When discussing best practices for patients who have presbyopia, multifocal contact lens manufacturers are often quick to point to their unique fitting guides that are tailored for their individual lenses. These manufacturers spend an inordinate amount of time developing these fitting guides because efficiency in prescribing multifocal contact lenses improves success with this modality in our practices and patients. The number of multifocal contact lenses and associated fitting guides in the market can seem overwhelming; however, in analyzing these various fitting guides, there are several common themes that link them together and result in some best practices to optimize successful outcomes.

Tips and Tricks

To determine the initial distance power, start with a fresh manifest refraction vertexed to the plane of the cornea, erring on the side of the most plus. In selecting the initial add power when deciding between two add power options, the general recommendation is to select the lower power option so that you do not introduce too much plus too quickly. This allows patients to have a greater chance of adaptation. Even though manufacturers may offer multiple add powers in their product lines, it is nearly universally recommended to begin with the same add power in both eyes. However, later in the troubleshooting process when more near vision is needed, it is possible to break from equal add powers in each eye and either use a higher add or intentionally over-plus the distance power in the non-dominant eye.

Common tips for over-refraction include performing both a monocular and a binocular over-refraction with loose lenses out of the phoropter with the intent to push as much plus as possible (Figure 1). Generally, ±0.25D changes can be significant. When assessing the patient’s near vision, one recommendation is to not use visual acuity charts. Instead, practitioners can assess their patients’ visual acuity with more real-world tasks such as using a cell phone or reading from a magazine or book at ambient room illumination. However, there are some exceptions to this, where Snellen acuity measures do guide power choices.

Takeaways

To enhance successful multifocal contact lens prescribing, adhering to these unifying practices found in manufacturers’ fitting guides can lead to more efficient prescribing outcomes. Remember, it is always recommended to consult the specific manufacturer’s fitting guide to fully optimize the design and reach a final prescription and a satisfied patient. CLS