1/3/2013

Understand Patients Goals Multifocal Contacts: How They Work and How to Make Them Work Mile Brujic, O.D.

Disclosure

• 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

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

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Success Doesn’t Mean “No Glasses” 3 ADD Designs

• Near vision only glasses AIR OPTIX® AQUA MULTIFOCAL 3 ADD System • ? Monovision Glasses? • Sport specific sunwear for presbyopes

LO ADD MED ADD HI ADD Up to +1.25 +1.50 to +2.00 +2.25 to +2.50

Don’t Stray Too Much!

Fitting Tip: - Assess vision using real world targets!

2009-11-1119

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If Unsatisfactory Distance Vision: • 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

The Lens Design

Aspheric Zones Low ADD High ADD •Stereo Precision Technology Asphere

9Unique synergistic combination of the positive design aspects of the aspheric and zone designs

Power gradually becomes more plus (+) Power becomes more positive towards towards lens center. lens center, plus a distinct central zone 9Balance at all Distances of greater plus (+) power. Non-dependant on illumination Minimized ghosting, glares & halos

JJVC, data on file.

Fitting Tips for SUCCESS

• Spectacle ADD • Lens ADD Power – +1.25D or less – Low ADD OU – +1.50 to +1.75D – High ADD OU • With increased minus in distance Rx by ‐ 0.25 or ‐0.50D if needed

– +2.00D and up – High ADD OU

JJVC, data on file.

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The Multifocal Success!

THE REAL DEAL ON MULTIFOCAL CONTACT LENSES

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The “OK” Multifocal Experience!

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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

Central Pooling: Correct Fit: Skirt Curve too Steep Thin NaFl Layer

OCT Photo of Duette Junction 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

Skirt Curve Too Flat

CentralCentral Bearing: Bearing - STEEPEN Correct Fit: Skirt Curve tooSKIRT Flat Thin NaFl Layer

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

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Proper Patient Insertion –3 Methods

D LENS: DOMINANT EYE N LENS: NON-DOMINANT EYE

Mark (Engineer), 48 year old 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‐week progress visit.

Mark (Engineer), 48 year old NP Mark (Engineer), 48 year old NP Chief Complaint Blurred distance and near (loss of crispness). Has considered just going to spectacles. • 1‐week progress visit –Patient states near vision needs Previous CL Rx OD: Soflens MF 8.5 -0.75 / Low Add to be better: D: 20/30+ N: 20/30-2 – OD: D: 20/20‐2 N: 20/60+ OS: Soflens MF 8.5 -1.00 / Low Add D: 20/30 N: 20/40+ – OS: D: 20/30+ N: 20/30 Over-Refraction: no improvement with flippers. – OU: D: 20/20‐ N: 20/30 Manifest Refraction OD: -0.50-1.00x174 D: 20/15 – SOR: +0.25 OD and +0.25 OS OS: -0.75-1.00x018 D: 20/15 – Fit: 0° OD and 5° T OS, good c,c,mvmt OU ADD: +1.75 N: 20/20 OU Dominance R eye dominant with +2.00 Fog • Ordered New Diagnostic CL’s: Pre-Fitting ConferenceDemonstrated cylinder to patient and – OD: Proclear MF Toric 8.4 ‐0.25‐0.75x175 / +1.50 Add / D lens improvement (PFC) in crispness. – OS: Proclear MF Toric Diagnostic CL Fit ?? 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: y Vision and comfort pretty good, improved near.

y OD: D: 20/20 N: 20/40‐

y OS: D: 20/30‐ N: 20/25+

y OU: D: 20/20 N: 20/25+ y Stable over‐refraction and fit OU € Final CL Rx: y OD: Proclear MF Toric 8.4 ‐0.25‐0.75x175 / +1.50 Add / D lens y OS: Proclear MF Toric 8.4 ‐0.50‐0.75x015 / +1.50 Add / N lens

-Female in her early 40’s -50 year old female -Low myope (-1.25 sph) OU -Refraction +4.25-0.25 x 090 20/20 +7.75-1.50 x 050 20/30 -Etafilcon A / 8.3 / -1.25 OD add +2.00 20/20 -Senofilcon A/ 8.4 / 14.0 / -1.00 OD, +0.75 -K’s OD 46.25/45.75 @ 119 OS OS 45.12/46.75 @ 127

-In for yearly examination Mild dry eye OU -Something seems wrong with her near vision 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.

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Thank You [email protected]

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