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1/3/2013
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Multifocal Contacts: How They Work and How to Make Them
WorkMile Brujic, O.D.
• The speaker has no financial or proprietary interest in any of the products that are mentioned
• The speaker has received honoraria for consulting, performing research, speaking and/or writing from: Alcon Laboratories, Aton, Bausch + Lomb, CooperVision, TelScreen, Transitions, Vistakon, Vmax Vision, Eyemaginations, RPS Adenodetector, Teague Training Group
Disclosure
Once multifocal lenses were
discussed, 75% of CL wearers and 60% of spectacle wearers were interested in
trying them.
The Contact Lens Council. Aug., 2007
Understand Patients Goals
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Success Doesn’t Mean “No Glasses”
• Near vision only glasses• ? Monovision Glasses?• Sport specific sunwear for presbyopes
Don’t Stray Too Much!
Fitting Tip:- Assess vision using real world targets!
2009-11-1119
3 ADD Designs
LO ADD Up to +1.25
MED ADD +1.50 to +2.00
HI ADD +2.25 to +2.50
AIR OPTIX® AQUA MULTIFOCAL 3 ADD System
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If Unsatisfactory Distance Vision:
Power becomes more positive towards lens center, plus a distinct central zone
of greater plus (+) power.
Power gradually becomes more plus (+) towards lens center.
High ADDLow ADD
Fitting Tips for SUCCESS
• Spectacle ADD– +1.25D or less– +1.50 to +1.75D
– +2.00D and up
• Lens ADD Power– Low ADD OU– High ADD OU
• With increased minus in distance Rx by ‐0.25 or ‐0.50D if needed
– High ADD OU
• Symptom Resolution– Always start by checking O.R.– Distance unacceptable:
• Add ‐0.25 to dominant eye• Decrease add in dominant eye• If persists, low ADD OU
– Near unacceptable:• Increase add in non‐dominant eye• Add +0.25 to non‐dominant eye• If persists, high ADD OU
JJVC, data on file.
The Lens Design
•Stereo Precision Technology
Unique synergistic combination of the positive design aspects of the aspheric and zone designs
Balance at all DistancesNon-dependant on illuminationMinimized ghosting, glares & halos
Aspheric Zones
Asphere
JJVC, data on file.
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THE REAL DEAL ON MULTIFOCAL CONTACT
LENSES
The Multifocal Success!
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The “OK” Multifocal Experience!
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OCT Photo of Duette Junction
Using NaFl to Evaluate Duette™ Fit
• High molecular weight NaFl, i.e. Fluoresoft NOT REQUIRED
• Traditional fluorescein strips can be used
Proper NaFl concentration –too little NaFl & lens may show
false appearance of bearing
Skirt Curve Too Steep
Other indicators Skirt Curve is too Steep:
• Discomfort expected because lens will be elevated too high to allow support from an excessively thick tear layer
• Awareness of the skirt under the upper lid
Central Pooling:Skirt Curve too Steep
Correct Fit:Thin NaFl Layer
Skirt Curve Too Flat
Other indicators Skirt Curve is too Flat:• Initial movement seen but may decrease w/ wear time• Patient may report central discomfort • Excessive decentration of lens
Central Bearing - STEEPEN SKIRT
Central Bearing:Skirt Curve too Flat
Correct Fit:Thin NaFl Layer
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Proper Patient Insertion – 3 Methods
Mark (Engineer), 48 year old
Chief Complaint Blurred distance and near (loss of crispness). Has considered just going to spectacles.
Previous CL Rx OD: Soflens MF 8.5 -0.75 / Low Add D: 20/30+ N: 20/30-2OS: Soflens MF 8.5 -1.00 / Low AddD: 20/30 N: 20/40+Over-Refraction: no improvement with flippers.
Manifest Refraction OD: -0.50-1.00x174 D: 20/15 OS: -0.75-1.00x018 D: 20/15ADD: +1.75 N: 20/20 OU
Dominance R eye dominant with +2.00 Fog
Pre-Fitting ConferenceDemonstrated cylinder to patient and improvement (PFC) in crispness.
Diagnostic CL Fit ??
Mark (Engineer), 48 year old NP
D LENS: DOMINANT EYED LENS: DOMINANT EYE N LENS: NON-DOMINANT EYEN LENS: NON-DOMINANT EYE
Mark (Engineer), 48 year old NP
• Ordered Diagnostic CL’s:– OD: Proclear MF Toric
8.4 ‐0.50‐0.75x175 / +1.50 / D lens
– OS: Proclear MF Toric 8.4 ‐0.75‐0.75x020 / +1.50 / N lens
• At Dispensing Visit:– D: 20/20 OU and N: 20/30‐ OU
• Assurance this is a great start and schedule 1‐weekprogress visit.
Mark (Engineer), 48 year old NP
• 1‐week progress visit – Patient states near vision needs to be better:– OD: D: 20/20‐2 N: 20/60+– OS: D: 20/30+ N: 20/30
– OU: D: 20/20‐ N: 20/30– SOR: +0.25 OD and +0.25 OS– Fit: 0° OD and 5° T OS, good c,c,mvmt OU
• Ordered New Diagnostic CL’s:– OD: Proclear MF Toric
8.4 ‐0.25‐0.75x175 / +1.50 Add / D lens– OS: Proclear MF Toric
8.4 ‐0.50‐0.75x015 / +1.50 Add / N lens
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Mark (Engineer), 48 year old NP
1‐week post‐dispense progress visit:Vision and comfort pretty good, improved near.
OD: D: 20/20 N: 20/40‐
OS: D: 20/30‐ N: 20/25+
OU: D: 20/20 N: 20/25+
Stable over‐refraction and fit OU
Final CL Rx:OD: Proclear MF Toric
8.4 ‐0.25‐0.75x175 / +1.50 Add / D lensOS: Proclear MF Toric
8.4 ‐0.50‐0.75x015 / +1.50 Add / N lens
-Female in her early 40’s-Low myope (-1.25 sph) OU-Etafilcon A / 8.3 / -1.25 OD-Senofilcon A/ 8.4 / 14.0 / -1.00 OD, +0.75 OS
-In for yearly examination-Something seems wrong with her near vision
-50 year old female-Refraction +4.25-0.25 x 090 20/20
+7.75-1.50 x 050 20/30add +2.00 20/20
-K’s OD 46.25/45.75 @ 119OS 45.12/46.75 @ 127
Mild dry eye OU
Currently wearing Purevision Multifocals+5.00/High Add+6.00/High Add
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Monovision vs. Multifocal
• Changing Trends!
• 5/06 – Dr.’s Richdale, Mitchell and Zadnik²:– 76% of patients reported that they preferred multifocal contact lenses over 24% who preferred monovision CL’s.
• 7/07 – Dr. William J. Benjamin³:– 3:1 patients preferred multifocal over monovision CL’s.
1. Rev of Optom 2003 Dec. 2. Optom Vis Sci. 2006 May; 83(5): 266‐73
3. CL Spectrum 2007 July
Multi‐Focal / Monovision Study ‐Gupta et al.
• Compared visual function with silicone hydrogel multifocal contact lens to monovision with comparable silicone contact lenses.
• 20 presbyopic subjects were fit with either modality• After a 1‐month trial, assessed:
– (a) distance, intermediate, and near visual acuity (VA); – (b) reading ability;– (c) distance and near contrast sensitivity function (CSF); – (d) near range of clear vision; – (e) stereo acuity; and – (f) subjective evaluation of near vision ability with a
standardized questionnaire.Gupta N et al. Visual Comparison of
Multifocal Contact Lens to Monovision. Optom Vis Sci 2009.
