10 tips for fitting presbyopic contact lenses

Las Vegas-Have you ever asked a colleague for a contact lens (CL) fitting tip? How about 60 colleagues? Michael S. Gzik, FCLSA, NCLE, COT, conducted an informal survey of eye-care practitioners to garner a "top 10" list of fitting tips for soft, multifocal CLs. Gzik, of New York Optometric, Syracuse, NY, shared the tips at International Vision Expo West.

1. Always perform a pre-fitting visual acuity test for near and distance.

2. Always favor the dominant eye for the best-corrected distance vision.

4. Be aware that most successful patients are those with a distance prescription of +0.75 to +6.00 and –0.75 to –7.00, with add ranges of +1.00 to +2.00. These patients are accustomed to distance visual acuity compromises without their correction and typically have higher motivation preferring contact lenses over glasses.

5. Use the flattest fitting lens available. Often, excessively steep lenses cause fluctuating visual acuity.

6. Make sure the lens centers. This is very important, as lenses that aren't centered are often a cause of bifocal soft CL failure for patients.

7. Conduct a careful slit lens examination. This will play the most important part in your success. Corneal desiccation in the inferior quadrant will indicate your patient is an incomplete blinker, may have meibomian gland disorder, or may be getting external oil into the eye-such as eye cream or baby oil from make-up removal-and will require "blink therapy," lid scrubs, or supplemental lubrication. Advise your patients prior to fitting that not only their comfort, but also their visual success, depends on their compliance to your advice.

8. Use a topography map over soft CLs to determine alignment of the optics with the visual center based on the patient's pupil size.

9. Run as fast as you can in the other direction when a patient presents asking to be fit in soft lens multifocals! (Just kidding.)

10. Avoid the three Rs of fitting presbyopes: refit, refit, refund.