Optometric Management Special Edition

2015

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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 29 FE ATURE UP YOUR GAME WITH PRESBYOPES focal lens technology: We over-minus the distance in the dominant eye and under-minus it in the nondominant eye to provide mini-monovision. Te lens has such good op- tics and centration that it already provides the full range of vision it's supposed to — without the workaround. We saw this same trajectory with progressive spectacle lens technology. Early progressives weren't very good at getting the full add into the lens, so optometrists got in the habit of just prescribing 0.25D more plus. With newer de- signs, we stopped doing that. Te bottom line is that the ftting guide is the best way to determine the starting pair and any adjustments that need to be made. I rarely make more than one small change in one eye. BEST PRACTICES You need to start with a good refraction and add power determination (see "Avoiding Common Mistakes"). Although there are rough age guidelines, I feel it's important to test patients' near vision, and I like to use fused cross- cylinder over their distance prescription to determine the add. Tis is a quick way to test their accommodative ability in conjunction with their eye posture, or convergence. Tis lens needs to settle for about 10 minutes and its performance is best determined in the real world, not the exam lane. Some doctors have patients wait and then test it out by looking across the parking lot and down at their smart phone. Because of the way my work fow is set up, I usually send them home with trial pairs based on the ft- ting guide and I advise them, "Don't judge these by the frst few minutes!" Ten, I make any needed adjustments at the one-week check. IMPROVING VISION Trough the years I've been surprised by how ofen pa- tients tell me their previous doctor never even mentioned multifocal contact lenses. I see these lenses as a great way to build patient loyalty and generate referrals. Fitting multifo- cals allows us to retain contact lens wearers as they age and attract new wearers who become presbyopic and prefer not to wear glasses (Figure 1, page 27). Tere is minimal risk to re-ftting current multifocal wearers in these lenses or trying it on emerging presbyopes. In the worst-case scenario, the patient doesn't see any ben- eft over their current lenses. But in many cases, you can bring them new technology with the potential to improve their quality of life — and make you look like the hero. OM MICHAEL CISZEK, O.D., is in private practice at Visionary Eye Care, with two offces in Chicago. He received compensation from Johnson & Johnson Vision Care, Inc., for his time in writing this article. Visit tinyurl. com/OMcomment to comment on this article. § Data on fle, 2014. Based on in-vitro data; clinical studies have not been done directly linking differences in lysozyme profle with specifc clinical benefts † Helps protect against transmission of harmful UV radiation through the cornea and into the eye. *WARNING: UV-absorbing contact lenses are NOT substitutes for protective UV-absorbing eyewear, such as UV-absorbing goggles or sunglasses, because they do not completely cover the eye and sur- rounding area. You should continue to use UV-absorbing eyewear as directed. NOTE: Long-term exposure to UV radiation is one of the risk factors associated with cataracts. Exposure is based on a number of factors such as environmental conditions (altitude, geography, cloud cover) and personal factors (extent and nature of outdoor activities). UV-blocking contact lenses help provide protection against harmful UV radiation. However, clinical studies have not yet been done to demonstrate that wearing UV-blocking contact lenses reduces the risk of developing cataracts or other ocular disorders. Consult your eye care practitioner for more information. See page 4 for more important prescribing information. Avoiding Common Mistakes • Incorrect distance refraction or add power • DON'T over-minus for distance or over-plus for near — +0.75 over should blur out the best acuity line • DON'T use an old contact lens prescription • DO obtain a new, functional (maximum plus) distance refraction • DO determine an appropriate functional add (minimum plus to functional vision for essential tasks) • Multiple re-fts or low ft success rate • DON'T follow the ft guide from a different brand • DON'T refract in the dark • DO perform a modifed Humphriss over-refraction • Dissatisfed patient • DON'T promise to solve everything with a contact lens • DO set proper expectations for task-related spectacle wear in some situations as patients age • DO consider separate prescriptions for "work" and "play" Continued on page 30

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