GP Multifocal Applications and Troubleshooting

(An entire module of GP management of the presbyopic patient is available on this website.)

What should I consider when choosing the lens design?

“The most important information necessary to provide the proper design for the presbyopic patient is the visual requirement of the patient. If the patient needs intermediate acuity for computer use, for example, then a multifocal design is recommended. If the patient needs only distance and near vision and prefers fixed near vision capability, then an alternating vision bifocal design would be optimal. Previous lens history is also valuable, including previous lens design, distance-only or monovision correction, and success if monovision was tried.” (Ann Shackelford, ABB Optical Group)

“I consider the following five factors as most important:

  1. Previous lens wear and the type of lenses used.
  2. The prescription of the distance power.
  3. The reading needs of the patient.
  4. The amount of wearing times expected.
  5. What the reading expectations are.” (Jeff Birk, Essilor)

“Some important factors to consider would be the patient’s history, previous lenses worn, age of the patient, patient’s best visual acuity, and what the patient’s expectations are.” (Kelsey Roberts, Valley Contax)

“Patients’ visual needs, including computer use, small print, etc., are important. Details of their physical environment (lighting, etc.) are important to know, as well.” (Daren Nygren, Custom Craft Lens Service)

“Giving your lab consultant the most complete information will always improve your success in finding the right product for the patient. Presenting the options to your patient of soft, custom soft, GP corneal and scleral is the first step in providing suitable products.” (Keith Parker, Advanced Vision Technologies)

“There are three primary visual concerns that need to be addressed with presbyopic patients. They are distance, intermediate, and near vision. Ask the patient to identify two of the three concerns that are most critical to their visual needs. This will help determine which type of presbyopic design will be best suited to fit those concerns.” (Mike Johnson, Art Optical)

“When deciding on a GP multifocal design, whether corneal or scleral, we try to get as much information as we can in the initial design/fitting to ensure patient satisfaction. Aside from the obvious Ks, refraction, and add power, it is helpful to our consultants to know the patient’s visual/lens history, their occupation, which can create more severe visual demands, pupil diameter in normal illumination, lid position, and aperture measurement. Lens stability on eye is also critical, so clinical information regarding toricity or other topographical elements that can cause rotation or decentration is important.” (Derrell James, X-Cel)

What information should I provide the laboratory consultant?

“In addition to the usual Ks and spectacle Rx, lid-to-limbus position (superior and inferior), lid-to-pupil relationship, pupil size, tear film assessment, and lower lid tonicity are all helpful.” (George Mera, TruForm Optics)

“When providing information to the consultant about multifocal or progressive lenses, patient expectations are key. Other information is helpful, including the type of work and visual demands. Of course, we will always need information like Ks, refraction with add power, lid position, pupil size, HVID, and fissure size. These help us to determine the right lens parameters for the patient and what type of bifocal or progressive design will meet the patient’s needs.” (Dede Reyes, FCLSA, ABB Optical Group)

“Ks, spectacle Rx, add power, dominant eye, corneal diameter, and pupil size are all important to provide.” (Joe Hanson, ABB Optical Group)

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