G.P. MULTIFOCAL LENSES: A FITTING WORKSHOP

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1 G.P. MULTIFOCAL LENSES: A FITTING WORKSHOP Susan J. Gromacki, OD, MS, FAAO, FSLS Daniel G. Fuller, OD, FAAO, FSLS Cornea, Contact Lenses and Refractive Technologies Section The American Academy of Optometry Please silence all mobile devices and remove items from chairs so others can sit. Unauthorized recording of this session is prohibited.

2 Disclosure Statement: Susan J. Gromacki, OD, MS, FAAO, FSLS AccuLens, Alcon, Alden, Allergan, Bausch + Lomb, Bioscience Communications, Blanchard, CIBA Vision, Contamac, CooperVision,, Danker, Focus Labs, GPLI, Inspire, Johnson & Johnson, Pilkington Barnes-Hind, Sauflon, Shire, SLES, Sunsoft, SynergEyes, Valeant, Visionary Optics, Vistakon, Wesley-Jessen, and Westcon Daniel G. Fuller, OD, FAAO, FSLS Alcon, Bausch & Lomb, CooperVision, Johnson & Johnson

3 G.P. MULTIFOCAL LENSES: A FITTING WORKSHOP Susan J. Gromacki, OD, MS, FAAO, FSLS Daniel G. Fuller, OD, FAAO, FSLS Cornea, Contact Lenses and Refractive Technologies Section The American Academy of Optometry

4 References Gromacki SJ. Satisfying Boomers and Boomlets with Lenses. Contact Lens Spectrum 2008; 22 (12): 33-35, 51. Gromacki SJ. Fitting the Astigmatic Presbyope with Contact Lenses. Contemporary Optometry, pp. 1-6, Volume 6, Number 3, March Gromacki SJ. Monovision and Bifocal Contact Lenses. In: Hom MM and Bruce AS, eds. Manual of Contact Lens Prescribing and Fitting. Butterworth Heinemann Elsevier, St. Louis, Missouri, 2006; Chapter 22: Gromacki SJ. Soft Multifocal Contact Lens Update. Contemporary Optometry, pp. 1-6, Volume 4, Number 8, August Gromacki SJ. Preventing Contact Lens Challenges for Presbyopes. Contact Lens Spectrum 2004; 19(8): S1-8.

5 Select the Lens Design

6 General Categories, GP Multifocals: 1. Corneal GP Aspheric Simultaneous Front Back (can place additional add on front) 2. Corneal GP Alternating (Translating) 3. Scleral GP (Simultaneous, most are center distance)

7 Perform the Necessary Testing

8 All Multifocals: 1. New refraction and Ks 2. Determine dominant eye 3. Use diagnostic contact lenses *Perform overrefraction at distance Place in trial frame and Test near VA 1. Add plus power for better distance/near compromise 2. Increase add if possible for better near VA

9 Simultaneous Designs: Center Near Corneal and Scleral 1. *Lens must center well* (Scleral easier but sometimes slightly inferior temporal use toric PCs; also note the recommended central clearance for lens design) 2. For some back surface corneal aspherics, need to fit D steeper than K Best conditions: Ability to accept visual compromise Low to moderate adds Work in a stable lighted environment Modified monovision: the key to success

10 Scleral Multifocals For regular or irregular corneas No translation Most available multifocal scleral lens designs: simultaneous with CN optics May not work well for the irregular corneal patient if there is significant corneal scar tissue or residual higher-order aberrations. Can use more asphericity on back surface vs. corneal CL since don t have to worry about molding

11 Simultaneous Designs: Center Distance Corneal 1. Lid attachment: fits just like a spherical GP Ensures viewing through distance portion of lens Some translation, allows for easier utilization of midperiphery for near in general, can utilize higher add and less simultaneous vision than center near design 2. For some back surface corneal aspherics, need to fit D steeper than K

12 Alternating Designs Top distance, bottom near Can be less comfortable initially movement Rests on LL

13 When fitted properly, lower lid pushes up lens to utilize near portion of the lens

14 Parameters Overall diameter ( mm) Optic zone diameter ( mm) Prism (1-3 pd) Seg height (below pupil center to at lower pupillary margin) Truncation ( mm difference)

15 Fitting procedures Fit on flat K Evaluate stability/ need to increase prism Evaluate segment height Evaluate lens base rotation / need to compensate for rotation in lens seg axis order Determine need for truncation (if lens rotates too much on downgaze)

16 Best conditions Motivated patient Lower lid at or above limbus Rigid eyelids Low corneal cylinder ( D) Small to medium-sized pupils Need for crisp add/ high add ***w/o great intermediate need

17 Troubleshooting Simultaneous Designs

18 Poor distance acuity Check centration steepen or flatten BC Check for poor blinking Reduce lens diameter if too much lid interaction Add more (or take away) power for distance (then check near also)

19 Poor near acuity Check to see if lower lid is capturing the lens decrease lens diameter to obtain better translation into the near zone Add more power for near (check distance also) Send lens back to lab to add more plus to the periphery of the lens on the front surface

$Poor distance and near acuities Overrefract at distance and near$

20 Poor distance and near acuities Overrefract at distance and near *residual cylinder: lens will not work Lens non-wetting/depositing plasma treatment

21 Troubleshooting Alternating Designs Preventative maintenance: trial lens fitting

22 Poor distance acuity Alter BC to achieve better fit and alignment of seg with pupil Truncate to lower segment

23 Poor near acuity Flatten BC Increase add power Raise seg height

24 Flare at night Decrease seg height Could be due to squint d/c lens wear at night

25 Poor rotational stability Truncate Increase prism Steepen BC

26 Lens base rotation Increase prism Compensate for rotation in lens seg axis order

27 Lens slides under lower lid Increase prism Increase truncation

28 Thank you for your time and attention!

29 Please remember to complete your session evaluations on the Academy.18 meeting app Tweet about this session using the official meeting hashtag #Academy18

Soft CL Multifocals Design and Fitting. Soft Multifocal Lens Designs. Issues Surrounding Multifocals. Blur Interpretation. Simultaneous Vision Designs

Soft CL Multifocals Design and Fitting Mark Andre, FAAO Associate Professor of Optometry Pacific University Mark Andre, FAAO is affiliated with CooperVision, as a consultant. Issues Surrounding Multifocals