contact lens management
A Real Workhorse
See how the unique UltraVue 2000 customizes vision for presbyopes.
BY WALTER CHOATE, O.D.

Presbyopic patients can be a motivated and satisfying group, yet the physiological and optical challenges in fitting them with multifocal contact lenses can be significant. The contact lens industry, however, has given us many great designs, all of which work on the right patients when properly positioned.

One hydrogel multifocal that's become a workhorse in our practice is Opti-Centre, Inc.'s UltraVue 2000. This lens boasts material and design innovations that set it apart from the competition. These features let us position the UltraVue 2000 not only as a terrific problem-solving lens, but also as a mainstream choice for presbyopic contact lens fitting.

Fit the dominant eye with the D lens.

How to fit and where to get it

The UltraVue 2000 multifocal hydrogel lens is manufactured using the Benz 45 G 3X material, which is highly deposit resistant and maintains its hydration for extended periods of wear, making it great for marginal dry eye patients.

The unique optical design uses the concept of simultaneous vision with inverse geometry optics. Fit the dominant eye with the D lens, which has a spherical distance optic zone in the center surrounded by an aspheric progressive near zone.

The distance zone is available in the standard 2.3 mm size, but you can custom order it if you need a larger size. Fit the non-dominant eye with the N lens, which has a near spherical optic zone in the center surrounded by an aspheric distance zone. Order the near zone in the standard 1.7 mm size or larger.

Opti-Centre has licensed this design to CooperVision, which markets a molded version of the lens (Frequency Multifocal). This lens is manufactured using methafilcon A in a 2.3 mm zone for the D lens and in a 1.7 mm zone for the N lens. Striving for success

The UltraVue 2000 system provides a vast combination of lenses to solve almost any distance- or near-point problem, so it's critical to identify the patient's specific needs. The key to success with any presbyopic contact lens patient lies in the history and evaluation. Strive to optimize distance acuity with emerging presbyopes and near acuity with more advanced presbyopes; however, a careful history may bring greater success by zeroing in on a patient's exact needs.

The target visual acuities when fitting the UltraVue 2000 are:

• D lens -- 20/20 distance; 20/30 near
• N lens -- 20/30 distance; 20/20 near.

Although practitioners fit most patients with the D and N configuration, they also fit some with two lenses of the same design and the patients do quite well. For instance, a patient whose visual demands are mostly for distance (such as truck drivers, contractors or retail clerks) will benefit from two D lenses.

Conversely, a near-oriented patient such as a surgeon, dentist or computer programmer may do better with two N lenses. You can also tweak the powers of both the distance and near zones individually to optimize visual performance.

	Fit the non-dominant eye with the N lens.

It's predictable

Most of the currently available hydrogel multifocal contact lenses work well some of the time, but their lack of predictability is frustrating. Many designs are effective for patients who have low add demands but don't work well with more advanced presbyopia.

The UltraVue 2000 and the Frequency Multifocal both instill greater confidence in the fitting process than ever before. The lens quality is reliable, and the visual performance is predictable.

Most practitioners prefer a 2- to 4-week replacement cycle for patients. That's possible with the Frequency Multifocal, but what makes the UltraVue 2000 special isn't only its unique customization possibilities, but also its quarterly replacement option.

A cornerstone of practice

Successful monovision patients are rarely so enthusiastic that they generate referrals for your practice, but multifocal patients have become the cornerstone of our practices. It's not at all uncommon for one such patient to refer three to five new patients to us.

You need to position several lenses in your toolbox to meet the needs of today's demanding presbyopes. The UltraVue 2000 series is one lens that deserves a significant position in your armamentarium.

DR. CHOATE OWNS A GROUP PRIVATE PRACTICE IN NASHVILLE, SPECIALIZING IN THE TREATMENT AND MANAGEMENT OF OCULAR DISEASE, REFRACTIVE SURGERY AND SPECIALTY CONTACT LENSES. HE'S AN F.D.A. INVESTIGATOR AND CONSULTANT FOR VARIOUS MANUFACTURERS.