From the first part to the fourth installment of my series on multifocal contact lens, I rediscovered the fun of fitting these lenses. I had scorned these lenses and failed to appreciate, pure happiness and satisfaction that patients experience from wearing them. Presbyopic patients have expectations and concerns about contact lenses in general and specifically lenses for their age group. These concerns must be answered and doing it well will maintain patient confidence for the patient themselves, such as cognitive dissonance, or “buyer’s remorse” and for the doctor.
From the first word to the last word that you say to the patient, the doctor should be familiar with their patient’s interest and past experiences about contact lenses. It can uncover unmet needs and wants as well as biases or prejudices. Tailoring the presentation to those interests or potential needs will keep the interest level of the patient and supports the notion that you are listening to the patient. Explore what the light level at the work place is as this will have a significant impact on the usability of the lenses.
As an example, a 51 year old male presented for a contact lens evaluation and fitting. He is naive to contact lenses or prescription corrective lenses and had been using over the counter reading glasses for near vision. He is a blacksmith and has had multiple readers being damaged in less than a week of wear at work. His use of safety goggles over the readers were unwieldy and prevented him from doing his job well.
The uncorrected vision was OD 20/20- and OS 20/40, which not deter him from driving without correction. His refraction was OD Plano -0.50 axis 090 and OS -0.50 -0.50 axis 090 VA’s 20/20-1 each eye His reading vision at the preferred working distance of 18 inches was 0.60 M with +2. 00 reading addition. His palpebral fissures were large and although proptosis was suspected, the Hertel measurement were equal in each eye at 18 mm. Both upper and lower lids were loose. The remaining internal and external examination were unremarkable or unspectacular.
In this case, the patient had a high degree of motivation, but his expectations might also be equally high. He wanted contacts. However, managing those expectations begins from the outset of the first visit and continues throughout the patient experience within your office. I successfully fit the patient with a pair of multifocal soft contact lenses and after demonstrating satisfactory handling of the lenses, a one week “real life” trial was suggested where he would use the contacts for work. The expectations doesn’t stop there. Cognitive dissonance, the buyer’s regret, must be managed and that comes from everyone in the office from the receptionist to the business manager to deter from discouraging the patient in any way.
The real test whether this would be a successful fit came in the second and third follow up visits where he expressed complete satisfaction of the contacts while at work but not at driving a car. He felt they were worse than no correction. I adjusted the power of the dominant eye by increasing the minus, but kept the add power the same. He immediately saw an improvement in distance vision. He became satisfied after the third visit.
The take home message in multifocal soft contact lens fitting for the presbyopic patient is understand as much about the patient as you can. If there is a spark of interest, I think the doctor is in the unique position to capitalize on that interest. Denying a patient of that interest because of time constraints, doctor apathy or doctor knowledge is doing a disservice to the patient. Become familiar with multifocal lenses in their performance capabilities and their fitting characteristics and you can improve your own success with these lenses.