but I'm sure about one thing: I have a greater appreciation for what patients go through following the onset of presbyopia.

Ms. Jameson is laboratory supervisor for the Department of Clinical Sciences at the Pennsylvania College of Optometry and is a past chair of the AOA Paraoptometric Section.