Understand Multifocal Contacts: How They Work and How …

1 1/3/20131 Multifocal Contacts: how they work and How to Make Them WorkMile Brujic, 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 GroupDisclosureOnce Multifocal lenses were discussed, 75% of CL wearers and 60% of spectacle wearers were interested in trying contact Lens Council.

2 Aug., 2007 Understand Patients Goals1/3/20132 Success Doesn t Mean No Glasses Near vision only glasses ? Monovision Glasses? Sport specific sunwear for presbyopesDon t Stray Too Much!Fitting Tip:-Assess vision using real world targets!2009-11-11193 ADD DesignsLO ADD Up to + ADD + to + ADD + to + OPTIX AQUA Multifocal 3 ADD System 1/3/20133If Unsatisfactory Distance Vision:Power becomes more positive towards lens center, plus a distinct central zone of greater plus (+) gradually becomes more plus (+) towards lens ADDLow ADDF itting Tips for SUCCESS Spectacle ADD + or less + to + + and up Lens ADD Power Low ADD OU High ADD OU With increased minus in distance Rx by or if needed High ADD OU Symptom Resolution Always start by checking Distance unacceptable: Add to dominant eye Decrease add in dominant eye If persists, low ADD OU Near unacceptable.

3 Increase add in non dominant eye Add + to non dominant eye If persists, high ADD OUJJVC, data on Lens Design Stereo Precision Technology9 Unique synergistic combination of the positive design aspects of the aspheric and zone designs9 Balance at all DistancesNon-dependant on illuminationMinimized ghosting, glares & halosAspheric ZonesAsphereJJVC, data on REAL DEAL ON Multifocal contact LENSESThe Multifocal Success!1/3/20135 The OK Multifocal Experience!1/3/20136 OCT Photo of Duette JunctionUsing NaFl to Evaluate Duette Fit High molecular weight NaFl, Fluoresoft NOT REQUIRED Traditional fluorescein strips can be usedProper NaFl concentration too little NaFl & lens may show false appearance of bearingSkirt Curve Too SteepOther 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 lidCentral Pooling:Skirt Curve too SteepCorrect Fit.

4 Thin NaFl LayerSkirt Curve Too FlatOther indicators Skirt Curve is too Flat: Initial movement seen but may decrease w/ wear time Patient may report central discomfort Excessive decentration of lensCentral Bearing - STEEPEN SKIRTC entral Bearing:Skirt Curve too FlatCorrect Fit:Thin NaFl Layer1/3/20137 Proper Patient Insertion 3 MethodsMark (Engineer), 48 year oldChief ComplaintBlurred distance and near (loss of crispness). Has considered just going to CL RxOD: Soflens MF / Low Add D: 20/30+ N: 20/30-2OS: Soflens MF / Low AddD: 20/30 N: 20/40+Over-Refraction: no improvement with RefractionOD: : 20/15 OS: : 20/15 ADD: + : 20/20 OUDominanceR eye dominant with + FogPre-Fitting ConferenceDemonstrated cylinder to patient and improvement (PFC)in crispness.

5 Diagnostic CL Fit??Mark (Engineer), 48 year old NPD LENS: DOMINANT EYED LENS: DOMINANT EYEN LENS:NON-DOMINANT EYEN LENS:NON-DOMINANT EYEMark (Engineer), 48 year old NP Ordered Diagnostic CL s: OD: Proclear MF Toric / + / D lens OS: Proclear MF Toric / + / N lens At Dispensing Visit: D: 20/20 OU and N: 20/30 OU Assurance this is a great start and schedule 1 weekprogress (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.

6 20/20 N: 20/30 SOR: + OD and + OS Fit: 0 OD and 5 T OS, good c,c,mvmt OU Ordered New Diagnostic CL s: OD: Proclear MF Toric / + Add / D lens OS: Proclear MF Toric / + Add / N lens1/3/20138 Mark (Engineer), 48 year old NP 1 week post dispense progress visit:yVision and comfort pretty good, improved : D: 20/20 N: 20/40 yOS: D: 20/30 N: 20/25+yOU: D: 20/20 N: 20/25+yStable over refraction and fit OU Final CL Rx:yOD: Proclear MF Toric / + Add / D lensyOS: Proclear MF Toric / + Add / N lens-Female in her early 40 s-Low myope ( sph) OU-Etafilcon A / / OD-Senofilcon A/ / / OD, + OS-In for yearly examination-Something seems wrong with her near vision-50 year old female-Refraction + x 090 20/20+ x 050 20/30add + 20/20-K s OD @ 119OS @ 127 Mild dry eye OUCurrently wearing Purevision Multifocals+ Add+ Add1/3/20139 Monovision vs.

7 Multifocal Changing Trends! 5/06 Dr. s Richdale, Mitchell and Zadnik : 76% of patients reported that they preferred Multifocal contact lenses over 24% who preferred monovision CL s. 7/07 Dr. William J. Benjamin : 3:1 patients preferred Multifocal over monovision CL 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.

8 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 N et al. Visual Comparison of Multifocal contact Lens to Monovision. Optom Vis Sci Yo