prescribing for presbyopia

Adapting Multifocal Fitting to Current Times

BY TIMOTHY B. EDRINGTON, OD, MS, FAAO, & JULIE A. SCHORNACK, OD, MED, FAAO

When we first started practicing optometry (don't ask), you could typically prescribe a bifocal add by a patient's age. Testing and trial framing were generally performed at 40cm. Life and prescribing were less complicated.

Today's presbyopes have different near and additional intermediate tasks to take into account when testing and prescribing. Computers have become pervasive work and leisure tools. We can no longer meet the vision needs of our patients by prescribing adds by age.

Lens Design Advancements

Multifocal contact lens designs have greatly improved in recent years. Monovision remains a successful alternative. Today's presbyopes are often excited to try new vision correction alternatives including contact lens designs and/or materials. You should at least offer them the opportunity to experience these options.

Comprehensive fitting sets for many multifocal lens designs have increased our ability to demonstrate the useable vision these lenses can provide. We understand that diagnostic fitting may take additional chair time, but it also may generate patient success and enthusiasm.

Prescribe for Patients' Lifestyles

A detailed history, including vocational and avocational vision needs, is necessary to best address a patient's visual experiences. You routinely prescribe more than one type of spectacles for your patients. Similarly, patients may benefit from wearing more than one contact lens design. Consider prescribing two-week replacement multifocal contact lenses for work and social events and daily disposable, distance-only lenses for weekend tennis matches.

Think Outside of the 40cm Box

If a patient uses a computer for extended periods of the day, consider prescribing a multifocal soft lens designed to favor distance vision in one eye and near vision in the fellow eye. The near prescription should optimize the computer vision. You can do the same with a traditional single-vision monovision correction. These patients may benefit from a pair of low-add spectacles to wear over their lenses when needed for closer or more precise near tasks.

For multifocal lenses not designed with a bias toward distance or near, consider prescribing different adds for the right and left eyes. The stronger add will optimize vision at near and the lower add will optimize vision at intermediate distances. If the lens design you choose is available in only one add power, consider prescribing 0.50D to 1.00D more plus in the distance for the intermediate viewing eye. A spectacle over-correction may provide clearer vision at other distances.

Modernize Your Approach

The art of eye care takes center stage when prescribing contact lenses for presbyopes. The beauty of working with presbyopic patients is that there's no one right answer. By carefully listening to what's important to each patient from a visual standpoint, several options may lead to a successful outcome. Many eyecare practitioners in the past gave up on multifocal lenses. Now is the time to re-explore the many presbyopic lens options that are available. CLS

Dr. Edrington is a professor at the Southern California College of Optometry. E-mail him at tedrington@scco.edu. Dr. Schornack is the associate dean of Clinical Education and serves in the Cornea and Contact Lens Service at the Southern California College of Optometry.