Please note that the comments below are representative of remarks made in the chat room, and do not necessarily reflect the views of the moderators, the guest expert, or the GPLI.

• When fitting, Dr. Bergenske suggests starting with an aspheric because they are easier to fit and more comfortable for the patient.
   
• Computer users with adds in excess of 1.50 D need at least one aspheric lens (This is a form of modified monovision using an alternating design for full add in the other eye).
   
• Overplussing one eye in an aspheric fit will also generate a higher add.
   
• It's also possible to achieve a higher add by adding plus to the front surface of Lifestyle lenses, or using the Essential lens.
   
• Fit a translating bifocal for patients requiring critical vision, moderate add powers, where aspherics don't center or move excessively, and for large pupils.
   
• Dr. Maller fits many patients with a translating design on one eye and an   aspheric on the other to maximize the advantages of both types of lenses for a single patient. The aspheric lens is fitted to the non-dominant eye.
   
• How long do you refine a bifocal fit before deciding to change to another
  lens or modality type? The consensus answer is no more than three months, sooner if visual performance is really off. Those with trial lens sets find this less of a problem: they know whether or not the fit will be successful before lenses are ordered. Continue in the current design if you feel a fitting issue which can be addressed is causing the problem; otherwise switch to another design.
   
• Don't let semi-satisfied patients leave the office that way -- make the lens just about perfect before releasing.
   
• Use the ophthalmoscope in free space to see what the lens is really doing on downgaze and normal posture.
   
• Both Drs. Bergenske and Maller felt that having diagnostic sets were essential to fitting bifocal lenses.
   
• If the patient says "I see the letters but they are blurry" and reads 20/20 with difficulty, the fit is probably not going to work with the design they are wearing.
   
• It's important to question patients very specifically about the tasks they find difficult -- their idea of near may not be the same as the fitter's. For example: a real estate agent who complained of blur at near was really talking about reading contracts at closing. His actual need was for a sharp intermediate zone (approximately 28").

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