As with any multifocal or toric multifocal contact lens, it is beneficial to know the recommended fitting guide from the manufacturer. The tips below are our recommendations for fitting the SpecialEyes 54 Multifocal contact lens.
Insertion & Application:
SpecialEyes 54 multifocal custom contact lenses are made-to-order and arrive in glass vials. To remove the lens from the vial, shake the vial slightly, remove the cap, and pour the entire contents of the vial into the palm of your hand. Avoid using tweezers or fingernails to remove a lens from the glass vial as this may cause tearing. Rinse the custom soft multifocal contact lenses with a multi-purpose solution and then insert the lenses into the patient’s eyes. Allow the lenses to settle for approximately 15-20 minutes before assessment.
It is imperative to ensure that the fit of the multifocal or toric multifocal contact lenses are optimal before assessing vision.
1. The lenses should be well centered with optimal limbal coverage. Centration is critical as a patient looking through a multifocal contact lens with decentered optics may experience unwanted visual results.
2. The multifocal or toric multifocal contact lenses should have an optimal cornea to contact lens fitting relationship, meaning that the lens should not be too tight showing apical bubbles and/or impingement on the conjunctiva, or too loose where the lens may demonstrate edge lift, edge fluting, bubbles in the periphery, and/or decentration. Both a tight and loose fitting multifocal contact lens can be uncomfortable as well as produce a marginal visual result for the patient.
3. In addition, the multifocal or toric multifocal contact lenses should exhibit the least amount of rotation as possible. If a toric multifocal contact lens is rotated, the first assessment would be to determine if the rotation is stable or unstable. If possible, it is preferred to eliminate or reduce the amount of rotation in a toric multifocal contact lens that has a high amount of cylinder power. If the rotation is unstable and fluctuating, then the fit of the contact lens needs to be altered to correct this occurrence. If the rotation is stable we can either compensate by changing the axis or we can alter the fit and/or prism within the contact lens to reduce or eliminate the amount of rotation.
4. If you find the fit of the custom multifocal or toric multifocal contact lenses are suboptimal, order remake or exchange trial lenses correcting the fit issue. If fit is optimal, proceed by assessing visual acuity.
SpecialEyes recommends assessing binocular vision at distance and near. If vision is acceptable and meets your practice standards, then dispense the lenses and encourage the patient to wear them to facilitate adaptation. We find many times that a patient’s vision with the SpecialEyes 54 Multifocal contact lenses improves with wear and an appropriate adaptation period. Each practitioner has their own set standard for an adaptation period. For the 54 Multifocal contact lens, SpecialEyes recommends 1-2 weeks.
Follow- Up Visit
At the follow-up visit, encourage the patient to wear the multifocal contact lenses into your office and proceed with the following steps.
1. Reassess the fit of the contact lenses to ensure there is adequate movement and centration and that the cornea to contact lens fitting relationship has been maintained.
2. Next, evaluate binocular visual acuity at distance and near. If both distance and near visual acuity are optimal, then this first set of trial lenses become the patient’s first set of supply lenses. You may then contact SpecialEyes to order the remaining year’s supply of lenses.
3. If you have a desire to improve distance, intermediate, or near vision then proceed by obtaining the following data: accurate pupil measurements in regular room light or via your corneal topographer, binocular visual acuity at distance and near, monocular visual acuity at distance and near, and over-refraction results.
4. Contact SpecialEyes consultants with this information and they will assist you in making the correct power and/or multifocal zone changes to improve your patient’s vision.
SpecialEyes recommends over-refracting the SpecialEyes 54 multifocal or toric multifocal contact lenses with loose hand-held spherical lenses. When performing a distance over-refraction with a successful improvement to distance vision, take a moment to see what type of an impact that distance over-refraction has on the patient’s near vision and likewise.
Many times, we find that marginal visual acuity in a multifocal or toric multifocal contact lens can be attributed to pupil size and the manner in which the multifocal optics are distributed over the pupil diameter area. SpecialEyes consultants are trained to make appropriate multifocal zone changes and/or power changes. Feel free to reach out to them as they are there to assist you.
Coming up next in the SpecialEyes 54 Multifocal blog series we will be discussing the near center zone and how changing that zone will impact your patient’s vision.
The SpecialEyes Team