DISPOSABLE BIFOCAL LENS
A Modern Solution for an Age-Old Problem
By Bruce Don, BOptom
For a growing number of baby boomer presbyopes, the fountain of youth springs from a disposable bifocal lens.
The baby boomer generation has finally grown up. Now they are coming to terms with the same problems their parents faced a growing waistline, graying hair (or no hair) and failing near vision.
A myriad of options for the first two problems has existed for years. The third now has a solution: the Acuvue Bifocal. Vistakon, who brought us the first disposable contact lenses, has now taken it one step further by introducing a widely available disposable bifocal contact lens.
Like most baby boomers, I also faced the need for reading spectacles while wearing contact lenses. As a practitioner who has fitted countless contact lens patients over the past 20 years, I was also seeing other long-term contact lens wearers facing the same dilemma.
Previously, the options were either multifocal spectacles, contact lenses with reading glasses, contact lenses in monovision form or the early bifocal contact lenses. These options all had drawbacks after all, what is the point of spectacles on top of contact lens wear? Who wants compromised binocular vision? And the early bifocal lens designs were expensive and usually had a very low success rate.
I was excited to have the opportunity to be one of the first optometrists in my area to trial Acuvue Bifocal lenses. If this lens actually worked, the effect would be exhilarating.
After close to 100 fittings, I'm even more excited about the positive effects this lens has had on my practice and my patients' lives.
In order to learn as much as possible about the Acuvue Bifocal, we carefully tracked our fittings to identify factors that might predict success or failure. Of course, the statistic most interesting to contact lens clinicians is the overall success/failure rate of the modality. Of the 82 patients we initially trial fitted with Acuvue Bifocals, 69 (85 percent) are currently wearing them.
Most of our failures occurred early on. In fact, six of our 11 failed fittings were in the first two months of our experience. We learned two important lessons from these early patients:
- Do not ever attempt to refit happy monovision wearers. Three of the six early failures were happy monovision patients whom I was trying to upgrade into a better lens. Like many colleagues, I had fitted many patients with monovision, but felt it was generally a poor compromise. So early on, I tried to "rescue" several of these happy wearers from what I perceived as their pitiful fate. However good my intentions, the patients did not appreciate it.
- In your efforts to provide good near vision, do not compromise distance acuity. Another three of the early failures dropped out because they felt the distance acuity was insufficient. Enhanced monovision using a bifocal on the near eye and a single vision distance lens may salvage these fits. In fact, this is the form of bifocal fitting I use for myself.
Acuvue Bifocal Troubleshooting Tips
1. Trial fit the best-fit bifocal OU as outlined in the fitting guide.
2. Over-refract to maximize distance acuity.
3. If poor distance vision is a problem (it is the most frequent complaint I encounter), reduce the amount of add by 0.50D in both eyes. If distance blur persists, drop the add by another 0.50D in the dominant eye, and return to full add in the non-dominant eye.
4. Use enhanced monovision as a last resort, fitting a single vision lens to the dominant eye and retaining the best fit bifocal (full add) in the non-dominant eye.
Of our bifocal wearers, 72 percent were female maybe a particular quirk of my practice demographics. The average age of my Acuvue Bifocal patients is 51 years, and, interestingly, just over one half (59 percent) were previous contact lens wearers.
Sports and other hobbies did not adversely affect the wear or use of the lens. In fact, the binocularity afforded by this lens gave superior comfort to monovision.
A surprising finding was the success of the Acuvue Bifocal for hyperopic and emmetropic patients. Some 62 percent of our patients were hyperopic. Nine of our group of 82 (11 percent) required distance corrections between plano and +1.00D. Again, conventional wisdom says that emmetropic patients are not sufficiently motivated to succeed with bifocal contact lenses. My findings suggest otherwise.
Occupation did not seem to affect success or motivation to adopt an expensive lens option. Our Acuvue Bifocal patients ranged in occupation from domestic worker to physician, from opera singer to truck driver, from office worker to lawyer. However, the vast majority (over 80 percent) worked with computers for a significant portion of their day. These lenses provide significant benefits to computer users, not the least of which is the ability to view the computer monitor at any angle without craning the neck.
The lesson I learned is that I must present the bifocal lens option to every presbyopic patient without regard for his habitual method of correction.
Defining Contact Lens Success
What is the definition of success? These criteria apply to all contact lens wear, not just multifocal lenses:
1. Understand the difference between the patient's perception of success versus the practitioner's.
2. Many patients are happy wearing lenses only occasionally, even though better success comes through regular wear. This occasional wear could mean two to three days or weekends.
3. Success is what is right for the patient.
One of the most significant things I've learned about these lenses is the importance of fitter's attitude and the manner in which he or she presents lenses to the patient. The fitter's enthusiasm (or lack thereof) is critical. If you're not excited about this new modality, you can't expect the patient to be either.
Ask patients first about their expectations it is vitally important that the patient expects a realistic outcome. I always tell them about benefits and drawbacks of the lens, but downplay the negatives until they have had a chance to wear the lens and judge for themselves. At the end of the presentation, I discuss the compromises of the lenses, but reinforce all the benefits. At the end, the patient has the final say.
Try not to prejudge patients. If they are already wearing contact lenses and are over 40, then they readily accept the concept. With spectacle wearers, you may first need to discuss the advantages of contact lenses before entering into a specific discussion about bifocal contact lenses. It never ceases to amaze me the number of 40-year-old myopes who have never tried contact lenses. Bear in mind that spectacle use and bifocal contact lens wear are not mutually exclusive; many patients enjoy the freedom from their spectacles for specific activities, and all contact lens wearers should have spectacles. Computer users in particular find wearing bifocals much easier than constantly flipping their readers on and off as they move from hard copy to monitor.
Secrets to Acuvue Bifocal Success:
1. Believe that the lens works: the fitter's attitude does influence outcome.
2. Understand how the lens works.
3. Follow the fitting guide.
4. Suggest the lens to all presbyopic patients.
5. Don't be afraid to fail.
I've found that if the results are obvious, cost is never an issue with these patients. Baby boomers have a large disposable income, and bifocal lenses are a lifestyle choice. Many companies exist to cater to those wanting to stay and look young and active. Members of this generation have gone years, or even a lifetime, without spectacles, and no one is going to force glasses on them now. These lenses enable such patients to maintain their lifestyle and image long after the aging process has begun.
Don't wait for your patients to ask about these lenses. Being proactive will increase patient awareness of contact lenses. Over 40 percent of our Acuvue Bifocal patients were new to contact lenses.
I think the Acuvue Bifocal lens works, and works well. Even though the lens is not for everyone, my successful patients span many age groups, occupations and prescriptions. A success rate over 80 percent has me even more excited than when I first began fitting the lens over a year ago.
Never underestimate a presbyope's desire to wear the lenses or ability to pay for them. More importantly, don't underestimate their effect on your practice. At the rate the bifocal lens market is growing, if you don't offer bifocal lenses to your patients, someone else probably will.
Bruce Don graduated from the University of New South Wales, Australia, in 1982. He specializes in Contact Lenses and has been in full-time private practice for 20 years.