Let’s face it: no matter how amazing the multifocal lens technology gets, practitioners are still going to spend more time with their contact lens patients who desire multifocal lens correction. I would like to think that a little more time for patient education and a diagnostic lens fitting is acceptable for most of us; however, these visits often leave us behind schedule and frustrated. While there is a lot of science behind these lens designs, there is definitely an art to the lens prescribing. Here are some of the pearls that I’ve learned to lean on when I need them most.

Adaptation Is Not Immediate

There is a reason why the manufacturers’ fitting guides recommend a single lens as an endpoint, with the occasional adjustment caveat. It’s because our neurological system needs to learn how to use multifocal optics, so most of our patients will see better after a few weeks of wear. A recent study reported that new multifocal lens wearers experience a significant decrease in the amount of light distortion after 15 days of wear, especially in their dominant eye (Fernandes et al, 2018). Proper education about the adaptation process is key to successful prescribing.

Consider trying a pair of lenses that makes sense, and encourage patients to wear them during tasks that are less visually taxing at first before jumping into their normal high-speed work environments. Also, reassure patients that changes can be made, but making them too early in the process could reduce their chances of long-term success.

Don’t Overdo it

For patients to be able to wear the lenses during the adaptation period, they must be comfortable enough visually to function. If a pair of dispensed lenses allows patients to see comfortably at distance and functionally at near, then they are likely to see even better at near when they return for a follow-up visit. Be sure to use real-life acuity measures such as cell phones rather than the reduced Snellen chart to gauge needed add power. If patients can’t see the bottom line on the near card, they may think that the lens isn’t strong enough for reading. Low and medium add powers can show patients how the lens works at near without significantly reducing vision quality at distance. After the adaptation period, the add can be increased if needed, with hopefully less impact on distance vision. It all goes back to reassuring patients that changes can be made later and that adaptation is part of the process.

Understand Your Tools

The lenses also need to fit the eye to perform optically, so don’t forget to measure patients’ corneal diameter to ensure the best lens centering possible. Large corneas need large lenses, and vice versa. Pupil sizes that are atypical to their age-appropriate norm could also decrease the likelihood of success; these patients may be best served in a custom soft multifocal lens.

Optically, there are many multifocal designs available. Center near, center distance, concentric, and aspheric are just a few of the terms that describe the optics of these lens designs. Be sure to understand what you’re using so that you can switch the design of the optics if adaptation is unsuccessful.

Keys to Success

Efficient exam room techniques can improve your success with multifocals by helping you make educated changes at the appropriate time. Patients will see your confidence and trust your skill if you educate them along the way. Happy prescribing! CLS

For references, please visit www.clspectrum.com/references and click on document #276.