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Presbyopic patients are forever in search of the Holy Grail.

Or perhaps it is the fountain of youth. Their inability to find either source results in them taking out their frustrations on their eye doctor whose inability to give them unadulterated near vision is certainly cause for a public trial.

In all seriousness patient expectations are only part of the problem. Contact lens options for the presbyopic patient have been, in this optometrist’s humble opinion, subpar for far too long. The one-size-fits-all approach from major manufacturers simply does not provide the level of optical clarity and diversity required in the day-to-day practice. If the patient presents with a significant amount of cylinder the fitting paradigm becomes all the more muddled.

My practice has long found that most patients appear to subjectively prefer center-distance multifocals, especially those that are relatively early presbyopes. Now there enters a new player into multifocal space: the Duette Progressive Center-Distance design. Based off of SynergEyes traditional Duette platform, the new center-distance design boasts of several upgrades over its predecessors.

Center-Distance Optics: The center-distance optics allow for a more natural experience for the presbyopic patients when performing distance tasks.

Adjustable Zone Size: The distance zone is based on the patient’s pupil size in normal lighting conditions. It is available from 1.8-4.0 mm.

Add Powers: Available from +0.75-+4.00 D.

Ease of Ordering: The practitioner must provide the laboratory consultant with keratometry values, spectacle Rx with add power, and pupil size. Horizontal visible iris diameter (HVID) may also be useful in determining the initial skirt curve.

So, what are some tips to keep in mind?

As with any hybrid/RGP lens the refractive cylinder must nearly equal the corneal cylinder. It has been my experience that residual cylinder of greater than 0.50 diopters will significantly degrade visual acuity. Further, patients must properly care for their lenses as they now come standardized with the Tangible Hydra-PEG surface treatment. Failure to comply with recommended cleaning regimens will result in decreased functionality or removal of the coating and thus decreased comfort and visual performance.

There are no home runs when managing the presbyopic patient. The key to achieving a modicum of success is having a wide variety of tools at the practitioner’s disposal. With the introduction of the Center-Distance Duette Progressive an additional tool now exists that may unlock success for a portion of your patient base that previously was underserved.

*Disclosure: Dr. McKinnis has served as a consultant for SynergEyes, Inc. He has no financial interest in any lens manufactured by SynergEyes, Inc.

Ryan McKinnis
Dr. Ryan McKinnis is an optometrist with the Cleveland Eye Clinic. He is a Fellow in the American Academy of Optometry and a Fellow of the Scleral Lens Education Society.

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