If you haven't recently prescribed soft
multifocal contact lenses, now might be the time to give them
another chance. Designs, materials and lens reproducibility have all
Find Your Starting Point
recommend that you talk with your eyecare colleagues to narrow the
extensive field of multifocal lens choices down to a few to start
with. Then use the manufacturers' fitting guides and consultation
services to assist you with your initial fitting experiences. As you
gain experience with each design, you'll develop your own
prescribing strategies and fitting pearls.
multifocal lens options, select initial diagnostic lenses according
to manufacturers' recommendations. Abandon your phoropter and use
loose spectacle trial lenses to fine-tune the lens powers. One of
the most important steps in prescribing multifocals is to really
understand what's important to each patient from a vision
standpoint. Determine each patient's visual needs, especially with
regard to near and intermediate distances. A comprehensive
discussion regarding their work and leisure visual demands may help
to develop visual priorities.
intermediate needs, we commonly sit soft multifocal patients in
front of a computer screen. For final contact lens power
determination, we seldom need to change the power by more than 0.25D
or 0.50D from the manufacturers' guidelines. If a patient achieves
acceptable vision through the trial lenses, then dispense the lenses
and reschedule the patient to return in approximately one week for
follow-up care. If you, the patient and the patient's corneas are
pleased with the performance of the lenses, then prescribe. You
aren't searching for visual perfection, but visual happiness for the
the above scenario doesn't occur with every multifocal fitting.
Patients may report that their vision is pretty good, but could be
better at either distance or near/intermediate. For instance, a
patient might be satisfied with his near but not with his driving
vision. Consider in this case prescribing a single-vision lens with
the patient's distance correction on the dominant eye.
option is to prescribe a different multifocal design or a multifocal
lens from a different manufacturer that optimizes distance viewing.
An example would be an aspheric or annular design with a larger
distance optic zone located in the lens center.
options are also available for patients who are pleased with their
distance vision, but aren't completely satisfied with near vision
through multifocal lenses. If the near vision is acceptable for most
tasks, consider prescribing reading glasses for part-time wear when
option is to prescribe additional plus at distance and/or near for
the non-dominant eye. This may slightly blur the distance vision in
this eye, but will generally improve intermediate and near vision. A
single-vision lens for near is also an option.
The Bottom Line
are interested in new technology and new products. Even if you don't
prescribe multifocal contact lenses, the patient was able to try
something new. Patients will also view you as an eyecare
practitioner who embraces change and who is constantly exploring
ways to improve their visual welfare. Remember that there's no one
right answer when considering multifocal contact lenses for
patients. Good listening skills and creativity are the keys to
successfully prescribing multifocal contact lenses.