The global presbyopic population is growing rapidly, from an estimated 1.8 billion people affected in 2015 to 2.1 billion people in 2030.1,2 Despite these growing numbers, it seems that multifocal contact lenses continue to be underutilized among practitioners.3
The question is why? What is holding back eyecare providers from successfully fitting more multifocal contact lenses?
Historically, multifocal contact lenses have been known among eyecare professionals as challenging to fit despite advances in new contact lens technology.4 Early soft multifocal designs, such as concentric ring lenses, often required extensive fitting time and multiple trial lenses, which likely contributed to these perceptions.
Let's review a few common multifocal contact lens myths and discover the keys to unlocking successful patient outcomes and a thriving contact lens business.
Myth #1: “Patients aren’t really interested in multifocal contacts”
Despite what some may think, there is a growing number of presbyopic patients, including both previous or current contact lens wearers and spectacle-only wearers who are interested in wearing multifocal contact lenses.
A 2024 Beyond Vision report from the Contact Lens Institute found that around 50% of patients who wear glasses only are also interested in contact lenses, but only 10% noted that their eye doctor ever mentioned contact lenses as an option.5 So the notion that patients aren’t interested is false.
The truth is that many providers may not be taking the time to educate their patients on or offer multifocal contacts. Patients may not know multifocal contact lenses even exist, or maybe they weren’t a candidate in the past due to dryness or astigmatism.
“Patients want to hear from their provider about what options are available, what is the newest technology, and how contacts could benefit their life.”
Keep in mind that not every presbyopic patient is a good candidate or interested in multifocal contacts, but discussing them as an option with each presbyopic patient will allow you to become the expert and authority on this subject. And who knows, they may refer a friend or family member to you because they know that you are the best doctor for the job.
Keys to success
- Discuss multifocal contacts as a solution to patients' presbyopic challenges.
- Discuss advancements in technology and how they can benefit your patients.
Myth #2: “Multifocal contacts are complicated to fit and not worth the chair time”
Multifocal contact lens patients aren’t just a clinical opportunity, they are a revenue-driving, loyal base that can strengthen the long-term health of your practice. On average, I find that in my practice, these patients return more frequently for eye exams, have a higher revenue per patient, and show an increase in loyalty and referrals.
Although fitting multifocal contact lenses can sometimes require more chair time and multiple visits, it is 100% worth the time and effort. The key is to streamline your fitting process to increase your first pair success, which will equal better patient satisfaction and less of your time.
Multifocal fitting guides are critical tools for achieving a streamlined approach to initial fit, reducing unnecessary adjustments, and optimizing visual outcomes. Each brand of contact lenses has a unique design and therefore each fitting guide is tailored to that specific design, offering step-by-step instructions for troubleshooting.
Across Alcon, CooperVision, and Johnson & Johnson Vision, multifocal contact lenses consistently deliver fit success rates above 90%, often reaching 96 to 98% within just one or two trial pairs while using their specific fitting guides.6,7,8 However, keep in mind, these guides are not interchangeable between brands.9
Utilizing staff effectively during contact lens fittings can create a team-based approach to free up your chair time with these patients. Well-trained staff can perform preliminary steps like insertion, over-refraction, and visual acuity checks along with repeating measurements if changes are made.
By handling these tasks, the doctor can focus on high-level decision-making and troubleshooting. This can allow for complete fit the same day with no additional follow up appointments needed.
Keys to success
- Follow the fitting guides for each particular brand of multifocals
- Train and utilize staff members to assist with insertion, visual acuity, over refractions, and troubleshooting
Myth #3: “Multifocal contacts have low fitting success rates”
The most common reasons that I find for unsuccessful fittings and low success rates include:
- Unrealistic expectations
- Incorrect lens selection
- Poor candidate selection
- Not addressing underlying ocular surface disease
However, the majority of patients can find success with the right keys to success and addressing these common reasons for dropout. Many patients expect their vision to be perfect unless the correct expectations for multifocal lenses include compromise between distance and near, along with mild trade-offs (e.g., slight halos at night and reduced sharpness).
The conversation should be geared toward a positive discussion about how multifocals can help the patient to achieve their goals rather than providing suboptimal vision. However, a clear and concise conversation about realistic expectations can allow you to redefine success.
Selecting the right lens for the patients is important, but equally important is being flexible and not afraid to pivot when something isn't working. Advances in lens technology have allowed us to have so many options for multifocals these days and we all have our favorites. Keep in mind that certain fitting technology sometimes works better for certain patients and it is okay to pivot or switch brands if something isn't working.
Poor candidate selection is another factor that leads to low success rates. Patients with highly demanding visual needs, very Type A personalities, or minimal motivation may not be the best candidates for full-time wear with multifocals. Discuss with patients their specific goals and concerns to get a feel for their potential success.
Multifocal lenses do rely heavily on stable and consistent optics across the tear film. An unstable and irregular tear film due to ocular surface diseases can be problematic with multifocal designs, where multiple points of focus are already competing for clarity.
Ocular surface disease can also lead to more halos/glare along with discomfort.10 Pre-screening and pre-treating patients for dry eye prior to multifocal fitting can help avoid dropout and poor success from concurrent ocular surface issues.
Keys to success
- Discuss realistic and appropriate expectations to redefine success
- Don’t be afraid to try something different if running into a problem
- Address any underlying ocular surface disease
Myth #4: “Multifocal contacts are too expensive”
Price point is a common concern for both patients and practitioners. Although multifocal contacts have a higher sticker price compared to a standard single vision lens, I find that taking the time to educate patients on the value they provide often outweighs the cost concerns.
When compared to a high-quality progressive addition lens (PAL), multifocal contacts are comparable but with freedom from glasses. Ways to combat this thought process for patients are to discuss the value of performance vs. price, options for dual wear, and how to utilize insurance and rebates.
When it comes to discussing the value of performance, it is important to connect the dots between the patient's complaints or struggles with how multifocal lenses can solve these problems. Explain the benefits, including freedom from readers, improved mobility compared to PALs, and improved quality of life.
“Dual wear is a way to offset cost in patients who may want to wear multifocal contacts but not everyday.”
Most manufacturers of multifocal contact lenses have daily disposable options available, which are particularly well-suited for part-time wear. This modality provides unparalleled convenience, hygiene, and comfort—ideal for intermittent users switching between glasses and contacts throughout the day.11
The Double Duty Report from the Contact Lens Institute shows that 8 of 10 patients agreed that having the choice is a powerful benefit, including getting to decide what type of correction is best for different situations and gives them more control over their vision.12 Offering dual wear as an option may allow patients to wear both glasses and contacts with the ability to choose how much of each one.
Keys to Success
- Focus and emphasize the value of multifocal lenses first, then discuss costs.
- Create effective pricing strategies, bundles, and quotes to maximize patients' vision benefits and manufacturing rebates.
Conclusion: Changing the narrative
Multifocal contact lenses have evolved in design, comfort, and success rates9—but these outdated myths continue to limit their adoption. As optometrists, it's time to shift our mindset and embrace these lenses as an exciting opportunity rather than a difficult challenge.
By proactively educating patients, streamlining the fitting process, addressing ocular surface health, and clearly communicating value over cost, we can greatly increase multifocal contact lens success in our practices.
