Prescribing for Presbyopia

New Multifocal Designs: Give Back What Patients Are Missing

prescribing for presbyopia

New Multifocal Designs: Give Back What Patients Are Missing


I find it ironic that I'm writing this, my first article on presbyopia management, as I stare in the face of presbyopia myself. I turn 40 this year and already catch myself taking my glasses off to read some of the time or pulling back from something to see it clearly. I'm beginning to see what my professors always told me about not being able to understand presbyopia until you experience it yourself.

The good news, of course, is that presbyopia correction options are better than ever, no matter what your correction. Contact lens options are improving at a frenzied pace.

Rediscovering the Options

I was fortunate enough to attend a lecture by Stephen Byrnes, OD, at the recent American Academy of Optometry meeting in Tampa, Fla. Dr. Byrnes is a premier GP lens practitioner and a great speaker. His lecture dealt with the wealth of new GP multifocal options and how to select the right patient for each type.

I was amazed at how many new lens designs are available. I realized that I had been using mostly one brand of GP multifocal lenses for quite a while without evaluating any new options. Dr. Byrnes' lecture was just the boost I needed to recharge my GP multifocal batteries, so to speak.

A bigger question in my mind, though, was why don't more practitioners fit these lenses?

Not Just Monovision

I often write about how I will see patients who've been repeatedly told by other practitioners that some type of contact lens option is not available for them — when in fact it's been available for some time. Astigmats not being informed about soft torics is a common example. The same is true for GP multifocals.

I recently had a conversation with someone at my church who wears monovision GP lenses. Like many longtime GP wearers, he loves his lenses and is under the care of an optometrist whom I know to be a great GP practitioner. The patient said that the only thing he didn't like about monovision was his mid-range vision, a common complaint among advancing presbyopes. I suggested he ask about multifocal GPs at his next examination, and he was surprised that no one had educated him about this option before. I explained the pros and cons of this modality (improved intermediate vision and a slight loss of distance crispness, perhaps) and how the lenses worked. He was ready to call his practitioner the next day for an appointment!

A New Generation

Although my friend's story is about GPs, I think the same is probably true for all multifocal designs. The designs of the past are not the designs of today. The optics of the newest generation multifocals are worlds better than the previous generation and warrant your consideration if you aren't fitting them.

Monovision is great but, as we all know, has its issues (loss of intermediate vision and night driving difficulties). Don't make your patients settle for monovision when the new multifocals may be able to give them good vision at all distances again. CLS

Dr. Jackson is an assistant professor at Southern College of Optometry where he works in the Advanced Contact Lens Service, teaches courses in contact lenses and performs clinical research.