You can build a successful practice – not simply contact lens practice – but PRACTICE – via contact lens correction of the presbyopic patient. The various GP lens designs available today have an important role in helping you achieve this success by incorporation into your contact lens multifocal tool box. Here are 7 ways you too can be successful:
Always present the multifocal option to every presbyopic patient.
All they can say is no. I guarantee you that many of your patients – including spectacle wearers – have been considering it but needed someone to be proactive. Monovision is an option – although I would require over-spectacles for driving – however not one I ever emphasize to patients.
Minimal to no spectacle wear.
As a 22 year GP multifocal contact lens wearer I can assure you that elimination of the barriers presented by spectacles is an exceptional benefit. I wear –0.50D over-spectacles for night driving and your patients may desire this or possibly a slight amount of plus power for reading fine detail but by and large over-spectacle wear is typically not needed.
Front surface center-distance aspheric designs are an excellent option.
The current generation GP aspheric lenses allow high add correction and can allow for a spherical or near-spherical back surface. They should be empirically fit which allows the patient to experience the benefits of good vision at all distances after the application of their initial lenses. For the post-refractive surgery patient with residual refractive error which is often astigmatic, a reverse geometry design is available on the back surface to provide both a good fitting relationship as well as high-quality vision at all distances.
Don’t forget translating designs.
For patients who desire uninterrupted vision at distance and near or a have large (≥ 6mm) pupil diameter, a translating design provides the “WOW Factor” when it comes to vision. Although they need to position inferiorly and shift upward with inferior gaze – therefore, requiring prism ballast and 1 or more segment lines – they are actually relatively easy to fit and troubleshoot.
“But what about initial comfort?”
It has been found that both aspheric GP and translating GP multifocals result in improved initial comfort versus spherical designs due to the fact these lenses move less on the eye with the blink. (Bennett, Contact Lens Spectrum, February 2005)
“I want good vision but I don’t want a corneal GP lens.”
Our toolbox now includes ever-improving hybrid designs, including the Duette Progressive with hyper Dk GP and Si-Hy soft materials and three add powers. No less than 15 – 20 scleral multifocals are currently available which, like hybrids, are typically center-near but with the GP optics often result in very good distance vision.
Where can I go for help?
Your laboratory consultant is always the best place to start. Between providing consultative services on lens selection, evaluation and troubleshooting they can provide useful resources to help you. The ability to have an iPhone adaptor to your slit lamp allows them to see photos and video of the fit, further increasing the likelihood of patient success. The GP Lens Institute (www.gpli.info) has a 17 resource module (Building Your Practice with GP Bifocals and MUltifocals) and 10 archived webinars by leading experts.
