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Vinita Allee Henry, OD, FAAO

Vinita Allee Henry, OD, FAAO. By 2010 about 1/3 the US population will be in the 40 – 59 age group ( 74 million ‘Baby Boomers’ born 1946 – 1964). CooperVision. Patient Interest. Increased interest among baby boomers Peak earning period

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Vinita Allee Henry, OD, FAAO

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  1. Vinita Allee Henry, OD, FAAO

  2. By 2010 about 1/3 the US population will be in the 40 – 59 age group (74 million ‘Baby Boomers’ born 1946 – 1964) CooperVision

  3. Patient Interest • Increased interest among baby boomers • Peak earning period • Most common question to a consumer contact lens website: “Is there such a thing as bifocal contact lenses?” • Educate the patient that if motivated, they will likely succeed • Do not accept the concept of aging

  4. % People who need Vision Correction

  5. % Vision Corrected by CL’s

  6. Monovision vs Multifocals • Study showed 68% of previous monovision wearers preferred the multifocal lens • Study showed 76% preferred MF to monovision CLS 7/07

  7. Benjamin Study-CLS 7/07 • Compared PC MF to PC monovision • 46 subjects completed the study • 32 chose MF, 14 chose monovision (2.28 to 1 ratio) • Almost 70% preference for MF • Vision assessed 2.7-5.8% higher for MF for dist., near and overall vision

  8. Both modalities • 93.5% Achieved 20/20 vision at distance • 60.9% achieved better than 20/20 at near. • Only one patient failed to achieve 20/20 at distance and 18 at near. • Vision provided by MF more usable than monovision, better intermediate vision.

  9. Richdale study • Patients preferred MF CL’s 3:1 to monovision even though vision was comparable, but stereoacuity was not compromised with MF

  10. Motivation Visual Needs Evaluation of the cornea, lids & tears Determine Refraction & Add Educate Provide options Realistic expectations Fees Cosmesis Patient Selection

  11. Patient MotivationPlant the seed before the patient becomes presbyopic

  12. Be enthusiastic-Increase Pt’s Success • Present MF’s as an option to every presbyopic CL candidate • Diagnostically fit to demonstrate vision • Avoid comments like “more difficult” or “more time-consuming” or “compromised vision” Norman-CLS 9/03

  13. Visual Needs • Occupation • Hobbies • Intermediate tasks • Near tasks • Length of time spent doing distance, intermediate or near tasks

  14. Evaluate the Anterior Surface • Is the cornea healthy? • Record the position of the lids through the SLE • Quantity and Quality of the tears: TBUT, PRT, Schirmer’s, Tear meniscus, Fluorescein evaluation • Pupil size

  15. Determine the: Refraction & AddKeratometryDominant Eye

  16. Dominant Eye • Sighting through hands • Camera • +2 trial lens alternated between each eye at distance

  17. Educate the patient • Give the options: Distance CL’s with readers Monovision Bifocal CL’s*** • Fees • What are their most important visual tasks?

  18. Educate the patient • Set realistic expectations May be some level of compromise Multiple visits may be necessary • Meet most of their visual needs most of the time • Satisfactory VA may not be 20/20

  19. Educate the patient • There will be adaptation, perhaps 6-8 weeks • There will most likely be lens changes • If motivated, there is an 80% success rate

  20. Soft Multifocals

  21. Discuss Replacement Schedule

  22. Use normal illumination Let lenses settle 10-20 minutes Assess binocularly Hand-held trial over-refraction Over-refract monocularly with both eyes open Low Rx and emmetropes less successful <0.75D astigmatism Use everyday reading material Use least minus/most plus Best vision sphere, vertexed Dispense trials Follow-up in 3-5 days Fitting Tips

  23. Lens Selection • Soflens/PureVision Multifocal • Focus Progressive & Dailies Progressive • Frequency 55/Proclear Multifocal • Acuvue Bifocal/Acuvue Oasys for Presbyopia • Biomedics EP • Proclear Multifocal Toric • Cibasoft Progressive Toric • Essentials Soft Toric Multifocal

  24. Soflens Multi-focal • Bausch & Lomb • 2 week replacement • Daily wear • Low (< +1.50) and high (<+2.50) adds • Aspheric anterior surface, center near • Posterior spherical bi-curve • BCR 8.5, 8.8

  25. PureVision Multi-focal • Bausch & Lomb • 1 month replacement • Daily or Continuous wear • Low (< +1.50) and high (<+2.50) adds • Aspheric anterior surface, center near • Posterior spherical bi-curve • BCR 8.6

  26. Low add High addPower profiles

  27. Fitting Steps • Spherical equivalent, vertexed to cornea • Start with the 8.5 BCR SF or 8.6 BCR PV • Low add for adds < +1.50 • Mixed adds for +1.75 to +2.25 (low add on dom. eye) • High add OU for > +2.50

  28. Example: Spectacle Rx: OD –2.50, Add +2.00 Dom. eye OS –2.50, Add +2.00 Trial lenses: OD –2.50, BC 8.6, Low add OS –2.50, BC 8.6, High add

  29. Focus Progressive • Ciba Vision • 2-4 week replacement • DW or FW • Aspheric, center near • Small changes have big effect • BCR 8.6, 8.9

  30. Focus Dailies Progressive • Ciba Vision • Daily Disposable • BCR 8.6

  31. 16,500X magnification

  32. Fitting Steps • Use spherical equivalent, vertexed corrected • Trial lens Rx = Spherical equiv. + Add/2 • Over-refract with both eyes viewing

  33. Example: Spectacle Rx: –2.50, Add +2.00 Dom. eye OS –2.50, Add +2.00 Trial lenses: -1.50 OU

  34. Biomedics EP • CooperVision • DW • BCR 8.7, Dia. 14.4 • 2 week replacement • Proclear material

  35. EP Design • Biomedics EP is designed specifically for the visual needs of the emerging presbyope. The lens has a center spherical distance zone with a progressive aspheric zone that provides excellent intermediate and near vision.

  36. Fitting Steps • Use patient’s distance Rx • Require add of +1.50 or less • Emerging presbyopes

  37. Frequency 55/Proclear Multifocal • CooperVision • Monthly replacement • Flexible wear • 4 add powers (+1.00, +1.50, +2.00, +2.50) • Distance lens and Near lens • BCR 8.7

  38. Proclear XR Multifocal • +20 • BCR 8.7 • Adds +0.75 to +4 in 0.50D steps • Monthly replacement • Omafilcon 59%

  39. Proclear Multifocal XR Parameters

  40. Balanced Progressive Technology™The Lens Design CooperVision

  41. Fitting Steps • Determine from Refraction, Best Vision Sphere, adjust for vertex distance • Determine dominant eye • Place D lens on dominant eye and N lens on non-dominant eye • Evaluate at distance and near binocularly and then monocularly • Occasionally may use two D lenses

  42. Example: Spectacle Rx: OD –2.50, Add +2.00 Dom. Eye OS –2.50, Add +2.00 Trial Lens: OD –2.50, Add +2.00 D lens OS –2.50, Add +2.00 N lens

  43. Expected Visual Acuities CooperVision 44

  44. Need for Monocular Verification • Example: • Do not assume poor distance vision is associated with the D lens or poor near vision with the N lens. In this example the problem with the distance vision is with the N lens (adding +/- 0.50 to the N lens should correct this situation) • Vision should always checked binocularly. If there is a problem it must be checked monocularly to find the source of the problem Without monocular verification, Balanced Progressive Technology will have a reduced success rate. 45

  45. Acuvue Bifocal • Vistakon • 1-2 week replacement • DW or FW • 4 adds (+1.00, +1.50, +2.00, +2.50) • 5 concentric rings • Center distance • Inversion indicator • BCR 8.5

  46. Fitting Steps • Use spherical equivalent, vertexed Rx • Add Powers by age 40-46 +1.00 47-52 +1.50 53-59 +2.00 60+ +2.50 • Round adds down

  47. Example Spectacle Rx: OD –2.50, Add +1.75 Dom. Eye OS –2.50, Add +1.75 Age: 50 Trial Lens: OU –2.50, Add +1.50

  48. Acuvue Oasys for Presbyopia • BCR 8.4 • Powers -0.50 to -6.00 • Adds Low and Mid • 2 week replacement, DW & EW

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