Correcting Presbyopia – Fitting Pearls

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  • Evaluate tear film, pupil size and lower lid position
  • Use diagnostic lenses
  • Have available at least one aspheric and segmented diagnostic set
  • Get a complete list of CLMA member labs
  • Use trial lenses for over-refraction
  • Evaluate the position of segmented designs to the lower lid
  • Segment line should be at or near the lower pupil margin
  • To evaluate the reading portion of a segmented design, lift up the lid as the patient looks down: the lens should be pushed up. This is referred to as translation.
  • Some nasal rotation can be beneficial for reading
  • High eccentricity aspheric lenses are usually fit up to 3D – 4D steeper than K
  • Low eccentricity aspheric lenses are usually fit up to 1D – 2D steeper than K
  • Aspheric lenses typically require good centration with minimal lag on blink (1mm)
  • Some aspheric designs benefit from the lens positioning under the upper lid
  • Aspheric multifocals benefit from some lens translation when patient looks down to read
  • Use the CLMA lab consultants for fitting advice

Making Lens Design Changes

To improve the fitting relationship, make a significant change in lens design:

  • Change BCR at least 0.50D
  • Change diameter at least 0.3mm
  • Change amount of prism at least 0.50D
  • Consider switching lens design concepts if unsuccessful with one style

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