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Presbyopic Contact Lens Options B9 SAMPLE © The International Association of Contact Lens Educators www.iacle.org Attributions Lecture contributors* Robert Terry, Lewis Williams, Gina Sorbara, John Meyler, Rènée du Toit Lecture editor** Caroline Christie IACLE executive editor** Judith Morris IACLE reviewer** Nilesh Thite, Lewis Williams Lecture updated 2015-Apr-21 Lecture content rechecked 2015-Aug-21 * Original author(s) of lecture(s) **2015 Editors and reviewers © The International Association of Contact Lens Educators www.iacle.org IACLE SPONSORS Development and delivery of contact lens education by IACLE is supported through educational grants and in-kind contributions Industry Supporters Previous Supporters CIBA Vision Bausch & Lomb Allergan AMO Ocular Sciences © The International Association of Contact Lens Educators www.iacle.org Wesley Jessen Menicon Paragon Pilkington Barnes-Hind Aspect Vision Care SAMPLE ONLY The following slides are an excerpt from the revised IACLE Contact Lens Course lecture Presbyopic Contact Lens Options © The International Association of Contact Lens Educators www.iacle.org Current Presbyopic Options • DENIAL ! • Spectacles • reading glasses • bifocal / Multifocal spectacles • Contact Lenses • distance only CL + reading glasses • monovision GP • multifocal / bifocal in both eyes • enhanced monovision • Refractive Surgery © The International Association of Contact Lens Educators www.iacle.org Hydrogel Spectacles: Reading Glasses Inexpensive • Especially Ready Readers • Multiple pairs - one in each room! © The International Association of Contact Lens Educators www.iacle.org Spectacles: Bifocals / Multifocals BIFOCALS MULTIFOCAL S Both forms of correction involve visual ‘compromises’ © The International Association of Contact Lens Educators www.iacle.org Monovision: Definition …a ‘technique’ for correcting presbyopia in which reading power is incorporated into a single vision CL worn usually in the non-dominant eye © The International Association of Contact Lens Educators www.iacle.org Monovision: Outcome Clinical Studies show 67% success rate = 33% fail ! Greatest success in early presbyopes however… • Stereopsis (depth perception) • Reduced Contrast • Shortened Reading Times • Intermediate issues with > adds • Moral / professional dilemma • would you prescribe monovision specs? © The International Association of Contact Lens Educators www.iacle.org Ocular Dominance Determining Dominance McMonnies (1974) proposed 7 methods of determining the eye to be given the distance lens Methods currently used include • Sighting dominance • Blur suppression © The International Association of Contact Lens Educators www.iacle.org Sighting Dominance • One-handed pointing may be influenced by which hand is used or patient’s handedness • Hole-in-the-card, two-handed different to true directional dominance • Changes with position of gaze • Changes when +ve lens over one eye! Why then prescribe monovision on the basis of a test that changes as soon as you fit monovision? © The International Association of Contact Lens Educators www.iacle.org Blur Suppression • Distant spotlight viewed with optimal DISTANCE Rx worn in front of both eyes • Transfer a +lens of ADD power between the two eyes • Ask in which eye is it easier to ignore the ‘starburst’ • • that is the NON-Dominant eye +2.00DS blur test • Similar concept but letter chart employed • If NO preference then select eye with best acuity as the Dominant Eye © The International Association of Contact Lens Educators www.iacle.org Identify Dominant Eye • Patient corrected for maximum (optimal) distance vision in each eye • Correct for astigmatism > 0.75DC to optimise VA • Select chosen method of determining dominance Dominant Eye corrected for Distance Non-Dominant Eye corrected for Near © The International Association of Contact Lens Educators www.iacle.org Spontaneous Monovision! • Patients who are starting to become presbyopic can sometimes already be in monovision before concept even discussed ! • Due to… • a change in their prescription • having swapped their lenses over! • using an older lens (lower Rx) • If this is the case then go with the flow… • in respect to eye corrected for distance viewing © The International Association of Contact Lens Educators www.iacle.org Limitations of Monovision! Add > 2.25 D loss of intermediate vision • Supplementary corrections • readers for detailed near work • simple Ready Readers will not work • eyes are no longer corrected equally • Driving Glasses? • Consider extra (3rd) CL • for specific viewing distance © The International Association of Contact Lens Educators www.iacle.org Refitting Monovision Patients • The adapted monovision patient must re-learn to see BINOCULARLY, there is a re-adjustment period so you need to fully prepare them • Take them out of monovision, fit distance-only CLs & provide Ready Readers to use for a few days to re-adjust to binocular vision before refitting • Fit them that day encouraging them with their ‘range of vision’ especially at intermediate & night driving will be so much better (see in 3D again) © The International Association of Contact Lens Educators www.iacle.org Monovision Opportunities • Modified monovision • DV biased bifocal dominant eye • NV biased bifocal other eye • Fairly Common in multifocal lenses as add powers • Enhanced monovision • SV correction in dominant eye • Bifocal in other eye © The International Association of Contact Lens Educators www.iacle.org Ethical Considerations • Contrary to all our education & training • normally push maximum binocularity • a deliberate visual compromise • What is the wearers occupation? • professional liability / negligence issues • cautioning required • Consider supplementary Specs or CLs • enhanced near vision (detailed close work) • enhanced distance (driving)? © The International Association of Contact Lens Educators www.iacle.org Monovision: Summary Advantages • Good for early presbyopia • Easy to fit • range of lens designs, materials & modalities • Reduced chair time? • Less costly Disadvantages • Reduced stereopsis & contrast • Adaptation period (suppression) • Intermediate vision (higher add) • Unsuitable monocular patients © The International Association of Contact Lens Educators www.iacle.org Breaking Out of Monovision If you only do what you have always done… you will only get what you already have Reduced Stereopsis Reduced Contrast Intermediate Compromise Night Driving Issues Shortened Reading Times © The International Association of Contact Lens Educators www.iacle.org Vision Rating: Multifocal versus Monovision Perception - multifocals create visual problems like ghosting particularly when driving at night so many practitioners don’t even start with multifocals Satisfaction with vision for driving at night Ability to change focus distance Multifocals outperformed monovision in ALL aspects except high contrast near acuity © The International Association of Contact Lens Educators www.iacle.org Monovision versus Multifocal: Myths Chair time involved in fitting • No significant difference between monovision & multifocals • Perhaps influenced by latest CL designs Patients won’t pay more for multifocals • Presbyopic patients usually most stable financially , typically at the peak of their career earnings & usually willing to pay additional expense when the outcome results in satisfaction & convenience • Part-time use, especially with daily disposable multifocal lenses, further addresses the convenience issues & high material costs associated with premium lenses © The International Association of Contact Lens Educators www.iacle.org Contact Lens Options: GP & Hydrogel GP • Simultaneous • Spherical • Aspheric • Translating Hydrogel • Simultaneous • Spherical • Aspheric • Concentric multi-zone • Translating © The International Association of Contact Lens Educators www.iacle.org Exclusively available to IACLE members To access the complete lecture go to the member login at: www.iacle.org Not a member? See our website for details or contact us at: [email protected] © The International Association of Contact Lens Educators www.iacle.org THANK YOU www.iacle.org
