IT CAN BE DIFFICULT to be 100% successful with presbyopic contact lens wearers, but a few challenges with a specific lens, modality, or patient should not discourage practitioners from prescribing future patients with presbyopia contact lenses. Don’t miss out on the huge opportunity presented by this group of patients. While there are lots of important research projects aimed at improving the success of fitting these patients, and with the development of multiple manufacturer’s fitting guides, there is still a bit of “art” that goes into gaining that extra success.

WHAT IS THE "ART"?

Choose your words wisely.  I often begin a presbyopic contact lens fit or refit by explaining to the patient that multifocal contact lenses (or monovision) rarely provide patients with 100% of their visual needs throughout the day.

We all have stories. A patient arrives seeing 20/20 both distance and near while wearing multifocal lenses, but complains about not being able to read someone’s license plate down the road. Turn this into a positive and offer options. A potential response: “While that license plate may be difficult to see, you are seeing very well both far and near without the use of readers. That is the big advantage of this technology.”

A quarter-step change one way or another can make a big difference.  Along with choosing words wisely, consider explaining how the process of fitting multifocal contact lenses is customized to meet the patient’s unique visual needs.

When finalizing the contact lens prescription, let the patient make the choice based on their preference. For example, if the patient works with spreadsheets on a computer all day long, explain how modifying their prescription slightly for up close will improve their vision at the computer screen level. At the same time, remind the patient that their vision while driving at night may not be quite as sharp due to that change.

Consider this tip when finalizing a multifocal contact lens fitting. Inform the patient that one of the prescription combinations provides a little extra boost for distance vision and the other prescription combination provides a little extra boost for near vision. Remind him or her that this technology can provide really good vision for a vast majority of one’s visual needs, but rarely provides 100% of them. Then, ask the patient to choose the final prescription combination based on their preferences.

Part-time wear is not a failure.  Successful part-time wear is a huge win! Emmetropes can be some of the most challenging multifocal contact lens fits. They just do not want any potential loss of distance sharpness. With that being said, many emmetropic patients can achieve part-time wear success. Those times may be during their work week and less on the weekends, or vice versa. Let the patient make the choice based on individual preferences.

Successful presbyopic contact lens fits begin with listening to your patients’ needs and expectations. It is very important to understand the science of multifocal contact lens technology and provide reasonable expectations. Finally, apply some “art” to these fits to grow your success rates.