Johnson & Johnson Vision (J&J Vision) now offers Acuvue Oasys Multifocal contact lenses in the United States and Canada. The Acuvue Oasys Multifocal is built on the Acuvue Oasys two-week platform. It includes the Pupil Optimized Design technology used in the 1-Day Acuvue Moist Multifocal. The design also includes Hybrid Back Curve Technology and a proprietary embedded wetting agent to create a lens designed for performance and comfort, according to the company. J&J Vision says that the Pupil Optimized Design requires only three steps to fit: spherical refraction in ambient light; determination of ocular dominance; determination of functional add. This information is entered into the Acuvue Multifocal fitting calculator.

Acuvue Oasys Multifocal is manufactured in senofilcon A (38% water, reported Dk/t of 147) with Hydraclear Plus technology. Parameters include 8.4mm base curve, 14.3mm diameter, sphere powers from –9.00D to +6.00D in 0.25D steps, and adds of Low (+0.75D to +1.25D), Mid (+1.50D to +1.75D), and High (+2.00D to +2.50D). It also features a Class 1 ultraviolet blocker and a visibility tint.

I recently talked with practitioners who are actively fitting the Acuvue Oasys Multifocal lens in their practices.

Please tell us about your general experience with the Acuvue Oasys Multifocal contact lens.

According to Stephen Cohen, OD, of Scottsdale, AZ, while the Acuvue Oasys Multifocal lens is new, the material and design are already highly successful. “This lens combines the comfort and performance of the spherical two-week Acuvue Oasys with the familiar multifocal design of the 1-Day Acuvue Moist Multifocal,” he notes. “This lens can be confidently fit because the material and lens design have never been beat in studies on comfort, and we’ve already been successful with the multifocal design.”

He also noted that the Acuvue Oasys Multifocal is priced quite affordably compared to other specialty lenses.

Who are the best candidates for this lens and why?

Susan J. Gromacki, OD, MS, of Fulton, MD, believes that any presbyope desiring good distance, intermediate, and near vision without glasses is a good candidate for this lens. “This is because of the excellent pupil optimized design and comfortable senofilcon A material,” she explains.

Dr. Cohen notes that there is a dramatic attrition in contact lens use when patients reach their 40s and beyond—mostly due to comfort and vision issues as they become presbyopic and feel the need for reading glasses over their contact lenses. He adds that retaining contact lens patients in contact lenses supports his practice’s recall efforts and also helps to generate referrals and patient loyalty. Therefore, he says that his first target candidates could be emerging presbyopes as well as contact lens dropouts in their 40s and older.

However, he says that while he might focus on certain potential candidates, he makes a point to introduce the option to all patients who could potentially benefit. “We don’t ask patients whether they are interested in contact lenses; rather, we ask them what are the times when they would like to be able to see without having to wear their glasses,” he says. “This provides an open- versus closed-ended question that can start a discussion.

“When asked why they didn’t think that they could wear contact lenses, we might expect the answer to be dry eyes or astigmatism. But, one of the most common answers was ‘My [eyecare practitioner] never told me I could wear contact lenses.’ It’s not only what we say that has power. What we don’t say apparently does as well,” he adds. “By educating every patient at every visit about what is new, we build patient loyalty and referrals as well as support our recall efforts.”

Tell us about the fitting process for the Acuvue Oasys Multifocal contact lens and what has worked best for you.

Dr. Cohen noted that because the multifocal design comes from the 1-Day Acuvue Moist Multifocal, he was already familiar with the fitting process. “The ‘pupil intelligent’ design has helped significantly, since we know that pupil size can vary based upon refractive error, and this design takes that into consideration,” he says. “Even for those practitioners who haven’t had as much experience with the 1-Day Acuvue Moist Multifocal, the fitting guide for the Acuvue Oasys Multifocal greatly simplifies the initial lens choice as well as suggested modifications based upon patient comments.” He also noted that the Acuvue website has lens calculators to help with the lens selection as well as training programs for troubleshooting.

In Dr. Cohen’s experience, the fitting process for this lens is not significantly different from that of fitting a spherical lens as far as chair time. “With a clear and disciplined understanding about lens selection, the initial lens is frequently the final lens prescription,” he explains. “And when it is not, the incremental modifications often solve any issues quickly and effectively.”

Dr. Gromacki says that it is important to follow the fitting guide. “J&J Vision has created it to help practitioners be successful.” Dr. Cohen agrees: “It works. It will increase success rates and decrease chair time and number of follow-up visits.”

How has the Acuvue Oasys Multifocal lens helped with troubleshooting for particular patients? Tell us about any success stories in that regard.

Dr. Cohen says there are two areas of troubleshooting. The first is when fitting the lens. “The primary issue is following the fitting guide, which offers troubleshooting recommendation of ‘if this…then do that,’ he says.

Second is the general use of this lens for troubleshooting the challenging presbyopic population. “This involves patients who were previously told that they can’t wear contact lenses, patients who unsuccessfully tried other multifocal designs, unsatisfied monovision patients, and patients who have dropped out of contact lens use due to emerging presbyopia and/or comfort issues,” Dr. Cohen explains. “I’ve had patients who didn’t achieve the level of vision or comfort with other lenses (multifocal or monovision) and abandoned the idea of contact lenses who now have a new viable option. That, to me, is exciting—when we have a motivated but previously disappointed patient who can now have another chance at contact lens success.”

Dr. Cohen says that his greatest success has been in retention of contact lens use. “I have seen patients who were wearing spherical lenses but found themselves wearing them less and less due to the gradual need for reading glasses over the lenses. Having the Acuvue Oasys Multifocal has enabled these patients to remain in the brand of contact lenses that has worked well for them and to be able to continue to wear contact lenses without the need for glasses,” he says.

“If we consider the impact that this has on our practice, from both a patient satisfaction standpoint and an economic standpoint, we will realize that this option offers a significant positive effect—patients are happier because they can continue to wear contact lenses. These patients typically return for their regular comprehensive eye exams twice as often as spectacle patients do, so we are supporting our recall efforts,” he says. “From the business perspective, we realize the income from that additional exam and from the annual supply of contact lenses, both of which help our top-line income and bottom-line profits.”

Dr. Gromacki tells of a success story that hit close to home. “The first patient I fit was a very discerning one—my husband. He spends most of his working days at the computer, but he also drives to and from work and has meetings. He needs optimal acuity at all distances. I followed the fitting guide by determining ocular dominance with the +1.00 blur tolerance test. After completing the test, he asked me what I was measuring. I told him that his left eye is dominant, and he assured me that he knew for certain that his right eye was his dominant eye. Not to disagree with such certainty, I fit the right eye with the Mid add and the left eye with the High add; he has a +2.00D add,” she says.

She continues: “The next day, I asked him how he performed at work with his new lenses. He said, ‘I could see well to drive, and I could see my computer perfectly. But something isn’t quite right. I can’t put my finger on it.’ The light bulb went off in my head; I had allowed him to select the dominant eye. So I switched the eye dominance to what the fitting guide recommended, and then he did great at all distances with complete comfort. Lesson learned.” CLS