1. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org Presbyopic Contact Lens Options B9 SAMPLE

2. © The International Association of Contact Lens Educators www.iacle.org Attributions Lecture contributors*Robert Terry, Lewis Williams, Gina Sorbara, John Meyler, Rènée du Toit Lecture editor**Caroline Christie IACLE executive editor**Judith Morris IACLE reviewer**Nilesh Thite, Lewis Williams Lecture updated2015-Apr-21 Lecture content rechecked2015-Aug-21 * Original author(s) of lecture(s)**2015 Editors and reviewers

3. IACLE SPONSORS © The International Association of Contact Lens Educators www.iacle.org Industry Supporters Previous Supporters Development and delivery of contact lens education by IACLE is supported through educational grants and in-kind contributions CIBA Vision Bausch & Lomb Allergan AMO Ocular Sciences Wesley Jessen Menicon Paragon Pilkington Barnes-Hind Aspect Vision Care

4. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org SAMPLE ONLY The following slides are an excerpt from the revised IACLE Contact Lens Course lecture Presbyopic Contact Lens Options

5. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org DENIAL ! Spectacles reading glasses bifocal / Multifocal spectacles Contact Lenses distance only CL + reading glasses monovision multifocal / bifocal in both eyes enhanced monovision Refractive Surgery GP Hydrogel Current Presbyopic Options

6. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org Inexpensive Especially Ready Readers Multiple pairs - one in each room! Spectacles: Reading Glasses

7. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org BIFOCALS MULTIFOCALS Both forms of correction involve visual ‘compromises’ Spectacles: Bifocals / Multifocals

8. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org …a ‘technique’ for correcting presbyopia in which reading power is incorporated into a single vision CL worn usually in the non-dominant eye Monovision: Definition

9. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org Clinical Studies show 67% success rate = 33% fail ! Greatest success in early presbyopes however… Stereopsis (depth perception) Reduced Contrast Shortened Reading Times Intermediate issues with > adds Moral / professional dilemma would you prescribe monovision specs? Monovision: Outcome

10. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org Determining Dominance McMonnies (1974) proposed 7 methods of determining the eye to be given the distance lens Methods currently used include Sighting dominance Blur suppression Ocular Dominance

11. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org One-handed pointing may be influenced by which hand is used or patient’s handedness Hole-in-the-card, two-handed different to true directional dominance Changes with position of gaze Changes when +ve lens over one eye! Why then prescribe monovision on the basis of a test that changes as soon as you fit monovision? Sighting Dominance

12. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org Distant spotlight viewed with optimal DISTANCE Rx worn in front of both eyes Transfer a +lens of ADD power between the two eyes Ask in which eye is it easier to ignore the ‘starburst’ that is the NON-Dominant eye +2.00DS blur test Similar concept but letter chart employed If NO preference then select eye with best acuity as the Dominant Eye Blur Suppression

13. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org Patient corrected for maximum (optimal) distance vision in each eye Correct for astigmatism > 0.75DC to optimise VA Select chosen method of determining dominance Dominant Eye corrected for Distance Non-Dominant Eye corrected for Near Identify Dominant Eye

14. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org Patients who are starting to become presbyopic can sometimes already be in monovision before concept even discussed ! Due to… a change in their prescription having swapped their lenses over! using an older lens (lower Rx) If this is the case then go with the flow… in respect to eye corrected for distance viewing Spontaneous Monovision!

15. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org Add > 2.25 D loss of intermediate vision Supplementary corrections readers for detailed near work simple Ready Readers will not work eyes are no longer corrected equally Driving Glasses? Consider extra (3 rd ) CL for specific viewing distance Limitations of Monovision!

16. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org The adapted monovision patient must re-learn to see BINOCULARLY, there is a re-adjustment period so you need to fully prepare them Take them out of monovision, fit distance-only CLs & provide Ready Readers to use for a few days to re-adjust to binocular vision before refitting Fit them that day encouraging them with their ‘range of vision’ especially at intermediate & night driving will be so much better (see in 3D again) Refitting Monovision Patients

17. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org Modified monovision DV biased bifocal dominant eye NV biased bifocal other eye Fairly Common in multifocal lenses as add powers  Enhanced monovision SV correction in dominant eye Bifocal in other eye Monovision Opportunities

18. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org Contrary to all our education & training normally push maximum binocularity a deliberate visual compromise What is the wearers occupation? professional liability / negligence issues cautioning required Consider supplementary Specs or CLs enhanced near vision (detailed close work) enhanced distance (driving)? Ethical Considerations

19. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org Advantages Good for early presbyopia Easy to fit range of lens designs, materials & modalities Reduced chair time? Less costly Disadvantages Reduced stereopsis & contrast Adaptation period (suppression) Intermediate vision (higher add) Unsuitable monocular patients Monovision: Summary

20. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org Reduced Stereopsis Reduced Contrast Intermediate Compromise Night Driving Issues Shortened Reading Times If you only do what you have always done… you will only get what you already have Breaking Out of Monovision

21. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org Perception - multifocals create visual problems like ghosting particularly when driving at night so many practitioners don’t even start with multifocals Ability to change focus distance Satisfaction with vision for driving at night Multifocals outperformed monovision in ALL aspects except high contrast near acuity Vision Rating: Multifocal versus Monovision

22. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org Chair time involved in fitting No significant difference between monovision & multifocals Perhaps influenced by latest CL designs Patients won’t pay more for multifocals Presbyopic patients usually most stable financially, typically at the peak of their career earnings & usually willing to pay additional expense when the outcome results in  satisfaction &  convenience Part-time use, especially with daily disposable multifocal lenses, further addresses the convenience issues & high material costs associated with premium lenses Monovision versus Multifocal: Myths

23. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org Contact Lens Options: GP & Hydrogel GP Simultaneous Spherical Aspheric Translating Hydrogel Simultaneous Spherical Aspheric Concentric multi-zone Translating

24. © The International Association of Contact Lens Educators www.iacle.org © The International Association of Contact Lens Educators www.iacle.org Exclusively available to IACLE members To access the complete lecture go to the member login at: www.iacle.orgwww.iacle.org Not a member? See our website for details or contact us at: iacle@iacle.orgiacle@iacle.org

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