I have had the best success with Frequency 55 Multifocal. All the Multifocals I have tried seem to work the best on early presbyopes (45-early 50's) with at least a moderate Rx (-2.00 +).
I have had the best success with Frequency 55 Multifocal. All the Multifocals I have tried seem to work the best on early presbyopes (45-early 50's) with at least a moderate Rx (-2.00 +).
Crescent Fused PMMA Bifocal. It works, patients can see. Cylinder is seldom a problem and can be delt with when it is.
Favorite multifocal contact lens is an oxymoron.
Agree!
Proclear..same design principle as freq55 but more comfy....
i dont think there is a "best multifocal " it is whatever works best,often i find a combination of lenses give good results ie an acuvue bifo in one eye and a 66 multi in the other, also like chip i find GP lenses work better when there is more than 1 dioptre of cyl involved.
To find out what,s happening in the UK optical market:
http://theOptom.com
Look my practice in recent years has evolved (or decreased) to the point that about all I fit is bifocals, trifocals, and torics.
As far as results (patient happy wears for decades, sees well) you can't beat a crescent fused bifocal (no seams, or ridges). But they are not for shoesalesmen fitters, you must be able to design, fit and modify lenses yourself.
Second choice would be an aspheric rigid on low adds.
Third choice a straight line HGP.
Now for the low powers, inconsistant wearers, and wimps, and incompetent fitters. The B&L Softlens multi, followed by the Lombart (formerly Ciba, formerly something else) bifocal.
Chip
How do I know this, I made my first (actually Dick Camps) first bifocals in 1958 and have been fitting them since 1962, thousands of them.
Last edited by chip anderson; 11-08-2005 at 02:17 PM. Reason: Parting shot
chip do you persuade clients that were previously wearing soft to switch to GP lenses or do you just fit existing wearers of GP lenses ?
To find out what,s happening in the UK optical market:
http://theOptom.com
Chip..why would you put someone in a PMMA lens? Way better things exist for people who would like a healthy cornea...
Pauly47,Originally Posted by pauly47
You must be new to optiboard.
:cheers: Life is too short to drink cheap beer.
Pauley:
As I said there are no seams or ridges. Edema can be avoided with skillfull manipulation of lens design. The lenses lasts a long time and does not collect lipids and other deposits which I feel cause more problems than are eliminated by dk. Have patients who have been wearing same for 30+years with no problems. Don't think I will ever see a soft or HGP lens wearer who goes 30, 40, or 50 years of wear with no problems or damage.
But the better stuff is better for shoesalesmen fitters.
Chip
Chip!
How often would you see the patients that you fit with RGPs?
Do they come back every year or every ten years(this is my experience).
You must charge alot for the fit to cover this....
I have quite a bit of luck fitting essentials extra. but cant wait to try the crescent if the gp master says its good it must be. Chip is that the lens you would use for the patient who does a lot of mid range? BTW whats all of the training going to cost us?:D
Paul:cheers:
If you want mid range and the patient is over 55 you may need an aspheric or a trifocal.
Didn't mention too much about training as to experience, it's still costing me.
I fit softlens multifocals and so far I am not impressed. I nearly always prefer to fit monovision which I feel works better and is easier to fit. The softlens multifocal requires much more chair time and always seems as if the patient is "compromising". At least 20% of the patients ultimately come back asking for a different solution. I've also fit modified monovison with one spherical lens and the other a multifocal (may be a good hedge bet for those who don't like either monovision or multifocals). I was recently going to try Polyvue which also has a multifocal fitting set that seemed interesting.
Incidentally, I've used multifocal lenses to simulate for patients post- CK vision. Ultimately, I realized that near and distance vision is better post conductive keratoplasty than it is through a multifocal contact lens.
80% success is great on soft lens bifocals of any kind. 80% success on monovision would also be phenominal. Remember with monovision you are giving the patient the advantage of being one eyed with no depth preception, if the add is over two you are giving him the option of not being able to drive home if something happens to the distance lens or eye.
Oh, where oh where did our chair time become more important than doing the best thing for the patient. Medicine just ain't what it used to be.
Chip:angry:
Kind of reminds me of a local ophthalmologist (Now retired, thank God) that when I talked to him about the lousy sockets he gave me (shifted spheres) to fit with prosthesis, told me: "But I learned in the charity hospital in Memphis and to do it my way takes 12 minites, and to put one of those Allen's in takes 45.
Last edited by chip anderson; 11-09-2005 at 07:09 PM.
Multifocals are a conundrum.
The first decision a fitter has to make is whether reduced physiology is an acceptable trade-off for better designs. Back surface aspheric RGPs may generate quite an add, but they sure do affect the corneal shape. Custom made annual replacement soft multifocal lenses are nice to work with, but are not up to our standards, these days.
Generally aspheric optics are more acceptable than target or annulur designs due the lack of crisp junctions for less monocular diplopia. That being said, the maximum add you can really get with a soft aspheric is +1.50, IMO. With higher index RGPs and the overall better optics from a hard surface, I think the add can go close to a +2.00.
Alternating RGP multifocals are plain uncomfortable, and they don't work for a computer. They're great, maybe, in your hands, Chip, but they're not a solution for the masses.
Truth is, there are two kinds of patients: vision people, and convenience people.
If they want vision, go full distance with spectacle overcorrection for near.
If they want convenience, go with disposable soft aspherics. If their add exceeds +1.50, better get ready to induce up to +1.00 monovision to make up the difference.
I use B&L's SLMF (really the C-vue from Unilens). Low add is for +0.75-+1.25 patients. High add for +1.25-+1.75. For adds over that, overplus up to +1.00 as needed for monovision effect.
KISS, baby.
If you like RGP multifocals, Art Optical has a decent alternating/aspheric hybrid called "Renovation" that works pretty well and has a very low eccentricity back surface aspheric fitting curve that won't warp the cornea. I'm only about one to two years away from fitting myself in these!
We have luck with frequency and soflens multifocal....as far as mono vision, on a rare occasion Dr will fit a modified mono, never just a mono.
DRK: there are RGP Trifocals, and they work for the computer unless the screen is too eye in relation to the eye. So far I haven't fit but a few, but 100% success on the small sample I have tried.
Chip
SofLens MultiFocal by B&L are the bifocal contact lenses I like the most.
Visit eye Topics for detailed consumer information on Contact Lenses, Eyeglasses, Sunglasses, Reading Glasses, Safety Eyewear, LASIK & Vision Surgery, Nutrition & Vision, Vision Therapy, Eye Exams, The Sense of Sight, Vision Disorders, Eye Health, Children's Vision, Computers & Vision, Vision & Aging & Low Vision
Lens 101 an open discussion of contact lenses
Are you listed in Vision Directory?
The one that works on the patient in hand.
Chip
You are right no one lens works for everyone.
RGP bifocals will get you a 70-80% sucess rate if you do a good job with patient selection.
I first started fitting mono-vision in 1978, had over 600 fitted over first 5 year period with 90% sucess. Still the easy way out but not the best way sometimes. Always reccomended a 3rd lens [distance] for a lot of night driving. You can also make a pair of driving glasses with AR to wear over the mono fit, works great and increases sales.
After fitting CL for over 37 years, I have QUIT, lost the desire.
Sometimes though I get the bug to fit the RGP's on the more difficult people. They are grateful and don't mind paying a good fee for the time involved.
Soft lenses suck as far as profit.
Monovision is not a bifocal. This is unilateral vision without steropsis. Charges for this shouldn't be much more than a SV pair as little or no more skill or time is involved.
Chip
Agree on former point, but not on latter. Just to have them try it, return, and tell you they don't like it takes up chair time!
Chair time.....................
drk, you sound like my $ 500.00 p.h. lawyer who charges phone calls in increments of 15 minutes.
(I learned and make him talk a full 15 minutes, even if it's only about the birds and the bees)
:bbg:
There are currently 1 users browsing this thread. (0 members and 1 guests)
Posting Permissions
Reply With Quote
Bookmarks