A Consensus: GP Multifocals Can Help Build Your Practice
By Edward S. Bennett, OD, MSEd, FAAO
Effective leadership begins with building consensus. This is no easy task with the diverse opinions that often exist. However, for everyone who has crossed into the twilight zone of presbyopia, it is evident that consensus does exist: this is an ill-received, if not a hated, condition.
Where consensus does not exist pertains to the contact lens management of presbyopia. It has been found that when contact lenses are proactively recommended to presbyopic patients, approximately two-thirds of them will be fit into contact lenses (Jones, 1996).
The recent trend of practitioners preferring multifocals over monovision as a first choice for presbyopes is encouraging (Nichols, 2010). Improvements in soft multifocals also have resulted in overall patient preference and satisfaction with this modality versus monovision (Situ et al, 2003, and others, full list available at www.clspectrum.com/references.asp).
However, patients do need to be informed that multifocal wear—with multiple corrective powers in front of the eye with most designs—does represent compromise. The least visual compromise, however, results from GP multifocals, which have not only been preferred 3 to 1 when compared to monovision (Johnson et al, 2000), but also result in the highest visual performance when compared to soft multifocals and monovision (Rajagopalan et al, 2006).
Practitioner hurdles to fitting GP multifocals often pertain to initial comfort and complexity of fit. Well-fitted aspheric, concentric, and segmented bifocals and multifocals have one characteristic in common: limited movement with the blink. In fact, GP aspheric multifocals and segmented bifocals are more initially comfortable than spherical GPs are as a result of this factor (Bennett, 2005).
Aspheric or concentric multifocal fitting is similar to a soft multifocal fitting. The lenses can be ordered empirically from the manufacturer so that the patient's first experience in a GP multifocal will likely be positive and would simulate the inventory approach to fitting soft multifocals. Likewise, having patients walk around the office and perform everyday tasks and report what is optimum, less than optimum, etc., is beneficial. Visual acuities can then be performed at distance and near, and if there is a decrement consistent with their symptoms, use loose trial lenses (or preferably a flipper bar) over the impacted eye—with both eyes open—to determine the change in lens power necessary.
Even segmented bifocal fitting can be performed empirically when fitting the Bi Expert lens (Blanchard, Art Optical, Essilor) simply by performing a series of anatomical measurements, in addition to refractive testing, and submitting this information to the laboratory.
More Information Available
Many online resources are available from the GP Lens Institute (www.gpli.info) to assist in fitting and troubleshooting of GP multifocal and bifocal lenses. These include a case grand rounds troubleshooting guide, a narrated PowerPoint, a clinical pearls pocket guide, and a comprehensive GP presbyopia program (“Rx for Success”) for practitioners, staff, and patient education.
When practitioners make the effort to proactively prescribe presbyopic patients with multifocal contact lenses—especially GP designs—there will be consensus that GP multifocals are practice builders. CLS
For references, please visit www.clspectrum.com/references.asp and click on document #187.
Dr. Bennett is assistant dean for Student Services and Alumni Relations at the University of Missouri-St. Louis College of Optometry and is executive director of the GP Lens Institute. You can reach him at email@example.com.