Make GPs an ideal fit for presbyopic patients: advances in bifocal and multifocal designs allow you to fit many patients, even if they require higher adds and more intermediate correction

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As both a presbyope and contact lens wearer, I enjoy dining out with others my age and having them ask me why I don't wear glasses or hold the menu with my arms outstretched. I also enjoy sharing this experience with my presbyopic patients--many of whom are motivated to find an alternative to wearing glasses.

Gas permeable (GP) bifocal and multifocal contact lenses represent one such opportunity for these patients and your practice, especially when you consider that some 50,000 additional patients become presbyopic each day. (1) These patients depend on you to meet their visual needs in the workplace and for recreational and social activities. Research has demonstrated that multifocal GP designs, such as aspherics, can provide acceptable distance and near correction for presbyopic patients and can even be optimized for a given patient by considering his or her degree of ametropia and corneal topography. (2)

If you want to offer your patients GP lenses, become comfortable with prescribing them. A good place to start: aspheric multifocal designs for GP lens wearers who are new presbyopes. If you follow the manufacturer's fitting philosophy guide, you should, in most cases, achieve good centration, and the patient will gain some add power. And, very shortly, you'll gain confidence to fit more patients, including those who require higher adds or more intermediate correction.

Ideal Candidates

Good candidates for aspheric multifocal lenses not only include early presbyopes but:

* Individuals who can benefit from a progressive add. These include computer users and anyone else with visual demands at more than two distances.

* Athletes. (Yes, presbyopes still play sports.) The relatively tight-fitting aspheric designs minimize dislodgment in the tennis, softball, racquetball and basketball player.

* Individuals whose lid anatomy is not conducive to segmented, translating bifocals.

Translating GP bifocals still should have a prominent role in the presbyopic contact lens practice. These executive, crescent and similar type of prism-ballasted designs are an excellent alternative for individuals who want excellent vision at distance and near (intermediate vision is also available in many of the newer designs).

To be successful with a segmented translating design, the patient's lower lid should be no lower than 1mm below the inferior limbus. These weighted, or ballasted, lenses need to fit on or near the lower lid so that the lens is pushed up as the patient looks down. If the patient's lower lid is too far below the limbus, the lenses won't translate properly. Likewise, if the lower lid is too flaccid, translation will not likely occur upon downward gaze.

Breakthrough Technology

Aspheric multifocals that provide higher adds are perhaps the most exciting breakthrough in recent times. Traditionally, we considered the simultaneous vision of an aspheric lens to be a disadvantage because the patient had distance and near correction in front of the pupil at the same time. Over time, however, we learned that for an aspheric design to be successful, it must translate (i.e., shift up) to assist in providing the patient with add power.