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Mastering the Simplified Multifocal Contact Lens Fitting Process

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In the past, multifocal contact lens fitting was time-consuming and involved a great deal of trial-and-error to get an acceptable fit.

In this final webinar in our series on presbyopia, Milana Matz, OD of North Suburban Vision Consultants in Deerfield, IL, will walk us through Alcon's "Simplified Multifocal CL Fitting Process".

This process has resulted in high rates of fit success, including 80% success with 1 lens per eye, and 96% success with 2 lenses or less per eye!

Dr. Matz will review the process, and several real-life case studies of presbyopic patients fit into multifocals. We hope to see you there!
 
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By the way, Paul plans to attend this one live, we want this session to be somewhat interactive -- he comes from a generation where fitting MF lenses was fraught with difficulty, so i'll be curious to hear what he thinks about this process and modern multifocals in general...
 
AdminWolf said:
Dr. Matz will review the process, and several real-life case studies of presbyopic patients fit into multifocals. We hope to see you there!
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This Webinar is designed to attract those who have hesitated fitting mutifocals because of a perception that it requires specialized expertise and great amount of chair time.

The Webinar is a step by step cook book approach to success with minimum chair time required.
 
AdminWolf said:
By the way, Paul plans to attend this one live, we want this session to be somewhat interactive -- he comes from a generation where fitting MF lenses was fraught with difficulty, so i'll be curious to hear what he thinks about this process and modern multifocals in general...
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I was one of the earliest proponents of mono vision. There are still many mono vision patients wearing contact lenses. There is a large market for this group who might appreciate binocular vision with multifocal.

Full disclosure: My wife, (Adam's mom) was one of the earliest monovision users. She now has post cataract implants, using a mono vision prescription.

For sure spending an hour interactively participating with the speaker might allow you to re-think adding multifocal as a choice for presbyopes.
 
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Hope to see everyone at tonight's show. it should be a fun one, since Paul is venturing out of the house to take part.

Looking for some good back-and-forth about multifocals, probably won't be difficult with Captain Monovision next to me...

see ya there!
ad
 
For those who are gun shy dealing with multifocal contact lenses. A very simple cook book approach.

The market is poised. Alcon is doing their bit with consumer marketing.

Your practice should have baby boomers wearing mono vision. They are ready to use both eyes for distance, intermediate and near.

Your generation x contact lens patients are reaching presbyopia. They are a really market.

Any questions? This is the place to ask.
 
AdminWolf said:

In the past, multifocal contact lens fitting was time-consuming and involved a great deal of trial-and-error to get an acceptable fit.

In this final webinar in our series on presbyopia, Milana Matz, OD of North Suburban Vision Consultants in Deerfield, IL, will walk us through Alcon's "Simplified Multifocal CL Fitting Process".

This process has resulted in high rates of fit success, including 80% success with 1 lens per eye, and 96% success with 2 lenses or less per eye!

Dr. Matz will review the process, and several real-life case studies of presbyopic patients fit into multifocals. We hope to see you there!


*** CEwire2020 Updates ***

Early Registration for CEwire2020 opened this week! Participants at this webinar will get the latest course updates and news about the event. Don't miss it!
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I missed this webinar. Can I watch it anywhere?
 
Welcome Masoome! We are honored by your presence. Please continue to post!
 
AdminWolf said:

In the past, multifocal contact lens fitting was time-consuming and involved a great deal of trial-and-error to get an acceptable fit.

In this final webinar in our series on presbyopia, Milana Matz, OD of North Suburban Vision Consultants in Deerfield, IL, will walk us through Alcon's "Simplified Multifocal CL Fitting Process".

This process has resulted in high rates of fit success, including 80% success with 1 lens per eye, and 96% success with 2 lenses or less per eye!

Dr. Matz will review the process, and several real-life case studies of presbyopic patients fit into multifocals. We hope to see you there!


*** CEwire2020 Updates ***

Early Registration for CEwire2020 opened this week! Participants at this webinar will get the latest course updates and news about the event. Don't miss it!
Click to expand...
I had a patient who wanted to try multifocal lense. Distance refraction was plano and add +0.75D . I tried a pair of Baush and Lomb trial lenses plano/low add. Distance vision was 20/20 but she complained about blur vision in near. I followed the rule and add +0.25D distance overrefraction so +0.25 low add right eye and +0.50 low add left eye. But she said distance vision is declined through window ( actual outdoor environment)
Finally I ordered plano/low add for the dominant eye and plano high add for non dominant eye. here's my question. Why guidelines in the video didn't help me? Where was I wrong?
 
I like your first and third approach.

The low add in the multifocal should have provided good enough near vision for a person needing a +0.75 add. I would have tried that first as well.

But sometimes things don't go as planned.

Your second approach was OK, but I would not have "overplussed" the dominant eye. I would have tried to just overpluss the non-dominant eye, which I think you did.

Your third approach should work...it's very much like your second approach, but you don't overpluss the dominant eye, and the distance vision should stay clear.

If the patient still doesn't like the distance vision, you may have to eliminate the dominant eye lens altogether, and just work with the non-dominant eye.

Good case!
 
Masoome Rezaee said:
I had a patient who wanted to try multifocal lense. Distance refraction was plano and add +0.75D . I tried a pair of Baush and Lomb trial lenses plano/low add. Distance vision was 20/20 but she complained about blur vision in near. I followed the rule and add +0.25D distance overrefraction so +0.25 low add right eye and +0.50 low add left eye. But she said distance vision is declined through window ( actual outdoor environment)
Finally I ordered plano/low add for the dominant eye and plano high add for non dominant eye. here's my question. Why guidelines in the video didn't help me? Where was I wrong?
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Emmetropes, early presbyopia, and MF is a poor mix in my opinion.
 
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Jeff Kiener said:
I like your first and third approach.

The low add in the multifocal should have provided good enough near vision for a person needing a +0.75 add. I would have tried that first as well.

But sometimes things don't go as planned.

Your second approach was OK, but I would not have "overplussed" the dominant eye. I would have tried to just overpluss the non-dominant eye, which I think you did.

Your third approach should work...it's very much like your second approach, but you don't overpluss the dominant eye, and the distance vision should stay clear.

If the patient still doesn't like the distance vision, you may have to eliminate the dominant eye lens altogether, and just work with the non-dominant eye.

Good case!
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Thank you
I'll try your suggestion next time
 
Masoome Rezaee said:
I had a patient who wanted to try multifocal lense. Distance refraction was plano and add +0.75D . I tried a pair of Baush and Lomb trial lenses plano/low add. Distance vision was 20/20 but she complained about blur vision in near. I followed the rule and add +0.25D distance overrefraction so +0.25 low add right eye and +0.50 low add left eye. But she said distance vision is declined through window ( actual outdoor environment)
Finally I ordered plano/low add for the dominant eye and plano high add for non dominant eye. here's my question. Why guidelines in the video didn't help me? Where was I wrong?
Click to expand...

The only place you were wrong was in selecting this patient for multifocal contact lenses. Her uncorrected vision is not yet bad enough for her to accept the limitations of multifocal contact lenses. Try again in five years.
 
It was a good experience for you Masoome. You learned something important. Multifocal soft lenses are nowhere near as good as the manufacturers represent. -Charlie
 
Jeff Kiener said:
If the patient still doesn't like the distance vision, you may have to eliminate the dominant eye lens altogether, and just work with the non-dominant eye.
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It should have been step 1: +.75 sphere or +.50 sphere OS only. Don't be hatin'
 
We need an update from Dr. Kiener on incorporating some of the recent additions to the bifocal schema. He is a savant with this stuff.
 
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Charles A McBride said:
Multifocal soft lenses are nowhere near as good as the manufacturers represent. -Charlie
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Truer words have never been spoken.

When I get a plano presbyope that wants contacts for the first time I explain it to them like the contacts will give them a particularly nasty case of gonorrhea.
 
Mike Ware OD said:
Truer words have never been spoken.

When I get a plano presbyope that wants contacts for the first time I explain it to them like the contacts will give them a particularly nasty case of gonorrhea.
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I agree with you both. Theses things are not fun to fit and nothing close to what is told to us by the reps or cl companies.
 
Yes, agree with Charlie, Mike & Mark,

The sales rep just gets back from an annual sales meeting, and is indoctrinated with all their swag on how these new MFs, will make millions see better, look young, and appear 15 lbs thinner when looking in the mirror. (sort of like marketing Vuity). And besides, the rep wins a trip to Italy if their numbers are up 30%.

We get that emmetropic 2.25 presbyope in the chair that wants those lenses. Let the fun begin.
 
Mike Ware OD said:
Truer words have never been spoken.

When I get a plano presbyope that wants contacts for the first time I explain it to them like the contacts will give them a particularly nasty case of gonorrhea.
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Monovision all day long on plano presbyopes.

I believe one popular poster said to throw everything out but high adds. Fit everyone into high adds. Wonder how that would work with you plano presbyopes? Maybe he was just trying to eliminate competition by throwing the young ODs off with the high add stuff.
 
Steve Howard said:
one popular poster said to throw everything out but high adds.
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That poster was speaking of DT 1 Multifocals only, Steve. As a PIA emmetropic absolute presbyope myself, they don't even come close. I can tolerate Oasys MF's though.
 
Charles A McBride said:
Multifocal soft lenses are nowhere near as good as the manufacturers represent. -Charlie
Click to expand...
Well, Charlie wrote that over a year ago and wow, have things changed!

Oh.....wait. NOT.

So I'll add a few comments to this thread:

1. Fitting not-emmetropes who are currently in CLs to multifocals is a no-brainer. Early to mid presbyopes---easy peasy. Absolute, a little harder but surely do-able. For the former almost anything fit centered or at least over the optical axis will work. For the latter you have near-center in the non-dom and distance center in the dom eye like Biofinity.

2. Fitting emmetropes new to CLs is indeed a big ask. But still do-able if you present realistic expectations. "You're distance vision is not always going to be perfect but you will be mostly, not always, free of using near specs."

3. The Big Failure either way is ignoring ATR astigmatism correction (their distance vision will always suck) and not embracing undercorrecting WTR astig in the not-dominant eye.

4. Big Failure #2 is ignoring dry ocular surface issues, especially toward the end of the day.

5. Big Failure #3 is adjusting the distance power in a 10ft room behind a photopter. You abolutley must use hand lenses in real space (20ft+, Snellen AND actual trees with leaves. Flowers good, too.)

Back in the day (still only a few months ago) I had near 100% success rate, using primarily Alcon DT1 or BL Ultra--and trying both for comparison as their e-values are not the same), sometimes Oasys and then Biofinity MF and Definity-material custom lenses for weird astigmats and steep/large corneas.

Worth the extra time in the resulting referrals when you succeed.

That's my two cents. Bye for now. :)
 
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