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-Concise)

“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)

What information should I provide the laboratory consultant?

“Spectacle refraction, K readings or topographies, add power, pupil size, and horizontal visible iris diameter (HVID) are important to provide.” (Al Vaske, Lens Dynamics Corporation)

“Patients’ expectations and visual demands are number one in the choice of a multifocal design, and number two is the amount of add power needed. Pupil size, corneal size, fissure size, type of current lenses worn (parameters and fit), positioning of the current GP lenses, whether they are a past monovision wearer, and dry eye indications are also good information to give.” (Jim Slightom, ABB Concise)

“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)

“Ks, spectacle Rx, add power, dominant eye, corneal diameter, and pupil size are all important to provide.” (Joe Hanson, Mid-South Premier Ophthalmics)

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