The future is here with multifocal contact lenses, yet so many patients are unaware of how far the technology has come or how it can improve quality of life… educating your patients and upskilling yourself on your approach to fitting is key.
I am a relatively recent graduate, driven to seek the best for my patients and eager to put into practice what I learned at university. Not long after starting in practice I realised that – surprise, surprise – not everyone likes to wear glasses. This motivated a strong interest in contact lenses… particularly for presbyopes who struggle with their near and distance vision and find their lives revolving around their specs.
Initially, I began dabbling with monovision and fitted some multifocal contact lens well. This usually ended up working for most patients however to be honest, sometimes it was hit-and-miss. Making multiple tweaks to get the prescription right chewed up appointment times and turned out to be the fastest way to lose a patient’s confidence.
Building a good reputation means getting it right the first time because then people believe in your skills. Even if your patient doesn’t understand what you’re doing, it’s important that they’re confident you do.
I’m the kind of person who wants to know the simplest strategy to get the best results every single time
In hindsight, I realise that as a recent graduate, I lacked the knowledge to instil this level of confidence – I just didn’t know enough.
Immersive Learning
Fast forward a few months and I received an invitation to attend an Alcon multifocal contact lens fitting workshop. As one of many contact lens companies I was familiar with, I thought this was a great opportunity to upskill in an area I wanted to improve on. The one day workshop transformed my thinking and elevated my success as a practitioner by adding skills to my arsenal that I could perfect.
I’m the kind of person who wants to know the simplest strategy to get the best results every single time. Consistency is key and this is what the day delivered through presentations, real patient experience, and role play scenarios.
First Time Fit
Importantly, I learned about different multifocal contact lenses, how they work and how to correctly fit them – the first time – and in a practical ‘real world’ way.
The key point that revolutionised my success in fitting multifocal contact lenses was pushing the plus to its limit in the distance refraction. At the time, I had been working with a 54 year old female. She had a real dislike for glasses, which fuelled her desire to try any contact lenses solution available. I could understand her frustration and determination – she had worn multifocal spectacles since hitting presbyopia, but to improve her spectacle comfort she remained significantly under-corrected due to her anisometropia. Her right eye was +3.50D but her spectacle lens had been dropped to +1.75 to match her left eye.
Prior to the workshop, I hadn’t had much success in achieving acceptable near vision for my patient by fitting contact lenses. Typically, when she came in, I’d grab some multifocal contact lenses with the same script and add as per her spectacles or I’d try fitting higher adds, monovision contacts or different brands – each time with no success. I had been going around in circles.
As well as pushing the plus to its limit, the workshop demonstrated the importance of carefully following a fitting guide and on my return to practice, I quickly discovered the joys of doing so.
When I next saw my patient, I started with a full maximum plus refraction to see how far we could push the plus. Although the full plus wouldn’t be ideal in spectacles, it worked well when fitting multifocal contact lenses. I had learned that the initial trial lenses needed to have the maximum plus that she could accept in her subjective refraction, and then an extra +0.25D in each eye.
When it came to choosing the add, I went for the lowest add required, as discussed at the workshop. This minimised aberrations and gave my patient the best quality distance vision.
The result? By implementing a simple strategy, I had achieved the great distance vision my patient had previously enjoyed and enabled her to see her phone too. It was an incredible improvement, which she thought was nothing short of miraculous.
In hindsight, all of the pointers I needed to find a successful solution for my patient were available in the fitting guide. Although I had read them, I didn’t learn to use them until I attended the workshop and truly immersed myself in learning techniques, complemented by real-life practice. I now had context to the fitting guide… what’s more, it quickly became second nature.
Heading Outdoors
Having become more practiced with contact lens fitting, I believe greater success can be achieved by managing patient expectations and empowering them with knowledge of how lenses work.
We know, for example, that with a near centre lens, pupil constriction in sunlight can affect distance vision. Explaining this to a patient in simple terms helps them understand how multifocal lenses work and reinforces the idea that in the consulting room, we aren’t necessarily aiming for 6/6 and N5 vision.
Taking a patient outside during a fit, gives them the feeling of‘real-world vision and the affect can be quite surprising. What may not feel right when vision is tested using a letter chart in the consulting room, may feel perfectly acceptable once outside.
Getting vision correct is an art and the process plays on a patient’s emotions and confidence – it’s got to feel good and it’s never only about the acuities.
Having learnt the art of contact lens fitting, and enjoyed so many positive patient experiences, I now talk to my patients about, and approach multifocal fittings with great ease, confidence, and even excitement. I know my positivity gives my patients confidence and that they respect my genuine motivation to give them another choice.
Identify the Need
I believe every patient can benefit from contact lenses in some way – whether for exercising, going out, going away on holidays, working in a trade or a profession… it’s just a case of identifying the need and talking to them about the options.
Lastly, a word of warning. You can become addicted to the success that comes with successful contact lens fitting. The woman I wrote about earlier brought her husband in for multifocal contact lenses, and her children in to have their eyes tested… it’s hard to describe the professional satisfaction I feel having improved quality of life – and even harder to describe the joy patients feel – but the most common response I get is, “I feel young again!”.
That’s life changing on another level.
Shon Prasad wrote this article on behalf of Alcon. The views expressed are those of the author and do not necessarily represent the views of Alcon. NP4 Number #A21803795640
Shon Prasad is an optometrist who graduated from Queensland University of Technology in 2016 with a Bachelor of Vision Science and Master of Optometry. He works primarily at OPSM North Lakes but also across other practices within the North Brisbane area. He is a member of Rotaract Club of Brisbane International and is also a Justice of the Peace.
