Today I want to touch on 5 key barriers that may limit successful multifocal contact lens fitting and how to overcome them.
1) Get Passionate about Multifocal Lenses – Demographic information tells us that presbyopes make up one of the largest segments of our practice. If you're not on board now with multifocal lenses you should be.
I've found that, by and large, those practices that have success with multifocal lenses are those practices that have experience fitting the lenses. Those that are successful fitting them will speak very differently about multifocal lenses with their patients because of the successes that they have had fitting previous patients. The catch 22 is that often times without those successes, it is difficult to communicate this technology with passion and with a high level of confidence to patients. My recommendation would be to mention multifocal lenses to everyone who is a candidate. This will get you more comfortable discussing multifocal contact lenses with your patients.
Here is an example of an effective yet easily delivered question that will usually peak a patients interest: “Did you know that there are contact lenses that will allow you to see things up close without the use of glasses? If you are interested, I think that you would be an excellent candidate.” From this simple question and statement, you will be able to gauge your patient's interest. For those that were unaware of the technology, you have now made them aware. For those that are interested, this will likely lead to further questions about these contact lenses. Be certain to discuss multifocal contact lenses with every candidate.
2) Setting Proper Expectations for Your Patients – Further questions from your patients regarding multifocal contact lenses will give you the chance to then describe the way they work in greater detail. Expectations are important because if set incorrectly, it has the chance of potentially leading to a fitting failure.
In discussing the technology with patients, I will always describe multifocal contact lenses as “increasing functional vision and minimizing the use of reading glasses.” This sets the goals very clearly from the start. It is positive in that you are letting the patient know what the contacts will do but yet realistic in its approach. In this way patients will think of the additional tasks that they will be able to perform with their contact lenses without the need for reading glasses including things like viewing a cell phone, computer, reading menus, seeing maps and reading the newspaper, just to name a few.
3) Follow the Fitting Guides – Industry places a significant amount of resources into determining the most successful strategies for selecting the initial diagnostic lenses and then trouble shooting any problems that may arise. There may be the temptation to veer from the guides, but this will often lead a practitioner and patient off of the path of fitting success. Many manufacturers include fitting guides in product literature and/or post them online.
4) Demonstrate Success Immediately – I will initially let the contact lenses settle anywhere from 10 to 20 minutes and then demonstrate success. The way I do this is, before I measure visual acuity, I will have the patient view their cell phone and ask them if they can see it. Before the appointment they likely could not see their cell phone without their reading glasses and now they can. Another task that I have these patients do is look at a computer screen in the exam room that is about 16 to 20 inches away from them. The immediate success that patients will have creates a positive experience with the lenses. I will then measure visual acuities and over-refract using trial lenses.
5) Follow up questions – When patients come in for their follow up visits after 1 to 2 weeks, make sure to ask them what they are satisfied with and what they wish they could improve about their vision. This is an opportunity for the practitioner to re-educate the patient on the benefits and limitations of multifocals. Additionally, this will allow the practitioner and patient to work together to determine whether the powers in the contact lenses could be modified to better meet their needs.
By following these 5 steps you are certain to improve your multifocal fitting success.
Dr. Brujic graduated from the New England College of Optometry. He is currently a partner of a successful four location optometric practice in Northwest Ohio. He practices full scope optometry with special interest in contact lenses and ocular disease management of the anterior segment and glaucoma. He publishes a monthly column in Review of Cornea and Contact Lens and has written in numerous other optometric publications. He is active at all levels of organized optometry.
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