2. Require acknowledgement of limitations
After the refraction, I sit face to face with the patient and ask how he spends his day visually. I then provide three contact lens fitting options as a presbyope. I explain the positive and negative of each, and we quickly review which option seems to best match his goals. Though I make a recommendation, and nine times out of 10 it will be for multifocal contact lenses, I force the patient to make the actual choice.
In essence, I make him ask for the fit and agree to the imperfections of the contact lens before we start. I do this by reiterating any potential negatives, and then I gain his acknowledgement.
“You understand that neither your distance nor near vision will be perfect? But our goal is for you to do most tasks most of the time without readers.”
“We may have to go through a couple sets of trials, which will require at least one additional visit, sometimes more. This is a process. Are you okay with all this?”
In no way do I avoid multifocal contact lens fits or represent them negatively. I believe strongly in recommending multifocal contact lenses, even to patients who come in only for glasses. I want them to clearly understand the limits of the design, our relative goals, and the journey to achieve them.
The biggest benefit I have found is that patients are happier on their return. We don’t have multiple lens changes and visits because they have a better understanding of their optimal vision. The majority of my multifocal contact lens fits are completed with only one follow-up visit after the initial fit—which makes the extra three-minute discussion worth it.
3. Match design to demands
Find out how your patient uses his eyes throughout the day and if distance or near vision is more important. Use this information when considering a center-near design, center-distance design, or one of each. I have one go-to brand that I always start with, but I also have a backup brand in each of those categories for the one-sided demands, such as a truck driver or accountant.
For each multifocal contact lens you use, learn it well. Always follow the fitting guide for the brand you choose.
Related: Top multifocal contact lens tips
4. Celebrate the functionality
Once we have decided to move forward with the multifocal fit, I no longer discuss negatives. The last thing you want is for the patient to leave your office looking for what may be wrong with his vision.
Emphasize what he can see. Get the patient excited about being able to read without his spectacles, and reiterate what an enhancement this will be to his functionality and quality of life. I tell the patient it’s going to get even better.
I explain that because of the dim light in the exam room, this is probably the worst vision he will experience. With better light and time for his brain to adapt, it will get even better, day by day. I say this, not as an appeasement or hope in the face of dissatisfaction, but as a way to build excitement.
I’m also careful not to derail his momentum by dilating at this visit. When he is able, I walk the patient out so I can continue to celebrate and watch him experience his vision in the natural light.