Article

The Bottom Line: Lens Design Selection Process and Where to Go for Help

The interest in contact lens fitting for the presbyope — by the presbyopes themselves — is becoming higher and higher, so it is important for today’s eyecare practitioner to have supply meet demand. Whether it is the baby boomers who are active, free-spirited, and individualistic or, increasingly, the Generation X population who are adaptable, resourceful, and independent, we have a population interested in change, cosmesis, and physical activity. Contact lenses are often an excellent option for these individuals if we are proactive in presenting them and believe that a “one type fits everyone” philosophy is not acceptable.

Many Available Options

Options for the interested presbyope include spherical soft multifocal designs, which are increasing in use as well as optical quality. However, as this issue is devoted to custom lenses — GPs, hybrids, and custom soft multifocals — these tools, when used, separate the practice that fits a specific indicated lens modality to a given patient from fitting every patient into an available inventory.

The fact is, there are few presbyopes who are not good candidates for multifocal contact lenses. The astigmatic presbyope — if concerned about initial comfort — can be fit into a custom soft, hybrid, or scleral multifocal. If uninterrupted vision is very important, a segmented, translating GP lens would meet this need. Likewise, good vision at all distances typically can be achieved with an aspheric GP design. If a patient has dry eyes, we have a viable option with the increasing popularity of multifocal scleral lenses. Table 1 lists each of these designs, along with pertinent patient selection and fitting pearls, as well as decision-making factors.1

Table 1. Multifocal Lens Selection.
Patient Selection and Fitting Pearls Decision-Making Factors (from Bennett & Quinn, 2014)
GP Aspheric Designs
  • Desires good vision at all distances
  • Fit empirically
  • If decenters inferiorly, steepen BCR
  • Large pupil patients are not good candidates
  • Great intermediate vision; good distance and near vision
  • Great astigmatic correction
  • Acceptable initial comfort
Segmented, Translating, GP Designs
  • Desires uninterrupted vision at distance and/or near
  • May take slightly longer to achieve an optimum fit
  • Lower lid must be close to or above lower limbus and lens must shift up with downward gaze
  • Great distance and near vision
  • Great astigmatic correction
  • Acceptable initial comfort
Scleral Multifocal GP Designs
  • Great option for dry eye patients
  • Good option for astigmatic patients desiring good initial comfort
  • Near-Center design although optics superior to soft multifocal lenses
  • Can fit spherical design and order with add
  • Expense and number of visits often greater
  • Great near vision; good distance and intermediate vision
  • Great astigmatic correction
  • Great initial comfort
Hybrid Multifocal Designs
  • Good option for astigmatic patients desiring good initial comfort
  • Near-Center design although optics superior to soft multifocal lenses
  • Can fit empirically but allow 2 – 3 weeks to adapt
  • Great near vision; good distance and intermediate vision
  • Great astigmatic correction
  • Great initial comfort
Custom Soft Multifocals
  • Ability to customize parameters including near and distance zones, diameter, and base curve
  • Astigmatic correction is present
  • Occasional wear is possible
  • Some compromise in vision versus other options
  • Acceptable distance, near and intermediate vision
  • Acceptable astigmatic correction
  • Great initial comfort

Resources

There are many useful resources for optimizing success with multifocal lenses.

The Contact Lens Society of America (clsa.info ) has a number of courses and publications pertaining to the contact lens correction of the presbyope on their website. Likewise, the GP Lens Institute (gpli.info ) has no less than 11 archived webinars on multifocal contact lens correction, as well as a number of other resources, including an entire series of unique presbyopic cases and their management in the “GP Case Grand Rounds Troubleshooting Guide,” a “Contact Lens Clinical Guide” emphasizing presbyopia, as well as an “FAQ” section. There is also a specialty contact lens coding and billing module as well as a laboratory consultant FAQs module that includes multifocal designs. The most important resource, however, is a 17-component “Building Your Practice with GP Bifocals and Multifocals” online module that includes resources for the eyecare practitioner, staff, and patients (Figure 1). This includes videos on how to present this option, how to fit and evaluate GP multifocals, care and handling, and addressing patient inquiries that come by telephone. It also includes a professional fee calculator, scripts to answer patient questions, a brochure for patients, and a patient reading card.

Perhaps the most important resource, especially with GP multifocals, is the laboratory consultant. These individuals can provide valuable advice on specific multifocal designs, fitting, and trouble-shooting. They can help with diagnostic fitting sets, evaluation of corneal topographies, and can provide photos or videos of lenses on eye. The latter is made easy via iPhone adaptors for the slit lamp biomicroscope. Every laboratory also has a number of design, fitting, and evaluation resources on its website and most allow access to webinars from noted experts in the field.

The Bottom Line

As you’ve seen in this supplement, there are several tools in your presbyopic contact lens fitting toolbox and having them all available to you will optimize success with a rapidly growing and interested population. These patients are often interested in contact lenses, even when we aren’t proactive in recommending them, and these lenses can help grow your practice.

Reference

  1. Bennett ES, Quinn TG. Multifocal lens decision-making 101. Contact Lens Spectrum; April 2014.