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28 S P E C I A L E D I T I O N 2 0 1 5 • O P T O M E T R I C M A N A G E M E N T . C O M THE EMERGING PRESBYOPE If an emmetrope or a single vision contact lens wearer in her late 30s to early 40s mentions anything about eye strain or blur, I trial frame a +1.00 add to see whether she likes it better. Some doctors don't test near vision or consider near cor- rection for patients under the age of 40, but I fnd that with the increased near demands of technology, patients are having problems with convergence and accommodation earlier than they did in the past. Assuming the patient responds well to the add, I say, "You're wearing contact lenses because you didn't want to wear glasses all the time, right? I can give you a lens that has that little bit of reading help that I just showed you incorporated into the lens itself, so you don't have to wear reading glasses over your contact lenses." It's a really easy conversation. Tis lens is a great lens to put on these younger patients. I tell them not to expect much change in how they see, but more in how they feel. Here's how I explain it: "Tat small adjustment made it easier for you to read for 20 seconds. Just imagine how much better your eyes will feel getting that near vision help all day long." It's also nice to know that patients will be able to con- tinue in this lens for many years as presbyopia progresses, simply by changing the add combination. THE CURRENT MULTIFOCAL WEARER I have a lot of patients currently in other multifocal con- tact lenses. When one of these patients comes in for an an- nual exam, I ask four questions: • Can you wear your lenses comfortably all day long? • How is your distance vision? • How is your computer vision? • How is your vision for reading or up close? If a patient can legitimately answer that his lenses are performing great on all four of those measures, then I prob- ably wouldn't suggest a change. But, hardly anyone is doing great on all four. Tat makes it easy to say, "I have a new lens that should address the problem you are having." I'm fnding that most of the time, this lens works better than the patient's current multifocals. FE ATURE UP YOUR GAME WITH PRESBYOPES TALK ABOUT TECHNOLOGY, NOT COST If you ask patients, "Do you want product A for $5 or product B for $10?" they will choose A every time. Wouldn't you? But if you tell them why a certain lens will meet their needs better or solve a problem for them, it changes the conversation. Now you are talking value, not price. I like to spend a little time explaining the technology that makes a more expensive lens worth the money. Being "new" is not enough of a beneft. For example, when introducing these lenses, I tell pa- tients that advanced technology helps it center well over the cornea, and I explain pupil optimization in layman's terms: "In some people, the pupil is a little larger or smaller than normal. So, if the lens is designed for a 7.0mm pupil and you have a 4.0mm pupil, you are missing all that vision around the edges. It's better to have a lens that is designed to closely match the pupil size we expect for people your age with your prescription." USE THE FITTING GUIDE I don't usually use ftting guides, but I use the ftting guide for 1-DAY ACUVUE MOIST MULTIFOCAL because it works (see below). In fact, if you try to ft this lens like you ft other multifocals, you may run into problems. Tat's because we've all become accustomed to using little tricks to compensate for the faws in older multi- Figure 2: A four-page ftting guide is available to help O.D.s successfully ft the lens. I LIKE TO SPEND A LITTLE TIME EXPLAINING THE TECHNOLOGY THAT MAKES A MORE EXPENSIVE LENS WORTH THE MONEY.