Multifocal Lenses--are they for real?

Discussion in 'Optometry Archives' started by Ted, Sep 27, 2006.

  1. Ted

    Ted Guest

    Hello group,
    I'm 48 y.o. and have been wearing Acuvues for years at -6.50 with 8.4
    BC. The last couple of years near vision is pooping out, and I tried
    monovision last year but it didn't work out for me due to needing close
    stereoscopic vision for my work. I found out what a drag it is wearing
    reading glasses over the last year so now I am trying out multifocal
    lenses.

    The first trial pair my O.D. gave me is B&L Purevision -6.50 with low
    add 8.6 BC. These are extremely comfortable lenses that give me
    excellent close vision (I feel young again!) and very good mid distance
    but bad distance vision. I wore the lenses plus my wife's glasses to
    drive back to the O.D. (and got excellect vision with them. Her
    glasses are -1.75/-1.25). O.D said she didn't think the lenses were
    riding too high, but is going to try me on a -7.00 in the same brand.

    Apparently the Purevision Multfocal only come in BC 8.6. My old lenses
    had a BC of 8.4. Could this account for my bad distance vision?

    Do Multifocal lenses need a break in period for my eyes to adjust?

    It will take a couple of days to get this next pair in, but I wonder if
    the higher power is going to degrade the close and mid vision.

    Maybe I'm simplifying but it almost seems like if I wore regular old
    Acuvues at a -5.75 I'd get the same vision (good close and mid, bad
    distance) as these high tech Multifocals.

    Is my experience typical?

    Thanks--Ted
     
    Ted, Sep 27, 2006
    #1
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  2. Ted

    p.clarkii Guest

    Apparently the Purevision Multfocal only come in BC 8.6. My old lenses
    Unlikely. for soft lenses, base curve is more related to the tightness
    of the fit of the contact on your cornea and does not contribute to the
    power of the prescription.
    you must learn to accept "less than perfect" distance vision with
    multifocal contacts in order do achieve adequate near vision. and I am
    serious when I say only "adequate" near vision because while your near
    vision will indeed be somewhat better it won't be perfect. when I fit
    someone with multifocal soft contacts I explain clearly that what we
    hope to achieve is a situation where their distance and near vision are
    "good enough" to achieve what they want to acheive but not perfect like
    bifocal glasses or single-vision contacts with readers is. they will
    NEVER be as good in the distance as your single distance contacts (as
    you've noticed) and you will certainly see better at near if you put
    readers on over your contacts like you did before. it all comes down
    to how much you want to get rid of your reading glasses. if you really
    want to do it, then I am usually successful fitting most people in
    multifocal contacts as are most eyedocs. just don't expect the
    impossible.

    I like the type of lens you are trying now, and I also have good
    success with Frequency 55 and Purevision Multifocals.

    To address your real question, yes you will adapt better to bifocal
    contacts as you wear them more.
    yes it will.
    yes. but your range of clear vision is much better with the
    multifocals rather than just cutting the power of a single vision
    lense.
     
    p.clarkii, Sep 27, 2006
    #2
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  3. Ted

    Ted Guest

    Oh, like how much they slide up and down when I blink?

    Thank you for the info. I'll try to reduce my expectations as much as
    I can.
    But I also don't want to reduce the incentive for the lense
    manufacturers to provide products that meet the needs of customers...
    :)
    (spoken with the inflated sense of entitlement typical of a baby
    boomer)

    Ted
     
    Ted, Sep 27, 2006
    #3
  4. Ted

    Dan Abel Guest

    [big snip]


    There are no good experiences and no good solutions. When presbyopia
    sets in, it's a question of what you are willing to live with. I was
    happy with contacts for distance and OTC reading glasses over them for
    near. There are other options. One that isn't recommended for most is
    contacts for near and distance glasses for far. Depending on strength
    (mostly having to do with how close you need to see for your work), you
    may be able to do all your indoor tasks (eating, reading, watching tv
    and walking around the house) without glasses, and just use the glasses
    for outside (driving, walking, sightseeing, etc.).

    For most people, presbyopia just gets worse with increasing age. What
    works for you now may not work in a few years.
     
    Dan Abel, Sep 28, 2006
    #4
  5. Ted

    LarryDoc Guest

    I'll second that! The manufacturers market their products to the most
    profitable demographic group first. And that's not presbyopes. At least
    not yet. We need to yell louder! We've done it before and it works. At
    least B&L is pursuing that (our!) market with their PV Multis which,
    IMHO is the best in it's class.

    (Note: lenses should not move more than 1/2- 3/4mm with blink!)

    Meanwhile, I somewhat disagree with my colleague on the "compromise"
    issue. I'd say that 75% of my patients have nearly equivalent distance
    vision with the PV Multi's as they had with their single vision lenses
    with dramatically better intermediate and often excellent near vision.
    The other 25% have varying degrees of "compromise" and sometimes
    less-that-satisfactory distance, traded for excellent near. And there's
    a group in that 25% for whom it simple doesn't work worth a damn. I've
    found that really small pupils (3-4mm in reduced lighting) and
    uncorrected astigmatism (more than .75) can be deal breakers.

    So, I'm hoping for toric versions and the ability to order specific
    center optic zone diameters.

    "They say I'm a dreamer, but I'm not the only one..."
    --John Lennon
    on another more serious issue.

    LB. OD
     
    LarryDoc, Sep 28, 2006
    #5
  6. Ted

    p.clarkii Guest

    Exactly!
     
    p.clarkii, Sep 28, 2006
    #6
  7. Ted

    LarryDoc Guest

    I would say that most patients require a "tweaking". Perhaps one or two
    additional fittings for some people, although I get a good number right
    on the first try! And, of course, sometimes it just doesn't work like
    either I expected or the patient desires.

    That being said, we're talking about changing the total power, the add
    power (high or low) for one or both eyes, sometimes using an aspheric
    single vision lens for the dominant eye. If the results are not
    realistic on the first attempt, the second trial happens right then and
    there. The wearer needs to have a pretty darn good close-to-desired
    result before taking them home and to work for a real-life trial. Then
    we "tweak".

    The adaptation time (it's an optical/brain thing) is often two days or
    so, sometime a week. But IMHO, if after a week it doesn't work, it wont.
    (Sometimes it does indeed take two weeks. Most people, including myself
    as the practitioner, are not that patient!)

    LB, O.D.
     
    LarryDoc, Oct 4, 2006
    #7
  8. Ted

    LarryDoc Guest

    It's good you know which eye is best suited to be the near lens if you
    are doing "bofocal", if you need to go that route. (I Like "multi-sivi"
    for multifocal-single vision.)

    Well, there are two things that come to mind: If you wore RGPs
    previously, if the fit was not optimum, either causing cornea molding or
    with incorrect power, you might have to wait a couple of weeks without
    lenses and re-start. If all was well.......

    IF head movement causes so significant changes in optics, then the fit
    isn't right. It does indicate that if it can be adjusted so that the
    good vision is the predominant vision, then great! Your almost there.
    IF not, then there are different RGP multifocal lens designs to try, and
    do try it in both eyes! That's the best way to assure good intermediate
    vision along with near and distance.

    From my last post, I wrote about how many trials before clear success or
    not success. That was assuming soft. Sorry. For RGPs, expect a little
    more tweaking as there are many more things to tweak. That also means
    perhaps a *better* chance at getting what you need!

    That your doctor has experience with RGP multifocals is a good sign. Not
    many of us fit those lenses. Even if he's "practicing" --learning, the
    lab consultants are often great help at troubleshooting lens fitting and
    designs. Be patient and communicate your needs and concerns.

    My RGP multifocals provide me with outstanding vision at all distances.
    Unfortunately, I cannot seem to get comfortable wearing them. I will try
    again!

    LB, O.D.
     
    LarryDoc, Oct 4, 2006
    #8
  9. It's not "extremely dangerous" to get multifocal IOLs, but it is
    optically a bad idea in my opinion. You always have at least 50% of th
    incoming light out of focus, no matter what your viewing distance is.

    In your case, I'd bemore concerned with the possiblilty of retinal
    detachment in that highly myopic eye, so I'd consder one of the new
    posterior chamber lenses (they leave your own crystalline lens in tact).
    They are very new, and do require a skilled surgeon (preferably one
    who has implanted at least 10 of them).

    w.stacy, o.d.
     
    William Stacy, O.D., Oct 11, 2006
    #9
  10. Ted

    LarryDoc Guest

    There a dozens of lenses available in your prescription, including some
    of the newer plastics. Even with correcting your astigmatism. Stocked
    lenses, too, although there are some that will require a couple of weeks
    to get them in your hands. If she's not aware of them, ask her to
    consult with someone who is.

    LB, O.D.
     
    LarryDoc, Oct 12, 2006
    #10
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