Advances in contact lens materials and design have improved the performance of multifocal contact lenses. These lenses can be a great option for many patients, including those with presbyopia, astigmatism, and lower prescription requirements.

Modern multifocal contact lenses offer a seamless transition in vision between distances and reduce visual disturbances and discomfort. With the right patient selection, education, and fitting processes, individuals can enjoy the benefits of multifocal correction without the inconvenience of readers.

Patient selection

We conduct a thorough ocular surface assessment to determine if patients have evidence of clinically significant dry eye disease (DED). If present, the condition must be treated and managed before prescribing contact lenses to ensure optimal comfort and vision. This step is especially crucial for multifocal contact lenses.

In my practice, we discuss contact lenses with all eligible candidates regardless of age, including those who may have never considered them before. That said, presbyopia is often a catalyst for patients to consider multifocal contact lenses to improve their intermediate and near vision.

Patient education

We use a systematic approach to patient education, discussing contact lenses and assessing patient interest throughout their eye care journey. Patients are introduced to the idea of contact lens correction as early as their initial call to the practice. Contact lenses are also mentioned to patients when they schedule appointments, check in for their appointment, and during the examination. We consistently gauge the patient’s interest in contact lenses, using quantifiable or open-ended questions. Often, this opens the door to a more detailed discussion.

We approach the conversion of neophytes to multifocal contact lenses differently depending on where they are in their eye care journey. We find that the majority of those who have worn single-vision contact lenses are interested in switching to multifocal contact lenses either part or full time after they learn about them. In my experience, those who have no previous experience with contact lens wear are surprisingly even more inclined to consider multifocal contact lenses. We’ve also found that patients with early presbyopia are interested in multifocal contact lenses as a solution to their vision challenges.

Navigating the fitting process

When patients express interest in multifocal contact lenses, they are usually scheduled for a follow-up fitting visit. If time permits, however, the fitting process may begin the same day.

The fitting process for new contact lenses involves insertion and removal training, evaluation of the lenses on the patient’s eyes, and adjustments to enhance visual quality. Once a trial lens is placed, it is allowed to settle on the eye for between five and 15 minutes. Patients are then asked questions such as, “How do the lenses feel on your eyes?” or “On a scale from 1 to 10, how comfortable do the lenses feel?” Their distance, intermediate, and near vision are assessed, and adjustments are made based on the manufacturer’s fitting guide to improve the quality of the patient’s visual system.

Patients with a fear of having things around or near their eyes may require special attention and a gentle approach. For those who need additional training, a separate session including instructional videos on insertion and removal and further hands-on assistance from our team is arranged. We always ensure that patients feel comfortable handling their lenses independently before they leave.

Patience is key when fitting multifocal lenses and helping new wearers adapt. We encourage patients to come in if any adjustments are needed. The time invested is worth it for patients’ satisfaction and in the long term for the practice.

Patient counseling and contact lens selection

The common concerns and questions that patients have about multifocal contact lenses include worries about clarity of vision compared with glasses, duration of wear, cleaning and hygiene processes, and potential limitations during specific activities.

We consider a patient’s lifestyle and visual needs when addressing their concerns. We ask them how often they plan to wear the lenses and tailor recommendations accordingly. For those who prefer part-time wear, we often recommend daily disposable multifocal lenses, like INFUSE One-Day Multifocal (Bausch + Lomb), ACUVUE OASYS MAX 1-Day Multifocal (Johnson & Johnson Vision), DAILIES TOTAL1 Multifocal (Alcon), and MyDay daily disposable multifocal (CooperVision), for their convenience and suitability.

These lenses have been designed to include proprietary moisture technologies that aim to provide hydration and relief from eye dryness. In our practice, we have found that INFUSE One-Day Multifocal contact lenses, which infuse electrolytes, osmoprotectants, and moisturizers into the lens material to optimize the wearing experience and minimize dryness and discomfort, work well for our patients with low prescriptions, especially if they are frustrated by their symptoms of early presbyopia (see “Success story”). The 3-Zone Progressive Design is the same as in ULTRA Monthly and Biotrue ONEday contact lenses (both by Bausch + Lomb), with which I have also had success.

We offer patients a contact lens trial before they commit and invest in the purchase of contact lenses, and we ask them to consider not just their vision but how they feel in the lenses and how easy or difficult they are to take care of. I articulate that my goal is to get them performing at 90–95 percent visual function, meaning they’re able to see and do most daily activities comfortably and confidently. I do advise them that they might notice some difficulty reading in dim light or driving at night.

Patients are contacted about two to four days after they receive trial contact lenses – especially new multifocal lens wearers – to ensure that they are navigating their real-world experience as anticipated.

If they feel like there is room for improvement, we’ll have the patient return to our office for further evaluation. If they are happy with the lenses, we provide patients with the opportunity to purchase them at that time. In my experience, four out of five patients are happy with INFUSE One-Day Multifocal contact lenses after the first fit.

Stay informed

Contact lens manufacturers have developed improved designs in just the last few years, so it’s important to initiate conversations with patients throughout their eye care journey and gauge their interest in advanced technologies such as multifocal contact lenses. These lenses can help more patients than ever before, including those with presbyopia, astigmatism, and lower prescription requirements. Staying informed about the latest products and engaging in conversations with patients is key to influencing their interest in exploring the benefits of multifocal contact lenses.