As eye care practitioners, there are some facts we always know to be true. These include the trifecta: First, new fits generate revenue. Second, specialized contact lens fittings can improve loyalty and set your services apart from the competition. And third, the contact lens industry has developed new and innovative products—e.g., multifocal lenses—which help us offer our patients greater visual freedom by minimizing dependence on glasses.
While there are several ways to help define a practice, consider your strength in delivering new technology and become the local expert on a particular specialization. For example, astigmatic presbyopes are patients who likely have been told that they cannot wear contact lenses and/or only have been offered monovision prescriptions. We know that monovision lenses can be successful in some situations. But in comparison, the newer multifocal lenses improve both vision and depth perception.
By fitting specialized contact lenses, your practice will become synonymous with cutting-edge expertise, and you will likely see better patient retention and an increase in word-of-mouth patient referrals. And, despite worries about excessive chair time, specialty contact lens fitting typically yields higher gross margins, too.
The Patient Response
A decade ago, a Review of Optometry survey found a nearly even split between eye care professionals who fit monovision vs. multifocal contact lenses.1 Since then, significant improvements in multifocal technology have resulted in a noticeable shift in presbyopic fitting trends.
In a May 2006 study, 76% of patients reported that they preferred multifocal over monovision lenses.2 In July 2007, another study replicated those results and found a 3:1 ratio of patient preference for multifocal over monovision lenses.3 The researchers also further demonstrated the added advantage of multifocal contact lenses in the improvement of various visual measurements, including contrast sensitivity and depth perception. When successfully fit with multifocals, patients can enjoy improved binocular vision vs. monovision and improved peripheral vision vs. spectacles.
The technological advances in multifocal designs make the adjustment period relatively quick and easy. Patients also gain the ability to have an intermediate focus, which is particularly important for those with a high add. Keep in mind, however, that there are some patients who will be unsuccessful in multifocal designs and may be better served by monovision.
Take the time to identify your patients’ occupations, hobbies and daily visual requirements. This information will help you properly identify their visual needs and discuss reasonable expectations in advance of the fitting.
When fitting hybrid contact lenses, make sure to check for bubbles after insertion. Their presence will hinder vision and comfort.
By taking a few extra steps to customize the multifocal lens fitting to the individual patient’s daily visual tasks, you likely will derail contact lens dropouts and inevitably gain the respect of presbyopic patients––who will, in turn, serve as ambassadors for your practice.
Keep in mind that presbyopic patients tend to command more time and energy—including increased chair, staff and doctor time. Therefore, it is important to understand how to properly bill and code for these patients. Develop your protocol ahead of time so everyone is on board when these patients come in for their visit.
For example, do you need a corneal topography at every follow-up appointment for a particular specialty fit? Which fitting sets are most important to keep in the office? By planning ahead, you will be appropriately compensated for your time and expertise.
Understand the Technology
• Soft multifocals. The soft multifocal toric market is the newest area of growth. These lenses combine the toric technology used to correct astigmatism with the most advanced soft multifocal lenses. This fitting process is two-fold. First, fit the toric correction and adjust for any rotation or instability. Second, customize the multifocal to the patient’s specific visual demands.
Remember to discuss appropriate visual expectations, the associated fees and the importance of follow-up care. Review how these lenses can provide clear distance and near vision for a vast majority of visual tasks. Try not to bog down the conversation by going into too much detail on the technical aspects of the lens, such as design. Instead, focus on the expected timeline.
Note: One of the major keys to success in fitting presbyopes with soft multifocal lenses is correcting the underlying low astigmatism. We know that uncorrected astigmatism results in distorted or blurred vision, as well as decreased “crispness” in visual acuity. It can cause headaches and eye fatigue. We also know that there is some loss of visual clarity with soft multifocal contact lenses. If we try to mask that cylinder, the overall loss adds up and the success rates decrease. We can help eliminate some of that by first correcting even low amounts of astigmatism. If there is any doubt, demonstrate the cylinder in the phoropter and listen to the response.
• RGP multifocals. For presbyopes, RGPs often can provide a greater range of clear vision, which enables the eye care professional to maximize both distance and near vision for their patients. RGPs also have the unique ability to mask irregularities of a compromised or irregular corneal surface.
For some patients, RGPs are the only effective way to achieve the best visual function. Patients will most often have difficulties when excessive movement exists, so monitor the fit closely.
• Hybrids. The hybrid platform is an excellent example of how material science can help even those with unique visual needs wear contact lenses successfully. The only commercially available hybrid lens for this use is the SynergEyes lens, which provides increased oxygen delivery to the cornea through the soft and rigid gas-permeable portions of the lens. There were no previous high-Dk hybrid lenses on the market due to the difficulty in bonding hydrophilic skirts to this materials.4
Certainly, we will always have patients who are intolerant of any lens design. But, for patients who would benefit from the optics that an RGP delivers and cannot wear the lenses because of issues of discomfort, hybrid lens technologies should be considered. The soft skirt surrounding the RGP will lessen the lens awareness.
Be comfortable and proficient as you work to satisfy the needs of your presbyopic patients. The newer multifocal designs provide good optics and comfort. Take advantage of this opportunity and grow your practice through your expertise.
1. Eisenberg J. Monovision vs. multifocal: which would you choose? Rev Optom. 2003 Dec. Available at:
http://revoptom.com/index.asp?page=2_1061.htm. Accessed May 2013.
2. Richdale K, Mitchell GL, Zadnik K. Comparison of multifocal and monovision soft contact lens corrections in patients with low-astigmatic presbyopia. Optom Vis Sci. 2006 May;83(5):266-73.
3. Benjamin WJ. Comparing multifocals and monovision. CL Spectrum. 2007 Jul. Available at: www.clspectrum.com/article.aspx?article=100637. Accessed April 2013.
4. Chou B. Rigid optics with soft lens comfort. CL Spectrum. 2006 Jul. Available at: www.clspectrum.com/article.aspx?article=13066. Accessed April 2013.