1 Multi-focals first
Always try to fit with multi-focal contact lenses in the first instance, you might think that mono-vision is easier but according to most research and my experience, most patients will thank you more for multi-focals. Most patients are wowed by new technology so try them out with the latest lenses, cost is not always an issue for this age group especially if it is for part time use. Having said that, there are some prescriptions and people that monovision will be the best route. It is important to remember that every px is different.
2 BVS every time
I think this is crucial whatever the design of lens and can lead to some surprising results. It is well worth taking the time to carry out an actual best vision sphere (BVS) refraction followed by a +1.00 blur sensory dominance test (if inconclusive try +0.75), and then try an add 0.50 less than the refracted NV add and increase if necessary. In cases of astigmatism over 1.00DC then look at the bespoke options available as these can work really well.
3 The Test Drive
This is essential in the process of multifocal fitting. Every px is different, every lens centres differently and then there are different designs. It’s important that the px is comfortable with the lenses before trying them in their own environment, so a walk about is important to gauge how happy they are before trying in the real world and an opportunity to optimise the prescription before they take them home. Get them to take the lenses for at least 15 minutes longer if they can and ask them what they use their near tasks for – texting? internet surfing? reading books? using a PC? etc. Ask them how they got on.
4 Forget Snellen, subjective scoring is the key
If ‘beauty is in the eye of the beholder’ then multi-focal success is just as subjective. I have found profound success asking the patient to score their distance and near vision out of 10 during their walk about using real world examples – mobile phone, shopping tasks, menus – before they ‘test’ their vision on our high contrast Snellen charts. Often the Snellen VA won’t tally with their subjective scoring but if it’s over 7/10 and legal for driving then you are onto a winner.
5 For young, non-presbyopic practitioners, a word, or three. Imperfect is OK
From the outset, do not over-egg what multi-focal contact lenses can do. It will not give a 60-year-old their 20-year-old vision, it will not turn back time. However, it will give the px something that will work incredibly well for 80-90% of their time, and without glasses on their nose – how goods is that? Believe me, most presbyopes would take that, with the exception of engineers. If you are not presbyopic then you simply do not have a clue how debilitating and inconvenient presbyopia is, especially to emmetropes.
6 Optical wardrobe
Most people have different clothesfor different occasions. For many of our patients there is not one single optical answer for their many needs. So why not offer them different options for different occasions. Specs might be the best option for certain things. Multi-focal contact lenses would be great when wearing specs is not desirable, but then single vision contact lenses might be the prime option in other instances. It is important to understand your patient’s needs because only you have the experience and knowledge to be able to create the answers to these needs and it may be more than one option, but why not? The happier your patient, the more loyal they will be.
7 Fit some front of house staff
Get some advocates on the showroom floor, talk to them about the options with their vision and get them to try multi-focal contact lenses. At least they can then have a frank and honest conversation about their experience with your patients. And, finally, have you tried them yourself?
