To get another opinion on fitting processes, I spoke with Amanda K. Lee, OD, who has a full-scope family practice in Myrtle Beach, SC.
She says that in the late 1990s and early 2000s, practitioners didn’t have many choices for soft multifocal contact lenses.
“At the time, my lens of choice was Acuvue Bifocal (Johnson & Johnson Vision),” she says. “Wanting to use new technology for my patients, I reached a lot for that product. Although I had less success fitting that product that today’s disposable multifocals, I had at that time equal success to fitting monovision. Fast forward to today and the newest technology in multifocals, and we get 80 to 90 percent success even with the first trial lens selection. I can fit a modern-day multifocal as fast as I can fit a spherical or toric product.”
Dr. Lee says two things prevent eyecare practitioners from fitting multifocals.
“One is the unwillingness to break ingrained habits of fitting monovision and the misperception that monovision is easier or faster as well as cheaper for the patient,” she says. “The other is the unwillingness to take the time to understand and try new technology.”
Dr. Lee brings up the multifocal option to patients by asking if there is a time that vision in their contact lenses has failed them—she calls this “needs-based” prescribing.
“Patients will often answer one of two ways: ‘I can’t see well at night when I try to drive,’ or ‘I can’t see my computer screen unless I move my head around.’ That allows me to open the conversation and offer them new technology so they can achieve those activities or unmet needs. Many patients still do not even know that soft disposable multifocal contact lenses exist,” she says.
Great lens options
Putting a patient in multifocal contact lenses historically required material compromises. Our latest materials were often available only in spherical lenses, but today we have our most wettable, breathable, and comfortable materials available in multifocal designs.
In the past, our lens options often limited fitting options. Most practitioners wanted to avoid mixing wear schedules or materials, which led to difficult-to-fit situations. If a patient wanted daily disposable lenses but needed a toric design, the patient and practitioner needed to choose between the desired modality or the required vision. Multiple manufacturers offering complete families of sphere, toric, and multifocal lens designs gives us the ability to provide for most—if not all—patient needs.