As the population ages, the presbyopic market (40+yo) will be a substantial source of income. With substantial disposable income, they have great buying power. These patients also influence others in coming to your practice and will build your practice. In other words, this population segment will become a cornerstone of your practice! Therefore, as new optometrists you HAVE to know what to do to help them, and what the common pitfalls of multifocal lenses are.
After listening to presbyopes’ needs almost every week for more than a year now… trust me it’s not always fun… I’ve gotten a sense of their priorities, their needs and their expectations. Here are some tips:
- Take a very good history. This cannot be stressed enough. What does the patient do for a living? How often do they wear contacts? How long do they plan to wear the contact lenses? In what environment? How small of a font do they read? Do they switch between near and far vision often? These questions will set the tone of your multifocal contact lens fitting either for new wearers or for patients who would like to consider switching from spherical to multifocal lenses.
- Set the expectations. In future articles, we will discuss the pros and cons of different types of multifocal fittings, such as monovision or aspheric multifocal lenses. Each type has its problems, which may hinder the patient from doing certain tasks. It is up to us to set the tone and make sure the patient is fully aware of the problems that lie ahead. If you promise perfect vision at near and far get ready for a lot of unhappy patients. Also, make sure that the patient knows that it may require a few trials before the best fit is found. There must be a time commitment.
- Use free space and use real life reading material. Sometimes we get too comfortable in our dark room, phoropter and high contrast Snellen charts. We forget that this is a very artificial environment. Have the patient read a book or tablet in an environment similar to their home or work. This is crucial for presbyopes because of the reduced vision at near; they tend to be very sensitive to the environment. Please educate what kind of environment is optimal for multifocal lenses, such as high contrast and good lighting.
- Have them wear the lenses for a week or two before making a decision. In the short amount of time that the patient is in your chair (and in an artificial environment), it isn’t easy to determine the real comfort and vision once the patient goes home. The patient needs to try them at home with extended wear time before giving more definitive feedback. For example, it may take some time for a patient to adapt to monovision lenses.
- Binocular vision is key! It’s fine to document monocular vision, but the purpose is to provide comfortable binocular vision. Certain types of fitting may have the dominant eye use a lens that enhances distance vision and the non-dominant eye tailored for near vision. So binocular findings are crucial in determining the fit of multifocal lenses.
- Instead of aiming for 20/20, focus on 20/happy. You’ve taken a great history. You know what the patient needs. Instead of aiming for 20/20 at near or far, focus on what the patient’s needs are. For example, if the patient functions well with a best corrected VA of 20/25 at near and far and does not need to see fine print, there is nothing wrong with meeting these requirements without being perfect.
Just as they say, Location! Location! Location!, for multifocal lenses it’s Expectation! Expectation! Expectation! In order to reduce the chance of disappointment, you must educate the pros and cons as much as you can and make sure that the patient is fully aware of the potential issues going forward. Once goals are set, everyone can come on board and start this fascinating journey!