SPOTLIGHT ON EDUCATION II:

Aspheric GP Multifocal Fitting Pearls

Dr. Ed Bennett

Many of the pearls when fitting aspheric multifocals are, in fact, similar to soft lens multifocal fitting. These include:

1. Empirical Fitting: Providing the laboratory with the recommended information (typically refraction, K’s/sim K’s, add power and sometimes pupil size) often results in an excellent experience visually for presbyopes experiencing GP multifocal wear for the first time. This, in turn, often lessens their perception of awareness due to the “Wow” factor.
2. Fit Assessment: The lens should center well or slightly superior-central. As the lenses in common use today are predominantly front surface aspheric they should have a back surface that aligns well with the cornea resulting in an alignment fluorescein pattern.
3. Take a Walk! After dispensing - while they are adapting - have them walk around the office and “take their lenses for a ride” looking at a magazine, off at a distance, perhaps at a computer, and then come back and report how they feel about their vision.
4. We Have Two Eyes Not One. For assessing the over-refraction, have them keep both eyes open and use flip lenses (often 0.25D) in front of each eye individually. It’s remarkable what a difference 0.25D makes in the subjective perception of vision.
5. Let them know that their vision will improve as they adapt to the lenses; GP aspherics are much easier to adapt to visually than soft multifocals due to both the optical quality and the center-distance optics.
6. But what if there is a problem? That’s no problem. Your laboratory consultant is worth their weight in gold for helping through the process, beginning with lens selection, and finishing with problem-solving. The ability today to use a cell phone adaptor for the slit lamp to take photos and video is very helpful to the consultant who is THE expert with that specific lens design. Common problems include an inferior decentering lens (often solved with a steeper base curve design) or the need for more add power (often solved by reducing the effective distance zone in either the non-dominant eye or both eyes). 
7. Communication = Success! Find out what their primary visual goals are and attempt to meet their primary goals. Never guarantee that they will not require over-glasses. They are infrequently needed with GP wearers but occasionally someone may desire a small amount of minus power to wear for night driving or a small amount of plus power to read very small print such as with medication labels. 
8. But what about monovision? Certainly monovision, like hybrid multifocals and scleral multifocals are tools that should be in the presbyopic fitting toolbox. That said, today’s designs have become so sophisticated and result in better vision than yesterday’s designs such that the benefit of good binocular correction at all distances make multifocals an option to be positioned first when providing the options to the patient. And if vision is an important, aspheric (and segmented, translating) multifocals need to be emphasized.

The Bottom Line

Every presbyope deserves to be asked if they would be interested in contact lenses. Those individuals who are existing wearers will be very motivated to stay in contact lenses. But you will be surprised to find that many presbyopes who are not wearing lenses will respond positively and not only will you change their life but they might represent your most prolific referral source. It’s quite evident that the presbyope represents your greatest opportunity and you can build a practice simply on the contact lens fitting of these patients.

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