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    Embracing new contact lens technology

    I recently attended one of our Optometry Times webinars, “Increasing your successful multifocal fits,” presented by our Editorial Advisory Board member David Geffen, OD, FAAO. David is one of the sharpest ODs I know, and his mastery of the subject matter was evident. I consider myself to be up to speed on this topic and was amazed at what I didn’t know! The webinar is available on our website (http://www.modernmedicine.com/webinars#eyecare).  

    Dr. Geffen: Prevening lens dropout with presbyopic patients         

    After the presentation, I wondered: with all the outstanding multifocal options for our contact lens patients, why in the world would anyone still choose monovision as a primary selection? Monovision is an antiquated technology dating back at least to the 1960s1 and goes against almost every tenet we’ve been taught regarding binocular vision. At its inception, it was the only method we had to keep our presbyopic patients in their contact lenses. Not a week goes by where I don’t see a patient wearing this modality. Many come to my office on the recommendation of a family member or friend who raved about their improved vision after I fitted them with multifocals.           

    I understand the attraction of monovision, especially in a busy practice: it requires no special lens, fitting is no more complicated than traditional lenses, and monovision is generally accepted visually by over 70 percent of patients.2 Likewise, some practitioners shy away from multifocal contacts due to a perceived complexity of the fit and increased chair time involved with multifocal contact lens correction.             

    Not saying that monovision doesn’t have a place in our armamentarium. It still does, albeit for those few rare cases when I just can’t get them comfortable in a multifocal. I am also a firm subscriber to grandma’s old adage: if it ain’t broke, Ernie, don’t fix it. In most cases, I’d say yes, but not when it comes to monovison. Many patients have simply gone along with that modality. They may not be aware of other options. That’s where we come in.

    Let’s face it: today’s presbyopes aren’t our grandparents. Baby boomers are more active with more visual demands and more disposable income to spend on what they want. This cohort is growing and is seriously underserved regarding presbyopic correction.3 These patients want the absolute best vision correction we have to offer, do not want to compromise their vision, and are willing to pay for the better technology. Today, that means multifocal contact lenses.

    What's the value of eye care?

    So, if you haven’t given multifocal contact lenses a whirl lately, consider them. These new soft multifocal designs have resulted in increased success rates and patient satisfaction versus monovision.3 Your patients will really appreciate your efforts at bringing them the latest in contact lens technology.


    1. Fonda G. Presbyopia corrected with single vision spectacles or corneal lenses in preference to bifocal corneal lenses. Trans Ophthalmol Soc Aust. 1966:25;70-80.

    2. Westin E, Wick B, Harrist RB. Factors influencing success of monovision contact lens fitting: survey of contact lens diplomates. Optometry. 2000 Dec;71(12):757–63.

    3. Bennett ES. Contact lens correction of presbyopia. Clin Exp Optom. 2008 May;91(3):265-78.

    Ernie Bowling, OD, MS, FAAO
    Dr. Ernie Bowling is Chief Optometric Editor of Optometry Times. He received his Doctor of Optometry and Master of Science in ...


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    • If you use Sharingan Contacts or what ever lens you use there are some ethics of wearing the contact lenses. So follow the advice of your doctor
    • I'm interested in wearing contacts lenses. How long does it take to get used to them?
    • StewartGooderman
      The problem with fitting presbyopic hydrogel/silicone hydrogel contact lenses is that from the beginning, all designs that had at least a remote chance of success had/has as its underpinning the idea of simultaneous vision: two images presented at the same time with the visual system looking through one to see the other. That's a basic design flaw because the unwanted image acts as a smoke screen when viewing the other. Even with the newest designs, the very first thing a manufacturer does is say "set expectations." If you have to do that, then you are doomed to providing compromised vision. We live in a computerized age where people are not working with devices 8 hours a day, they are working with them 15+ hours a day and these devices do not present absolutely clear objects. The presbyopic lens further degrades that object in a population who's visual flexibility has become challenged. I started attempting fitting of bifocal hydrogel contact lens in the days of Durasoft's translating truncated bifocal. Remember that disaster? In theory, the lens made sense because it had discrete distance and near areas, but how do you get a hydrogel lens to translate reliably and be comfortable with flaccid lids? Indeed, the newest designs are far better than "the good old days," but I still get the same complaints: "I still can't see the menu in a restaurant," "It's okay, but can you make it better?" Over and over and over.
    • Dr. EBowling
      Agree that the designs do need work. And we all hear those complaints every day. But the technology is improving, and the industry will get there. Thanks for commenting ! Ernie Bowling,OD

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