multifocal - fitting and troubleshooting

what are we expected to be able to fit with MF lenses

Each trial lens is based on the manufacturers fitting guide

You are expected to be able to do this with accuracy for all MONTHLY lenses without the fitting guide - can be asked this in an exam

You are expected to be able to do this with accuracy for all 2 weekly and daily lenses with the fitting guide for the initial lens being provided

procedure for fitting a MF lens (5)

ALCON MF lenses

what is the fitting guide for ALCON lenses

• use the MOST plus spherical equivalent distance rx - AND add +0.25 to each eye

• determine the spectacle add then select the contact lens add (LO, MED, HI):

Spectacle script WITH +0.25 Added	Contact lens trial
+1.00 Add +0.75	+1.00 LO
-0.25 Add +1.00	-0.25 LO
-0.75 Add +1.50	-0.75 MED
+2.00 Add +2.25	+2.00 HI
+0.00 Add +2.50	+0.00 HI

what is the fitting guide for Bausch and Lomb lenses (4)

• Spherical equivalent – spectacle refraction

• Select an add – from what u worked out in rx

• have either high/low adds — low (+0.75-+1.50) and high (+1.75-+2.50)

• the fitting chosen would be the distance sphere and then either high/low depending on the add:

Spectacle Rx	Trial lens
+0.50 +1.50 Add	+0.50 Low
-0.50 +2.50 Add	-0.50 High

what are the troubleshooting guidelines for Bausch and Lomb if there are near concerns (2) and distance concerns (2)

Near concerns:

•Up the Add

•Once High Add already in both eyes - add +0.25 to the distance power/spherical component in either eye but common to do in non-dominant eye (that will be used for reading)

Distance concerns:

•Modified monovision, sphere in dominant eye and not a MF lens

•Lower the Add in the dominant eye

what is the fitting guide for Cooper vision lenses (4)

• fit non dominant eye AND dominant eye with CD if the add is up to +1.50

• for higher adds (over 1.50) - we fit the dominant eye with CD and non-dominant eye with CN

• NOTE - cooper and vision do not work in low, medium and high adds - it is based on the specific power of the add

• if there is an add we do not have (falls in between the ranges) as shown in myope example (1.25) we select the lower add - so in this case +1.00 which result in both eyes being fitted with a CD

when ordering a MF lens with Cooper and vision what 3 pieces of information are needed

◦Distance power

◦Add power: this is specific to a power and not low, medium, high

◦Is the lens CD or CN - this is the only lens that the ocular dominance is critical before selecting the trial as you need to determine which eye received the CN in higher adds

if ordering with Cooper and vision and we have a +1.75 add what should we order (3)

• +1.75 can go either way - patient dependent

• usually start with lowest add

• best to order 3 lenses for the px - CD for each eye and also a CN and see based on what px prefers

what is the fitting guide for proclear 1 day multifocals (3)

• Boost system embedded in lens – don’t see add component listed on lens on blister due to boost function built into lens

• order full boost for non dominant eye (+1.25) and partial boost for dominant eye (+0.50) to the BVS

• do not need to indicate dominant/non-dominant eye when ordering or CD/CN etc.. - just the rx as it is

what is the firring guide for clariti multifocal lenses (2)

• non-examinable unless given this table in exam!!!

• myopes and hyperopes different between DE and NDE and what add they have - refer to the table

what is the evaluation and refinement guidelines for Cooper and vision - enhancing distance and near vision

• Each time you make a change - ensure px is still satisfied with distance and near

what MF lenses do Johnson and Johnson offer

• do not do monthly lenses - only max up to 2 weeks

• low, medium and high adds - not specific

• CN design

what is the fitting guide for Johnson and Johnsons 2 weekly MF lenses

Spectacle Rx	Trial lens
+0.25 +2.50 Add dominant	+0.25 MID
+0.50 +2.50 Add non dominant	+0.50 HIGH

fitting guide for Johnsons and Johnsons dailies and enhancement

• low and medium paired in both eyes

• high only in NDE in a high add from +2.50

explain how to do over refraction for distance (5)

• Check the binocular VA at distance and near first

• Then monocular VA distance and near. If not optimal, perform an O/R - steps above

explain how to do an over refraction for near

• Small changes in distance powers can have a large influence on near acuity.

• Recheck the near VA for every change made to the distance

• Remember additions in contact lenses are usually only available in +0.50 steps - don’t show them +0.25 steps unless you are able to order this

troubleshooting for distance vision - iacle - for 2 low adds, 2 high adds and mixed adds

troubleshooting guide for near vision - iacle - 2 low adds, 2 high adds and mixed adds

summary for fitting MF lenses and troubleshooting