Multifocal Myths Debunked: Myth #7

Multifocal Myths Debunked: Myth #7

MYTH #7: Emetropes do not do well with multifocals.

FACT: The screening process really plays the primary role when fitting for success with emetropes.

Here is where using the optics can save the day. Often, in the past, emetropes have been fit with monovision. In some cases they seem to do reasonably well in the low ADDs. When the distance VA is only compromised by perhaps 4 or less lines of acuity, in the non dominant eye, the disparity may be tolerated. Unfortunately, as the ADD goes up, everything changes. Usually, the breaking point is at +2.00 and +2.50, when the distance is now a comfort and safety issue and the mid range (computer vision) is sacrificed beyond tolerance.

My thoughts on this suggest a multifocal that can be adjusted to meet the different visual demands. First, catch them early. Second, use lenses that least interferes with the distance vision and perception. Third, be prepared to drop back to one multifocal lens on the non dominant eye. One additional consideration - always check to see if there is any uncorrected hyperopia. That can change the entire course of management.

Because I do not know the level of acceptance for any particular individual emetrope, I will suggest the binocular fit with ProClear EP to start. If the distance acuity is acceptable in the office, allow the patient to wear the lenses for 10 days to 2 weeks. Encourage them to stick with the trial to see if they can make the adjustment. If they struggle, perform monocular verification to see if there is an over refraction that improves the area of complaint. Generally, the complaint will be at distance and be predominantly the dominant eye.

If the patient does not respond well to an over refraction, consider allowing them to try again using the EP lens in the non dominant eye only. For many this will be acceptable as the EP lens has the least deleterious effect on emetropes distance vision when used in conjunction with the uncorrected dominant eye.

The next step in management, as the ADD increases to +1.50 and above, is to decide whether to use the ProClear Multifocal (D) or (N) lens moving foreword. In some cases the (D) lens with the new +1.50 ADD, applied to the non dominant eye, will continue to maintain best and most comfortable balance at distance and still provide the near and intermediate vision needed for most tasks. The last step at approximately +2.00 is to go to the (N) lens in order to get the quality near vision in the high ADDs.

Emetropes can be challenging. I believe if you develop a management program based on your confidence with the optics of ProClear Multifocal and ProClear EP you will improve the fitting success not only as the emetrope emerges but also as they mature.

How can you develop confidence? Try a dozen, select the patient based on realistic expectations, use the process consistently and most importantly get ready for the referrals! These are the very patients that have been told they can not wear contact lenses.

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