Understand Multifocal Contacts: How They Work And How To .
1/3/2013Understand Patients GoalsMultifocal Contacts:How They Work andHow to Make ThemWorkMile Brujic, O.D.Disclosure The speaker has no financial or proprietaryinterest in any of the products that arementioned The speaker has received honoraria forconsulting, performing research, speakingand/or writing from: Alcon Laboratories,Aton, Bausch Lomb, CooperVision,TelScreen, Transitions, Vistakon, VmaxVision, Eyemaginations, RPSAdenodetector, Teague Training GroupOnce multifocallenses werediscussed, 75% of CLwearers and 60% ofspectacle wearerswere interested intrying them.The Contact Lens Council. Aug., 20071
1/3/20133 ADD DesignsSuccess Doesn’t Mean “No Glasses” Near vision only glasses ? Monovision Glasses? Sport specific sunwear for presbyopesAIR OPTIX AQUA MULTIFOCAL 3 ADD SystemLO ADDUp to 1.25MED ADD 1.50 to 2.00HI ADD 2.25 to 2.50Don’t Stray Too Much!Fitting Tip:- Assess vision using real world targets!2009-11-11192
1/3/2013 Symptom ResolutionIf Unsatisfactory Distance Vision:– Always start by checking O.R.– Distance unacceptable: Add ‐0.25 to dominant eye Decrease add in dominant eye If persists, low ADD OU– Near unacceptable: Increase add in non‐dominant eye Add 0.25 to non‐dominant eye If persists, high ADD OUThe Lens DesignLow ADDHigh ADD Stereo Precision TechnologyAspheric ZonesAsphere9Unique synergisticcombination of the positivedesign aspects of theaspheric and zone designsPower gradually becomes more plus ( )towards lens center.Power becomes more positive towardslens center, plus a distinct central zoneof greater plus ( ) power.9Balance at all DistancesNon-dependant on illuminationMinimized ghosting, glares & halosJJVC, data on file.Fitting Tips for SUCCESS Spectacle ADD– 1.25D or less– 1.50 to 1.75D Lens ADD Power– Low ADD OU– High ADD OU With increased minus in distance Rx by ‐0.25 or ‐0.50D if needed– 2.00D and up– High ADD OUJJVC, data on file.3
1/3/2013The Multifocal Success!THE REAL DEAL ONMULTIFOCAL CONTACTLENSES4
1/3/2013The “OK” Multifocal Experience!5
1/3/2013Using NaFl to Evaluate Duette Fit High molecular weight NaFl, i.e. FluoresoftNOT REQUIRED Traditional fluorescein strips can be usedProper NaFl concentration –too little NaFl & lens may showfalse appearance of bearingSkirt Curve Too SteepCentral Pooling:Skirt Curve too SteepCorrect Fit:Thin NaFl LayerOCT Photo of Duette JunctionOther indicators Skirt Curve is too Steep: Discomfort expected because lens will be elevated too high toallow support from an excessively thick tear layer Awareness of the skirt under the upper lidSkirt Curve Too FlatCentralCentralBearing:Bearing - STEEPENSKIRTSkirt Curve tooFlatCorrect Fit:Thin NaFl LayerOther indicators Skirt Curve is too Flat: Initial movement seen but may decrease w/ wear time Patient may report central discomfort Excessive decentration of lens6
1/3/2013Proper Patient Insertion – 3 MethodsD LENS: DOMINANT EYEMark (Engineer), 48 year oldN LENS: NON-DOMINANT EYEMark (Engineer), 48 year old NP Ordered Diagnostic CL’s:– OD: Proclear MF Toric8.4 ‐0.50‐0.75x175 / 1.50 / D lens– OS: Proclear MF Toric8.4 ‐0.75‐0.75x020 / 1.50 / N lens At Dispensing Visit:– D: 20/20 OU and N: 20/30‐ OU Assurance this is a great start and schedule 1‐weekprogress visit.Mark (Engineer), 48 year old NPChief ComplaintBlurred distance and near (loss of crispness).Has considered just going to spectacles.Previous CL RxOD: Soflens MF 8.5 -0.75 / Low AddD: 20/30 N: 20/30-2OS: Soflens MF 8.5 -1.00 / Low AddD: 20/30N: 20/40 Over-Refraction: no improvement with flippers.Manifest RefractionDominanceOD: -0.50-1.00x174OS: -0.75-1.00x018ADD: 1.75D: 20/15D: 20/15N: 20/20 OUR eye dominant with 2.00 FogPre-Fitting ConferenceDemonstrated cylinder to patient andimprovement (PFC)in crispness.Diagnostic CL Fit?Mark (Engineer), 48 year old NP 1‐week progress visit – Patient states near vision needsto be better:– OD: D: 20/20‐2 N: 20/60 – OS: D: 20/30 N: 20/30– OU: D: 20/20‐N: 20/30– SOR: 0.25 OD and 0.25 OS– Fit: 0 OD and 5 T OS, good c,c,mvmt OU Ordered New Diagnostic CL’s:– OD: Proclear MF Toric8.4 ‐0.25‐0.75x175 / 1.50 Add / D lens– OS: Proclear MF Toric8.4 ‐0.50‐0.75x015 / 1.50 Add / N lens7
1/3/2013Mark (Engineer), 48 year old NP 1‐week post‐dispense progress visit:y Vision and comfort pretty good, improved near.y OD: D: 20/20N: 20/40‐y OS: D: 20/30‐N: 20/25 y OU: D: 20/20N: 20/25 y Stable over‐refraction and fit OU Final CL Rx:y OD: Proclear MF Toric8.4 ‐0.25‐0.75x175 / 1.50 Add / D lensy OS: Proclear MF Toric8.4 ‐0.50‐0.75x015 / 1.50 Add / N lens-Female in her early 40’s-Low myope (-1.25 sph) OU-Etafilcon A / 8.3 / -1.25 OD-Senofilcon A/ 8.4 / 14.0 / -1.00 OD, 0.75OS-50 year old female-Refraction 4.25-0.25 x 090 20/20 7.75-1.50 x 050 20/30add 2.00 20/20-K’s OD 46.25/45.75 @ 119OS 45.12/46.75 @ 127-In for yearly examination-Something seems wrong with hernear visionMild dry eye OUCurrently wearing Purevision Multifocals 5.00/High Add 6.00/High Add8
1/3/2013Monovision vs. Multifocal Changing Trends! 5/06 – Dr.’s Richdale, Mitchell and Zadnik²:– 76% of patients reported that they preferredmultifocal contact lenses over 24% who preferredmonovision CL’s. 7/07 – Dr. William J. Benjamin³:– 3:1 patients preferred multifocal over monovisionCL’s.1. Rev of Optom 2003 Dec.2. Optom Vis Sci. 2006 May; 83(5): 266‐733. CL Spectrum 2007 JulyMulti‐Focal / Monovision Study ‐Gupta et al. Compared visual function with silicone hydrogelmultifocal contact lens to monovision with comparablesilicone contact lenses. 20 presbyopic subjects were fit with either modality After a 1‐month trial, assessed:––––––(a) distance, intermediate, and near visual acuity (VA);(b) reading ability;(c) distance and near contrast sensitivity function (CSF);(d) near range of clear vision;(e) stereo acuity; and(f) subjective evaluation of near vision ability with astandardized questionnaire.Gupta N et al. Visual Comparison ofMultifocal Contact Lens to Monovision.Optom Vis Sci 2009.9
1/3/2013Thank Youbrujic@prodigy.net10
– OD: Proclear MF Toric 8.4 ‐0.50‐0.75x175 / 1.50 / D lens – OS: Proclear MF Toric 8.4 ‐0.75‐0.75x020 / 1.50 / N lens At Dispensing Visit: – D: 20/20 OU and N: 20/30‐OU Assurance this is a great start and schedu
Air Optix Aqua for Astigmatism Sphere Toric Multifocal Menicon internal profiling data on file 5-3.00 -6.00 3.00 5.00 250 150 100 50 0 Dk/t 200 200 180 120 100 60 20 80 40 0 . Miru 1month multifocal fitting guide Vision. 11 Top tips for a successful multifocal fitting Setting expectat
Air OptixMultifocal Alcon Monthly replacement SiHy Daily or Extended wear up to 6 nights 3 add powers (Lo, Med, Hi) Center near Dk/t 138 BCR 8.6, Powers 6 to -10 Dailies AquacomfortPlus Multifocal & Dailies Total 1 Multifocal Available in a 30 or 90 pack AC BCR 8.7/ Total 1 8.5 Powers 6.00 to ‐10.00
MobileConnect for iPhone User Guide 4 Contacts The Contacts list in Chat tab can contain different types of contacts as follows: Presence-enabled contacts Non presence-enabled contacts Any contact can be marked as a favorite and it appears at the top of the Contacts list in the Favorites section. Presence-enabled contacts are users with an Extensible Messaging and Presence Protocol .
Note: If you use Google Contacts for work or school, you can't select all contacts in the Directory. Outlook Contacts: 1.At the bottom of the page, select to go to the People page. 2.On the toolbar, select Manage Export contacts. 3.Choose to export all contacts or only contacts from a specific folder, and then select Export.
for Liberate iPhone Mobile App Enterprise Contacts You have the ability to search for a contact from the Enterprise Contacts on your mobile device. Search for a Contact To search for a contact in the Enterprise Contacts: 1. Tap 2. Select Enterprise Contacts 3. In the Search Contacts field type the name of th
There are several ways you can add contacts to your phone. Online accounts Log in to your online accounts to import contact information. Phone contacts Create and store contacts directly in your phone. SIM card Copy your SIM contacts to your phone. Outlook (Exchange ActiveSync ) Sync your work contacts with Outlook (Exchange ActiveSync).
3.2 Contacts 1. Find the following icon. 2. Click Contacts to open the list of contacts. 3. To add a contact, click . 4. To import or export contacts, press the menu key and click Import/Export. 5. To edit or delete a contact, select the contact, press the menu key and click Edit/Delete. Call records Contacts Keypad for dialing Voice call
Elliot M. Frohman, MD, PhD Correspondence to Dr. Frohman: elliot.frohman@utsouthwestern.edu Editorial, page 518 Optic nerve head component responses of the multifocal electroretinogram in MS ABSTRACT Objective: To employ a novel stimulation p
