Published in Contact Lens
How to Fit Multifocal Contact Lenses - with Downloadable Cheat Sheet
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Multifocal contact lenses can be confusing and frustrating to fit. Use this cheat sheet to make your initial fitting and follow-ups a breeze!
This cheat sheet highlights some important parameters and troubleshooting adjustments for multifocal contact lenses that will make your initial fitting and follow-ups a breeze! Especially when you have a patient who is unsatisfied with their near or distance vision.
Multifocal contact lenses can be confusing and frustrating to fit at times. Many clinicians will choose to use their personal experience to troubleshoot a lens fitting and use the same methods across all multifocal lenses. There are numerous fitting guides provided by the contact lens companies that are meant to make the optometrist’s life easier, but having them on separate sheets makes it very difficult to reference in a timely fashion.
In addition to that, the helpful information can be hard to locate among all the other product information on the information sheets.
We have partnered with Dr. Cindy Shan, who has gathered information from a variety of popular multifocal contact lenses and summarized not only the power and add determination parameters but the refinements suggested by these specific companies.
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Fitting guides are often forgotten when trying to troubleshoot a multifocal contact lens fitting, but they can be a beacon of hope. If the patient reports dissatisfaction with visual outcomes, the specific instructions generated by the company that produced the lens lays out helpful steps specific to their contact lens product.
One fitting method may not be applicable to all multifocal lenses on the market as each lens is designed differently and the company meant for them to be used in a different way. For example, Alcon has a helpful suggestion regarding their Dailies Total 1 multifocal lenses. They have suggested that the spherical power of the initial lens should be selected by adding +0.25D to the vertexed spherical equivalent contact lens power. It is common for optometrists to forget this easy step but it can make a world of a difference.
In addition, the selection of the add power can be very specific, especially for those with high add power requirements. Taking Clariti 1-Day Multifocal contact lenses as an example, they specify that for those with myopia and high add powers, to use a low add in one eye and a high add in the other. Without knowing the fitting guide specifications, it would be often to assume that a patient requiring a high add would be given two contact lenses with high adds but the fitting guide created by CooperVision shows that they suggest a different starting point.
The fitting guides also provide incredibly helpful tips and tricks for troubleshooting situations where the visual acuity is unacceptable. In particular, you will see that depending on if the distance or near vision is the issue, there are specific suggestions for the changes that can be made.
In some cases, it may be important to remind the patient that multifocal contact lenses are not meant to provide perfect vision at all distances. Rather, it is meant to decrease reliance on glasses for these different distances and will require small compromises in vision on either end. It is a delicate balancing act between the two regions of vision.
Always use your trial lenses for an over-refraction. It provides a more realistic view for the patient and is more accurate than a phoropter or autorefractor. Using trial lenses to test for ocular dominance is also helpful as it is more reliable than sighting dominance. As a reminder, use a +1.50D trial lens and hold it up to each eye monocularly. The eye that perceives more blur at distance will be the non-dominant eye and should be prescribed the near power.
Each lens was designed differently and will need to be adjusted differently. When you have tried endless combinations of lenses, take a peek at the original fitting guide for the lens or this cheat sheet and see what the manufacturer had recommended.
The cheat sheet groups together a variety of different lenses based on their add and power conversions as well as the refinements suggested by the specific company or lens product line.
Start at the top to help you select an initial lens. If vision is unsatisfactory, refinement of the initial fit can be made according to the steps written below.