BY JOSEPH T. BARR, OD, MS, FAAO, EDITOR

We held a workshop last month for our students to learn bifocal contact lens fitting and talked about the balance between distance and near vision. We decided not to say "compromise between distance and near" because it sounds negative, and although presbyopia correction is all about compromise, "balance" is true as well. Just as I insist to our students that the balance between the two eyes is critical, so too is balance helpful for best stereoacuity in presbyopic correction. Life is full of balancing and handling imbalance, and even though I and many other contact lens practitioners prefer bifocal or multifocal lenses to monovision, our April article "Use of Presbyopic Contact Lens Corrections in Optometric Practices" by Harris et al shows that many other practitioners still consider monovision and modified monovision a preferred modality. As Robert Mandell, OD, PhD, has pointed out, you can have balanced, somewhat imperfect vision in each eye with bifocal and multifocal lenses or you can have monocular blur at distance in one eye and at near in one eye with monovision. You'll have to choose your own balancing act as the monovision vs. multifocal debate continues.

I recently had a conversation with an industry leader who discussed the balance that manufacturers try to obtain and maintain with material properties (oxygen permeability, surface biocompatibility, modulus, thickness, lens design...the list goes on). This too is the subject of much debate these days. Is more oxygen transmission better, and can a contact lens have higher oxygen transmissibility and still have all of the other factors that comprise a good contact lens? This debate is occurring in marketing departments and in the courts, if not in the minds of practitioners. They just want happy patients who perceive that their contact lenses are in harmony with their eyes and meet their visual needs based on their lifestyle demands.

My colleagues often compliment me on my balance in my life, yet those closest to me tell me that I work too much. But that's when I'm most in balance: When I'm working hard and playing hard, whether it's at the office wearing my PALs or at the beach wearing my bifocal contact lenses or sports vision sun lenses. Balancing patients' vision and lifestyle needs, whether they're presbyopic or physiologic, is manifold in our world today and is a challenge with spherical and specialty contact lenses. But we're performing this balancing act better than ever.

Have a great summer, and don't be afraid to send us a letter or an e-mail about your own balancing acts to spectrum@boucher1.com.