It would seem that optometrists across the country have tried to or have achieved success in fitting multifocal contact lenses. Doctors want to do better. Because professional consultants and speakers that are funded or sponsored by the manufacturers cannot deviate too far from the “party line”, there may be a significant opportunity lost when success is achieved outside those boundaries. It is my goal to speak about these successes that don’t conform to what the fitting guide says.
One such example is fitting a biocular patient (a patient who has vision in both eyes but do not have binocular vision). Although not a common presentation, the methodology is similar to a normally functioning patient. In this particular case, the patient had corneal pathology that reduced.
vision to 20/40 in the dominant eye many years before and 20/20 in the non-dominant eye. For the past ten years, she no longer experienced diplopia. This was supported by 3rd degree fusion on the red lens and Worth Dot tests.
It may seem that the non dominant better vision eye should be fitted and the dominant poorer vision left uncorrected. In this case, I prcoeeded to fit +2.00 Add multifocal lenses in both eyes with +0.75 distance overplus in the dominant (poorer vision) right eye and a “on-sphere” Rx non dominant (better vision) eye.
The result was a lack of satisfaction in distance vision with both eyes open. Taking the left lens out and leaving the right lens in, however, improved significantly the overall satisfaction. Note that I had not asked the patient to read an acuity chart. Until I perceived that the patient was generally satisfied with the vision, I now hold off taking an acuity . Also, I did not take individual eye acuities but just took vision at distance and near open together even though the patient was biocular.
What doctors, new or old, will find refreshing is that patient problems are not usually predictable. Preconceiving a solution without adequately understanding the patient’s specific needs or constraints will not create a happy patient. Our common goal, after all, is to create happy patients.