contact lens management
Creating Happy Presbyopes
We have more options than ever for achieving bifocal contact lens success.
ROBERT B. MANDELL, O.D., PH.D.

If you fit contact lenses then surely you know that no single bifocal contact lens in the marketplace today works for all patients. If you're still looking for one magic lens that will make all of your presbyopes happy, you could wait forever. On the other hand, more good bifocal contact lenses are available now than ever before, which greatly improve your chances of success. The tools are within reach -- learn how to use them and you're on your way.

	Con-Cise's seamless bifocal lens uses spherical optics for both distance and near.

Don't forget your keys

Here are the two keys to success in fitting bifocal contact lenses:

1) patient communication

2) understanding the available bifocal lenses.

Lack of good patient communication is probably the single most important reason for dropping out. And patient communication is a two-way street -- you're learning from the patient what is important to his success and the patient is learning from you what he can expect for a result.

Identify the primary need

You can set the stage for success early by the way that you first communicate with the patient about bifocal contact lenses. It often helps to concentrate on the single thing that is most important to the visual needs of the patient and emphasize that first need throughout all phases of the fitting process. What is it that the patient misses most about his near vision? Identify that as the patient's first need and then emphasize to him that the primary goal of the contact lens fitting is to fulfill that first need.

When patients enter presbyopia, they are in no mood to compromise their visual capabilities. Good vision at all distances is still a recent memory and so many patients have unrealistic expectations of what can be accomplished with bifocals (such as their vision restored to the way it was at age 21!). If you don't prepare patients for some compromise in their vision, they will expect perfection in their contact lens correction. Spend time in patient education now to help achieve a successful fit.

Stock your dispensary

Becoming a successful bifocal contact lens fitter requires some effort. You don't have to know everything about every available lens, but you do need to have a cadre of lenses at your disposal that will fulfill the needs of most patients. This usually means having four or five different lens types available in trial sets or fitting sets.

You'll need to know how to fit gas permeable as well as soft lenses. Admittedly, GP lenses constitute a smaller proportion of current fittings, but they also present some of the best lens designs for bifocals. Check out some of the newer GP lenses. For example, the Seamless Bifocal lens from Con-Cise uses spherical optics for both distance and near. You'll be surprised at how easy it is to fit this lens.

Soft lens considerations

If your patient is a soft contact lens wearer or you determine from other data that soft lenses are the best choice for the patient, then the best lens type depends on the importance of near vision versus distance vision.

All soft bifocals are based on either a center distance, a center near or an alternating power rings construction. Learn which performs best at distance and which performs best at near, then match that to your patient's needs. The secret to success is to know which lens has the greatest chance of working for which patient.

DR. MANDELL IS THE AUTHOR OF CONTACT LENS PRACTICE. HE CURRENTLY SERVES AS AS DIRECTOR OF RESEARCH FOR CON-CISE CONTACT LENS CO.