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Medical Forum / General / Vision / October 2006Multifocal Lenses--are they for real?
Hello group, I'm 48 y.o. and have been wearing Acuvues for years at -6.50 with 8.4 BC. The last couple of years near vision is pooping out, and I tried monovision last year but it didn't work out for me due to needing close stereoscopic vision for my work. I found out what a drag it is wearing reading glasses over the last year so now I am trying out multifocal lenses. The first trial pair my O.D. gave me is B&L Purevision -6.50 with low add 8.6 BC. These are extremely comfortable lenses that give me excellent close vision (I feel young again!) and very good mid distance but bad distance vision. I wore the lenses plus my wife's glasses to drive back to the O.D. (and got excellect vision with them. Her glasses are -1.75/-1.25). O.D said she didn't think the lenses were riding too high, but is going to try me on a -7.00 in the same brand. Apparently the Purevision Multfocal only come in BC 8.6. My old lenses had a BC of 8.4. Could this account for my bad distance vision? Do Multifocal lenses need a break in period for my eyes to adjust? It will take a couple of days to get this next pair in, but I wonder if the higher power is going to degrade the close and mid vision. Maybe I'm simplifying but it almost seems like if I wore regular old Acuvues at a -5.75 I'd get the same vision (good close and mid, bad distance) as these high tech Multifocals. Is my experience typical? Thanks--Ted > Apparently the Purevision Multfocal only come in BC 8.6. My old lenses > had a BC of 8.4. Could this account for my bad distance vision? Unlikely. for soft lenses, base curve is more related to the tightness of the fit of the contact on your cornea and does not contribute to the power of the prescription. > Do Multifocal lenses need a break in period for my eyes to adjust? you must learn to accept "less than perfect" distance vision with multifocal contacts in order do achieve adequate near vision. and I am serious when I say only "adequate" near vision because while your near vision will indeed be somewhat better it won't be perfect. when I fit someone with multifocal soft contacts I explain clearly that what we hope to achieve is a situation where their distance and near vision are "good enough" to achieve what they want to acheive but not perfect like bifocal glasses or single-vision contacts with readers is. they will NEVER be as good in the distance as your single distance contacts (as you've noticed) and you will certainly see better at near if you put readers on over your contacts like you did before. it all comes down to how much you want to get rid of your reading glasses. if you really want to do it, then I am usually successful fitting most people in multifocal contacts as are most eyedocs. just don't expect the impossible. I like the type of lens you are trying now, and I also have good success with Frequency 55 and Purevision Multifocals. To address your real question, yes you will adapt better to bifocal contacts as you wear them more. > It will take a couple of days to get this next pair in, but I wonder if > the higher power is going to degrade the close and mid vision. yes it will. > Maybe I'm simplifying but it almost seems like if I wore regular old > Acuvues at a -5.75 I'd get the same vision (good close and mid, bad > distance) as these high tech Multifocals. > > Is my experience typical? yes. but your range of clear vision is much better with the multifocals rather than just cutting the power of a single vision lense. > Thanks--Ted > > Apparently the Purevision Multfocal only come in BC 8.6. My old lenses > > had a BC of 8.4. Could this account for my bad distance vision? > > Unlikely. for soft lenses, base curve is more related to the tightness > of the fit of the contact on your cornea and does not contribute to the > power of the prescription. Oh, like how much they slide up and down when I blink? Thank you for the info. I'll try to reduce my expectations as much as I can. But I also don't want to reduce the incentive for the lense manufacturers to provide products that meet the needs of customers... :) (spoken with the inflated sense of entitlement typical of a baby boomer) Ted > > > Apparently the Purevision Multfocal only come in BC 8.6. My old lenses > > > had a BC of 8.4. Could this account for my bad distance vision? [quoted text clipped - 14 lines] > > Ted I'll second that! The manufacturers market their products to the most profitable demographic group first. And that's not presbyopes. At least not yet. We need to yell louder! We've done it before and it works. At least B&L is pursuing that (our!) market with their PV Multis which, IMHO is the best in it's class. (Note: lenses should not move more than 1/2- 3/4mm with blink!) Meanwhile, I somewhat disagree with my colleague on the "compromise" issue. I'd say that 75% of my patients have nearly equivalent distance vision with the PV Multi's as they had with their single vision lenses with dramatically better intermediate and often excellent near vision. The other 25% have varying degrees of "compromise" and sometimes less-that-satisfactory distance, traded for excellent near. And there's a group in that 25% for whom it simple doesn't work worth a damn. I've found that really small pupils (3-4mm in reduced lighting) and uncorrected astigmatism (more than .75) can be deal breakers. So, I'm hoping for toric versions and the ability to order specific center optic zone diameters. "They say I'm a dreamer, but I'm not the only one..." --John Lennon on another more serious issue. LB. OD I'd say that 75% of my patients have nearly equivalent distance >vision with the PV Multi's as they had with their single vision lenses >with dramatically better intermediate and often excellent near vision. Would you say that it takes several fittings to get it to that point? Or do you get them on the first try? I am walking around in my first version and everything is "swimming" and I have to go back in two days. Please see my other post from yesterday (october 3) and your thoughts would be appreciated. Am I going to be the 25 % or is it possible with a few tweakings to get as you describe for your 75% patients? Thanks. > I'd say that 75% of my patients have nearly equivalent distance > >vision with the PV Multi's as they had with their single vision lenses [quoted text clipped - 9 lines] > > Thanks. I would say that most patients require a "tweaking". Perhaps one or two additional fittings for some people, although I get a good number right on the first try! And, of course, sometimes it just doesn't work like either I expected or the patient desires. That being said, we're talking about changing the total power, the add power (high or low) for one or both eyes, sometimes using an aspheric single vision lens for the dominant eye. If the results are not realistic on the first attempt, the second trial happens right then and there. The wearer needs to have a pretty darn good close-to-desired result before taking them home and to work for a real-life trial. Then we "tweak". The adaptation time (it's an optical/brain thing) is often two days or so, sometime a week. But IMHO, if after a week it doesn't work, it wont. (Sometimes it does indeed take two weeks. Most people, including myself as the practitioner, are not that patient!) LB, O.D. Thank you so much for responding. The first pair he gave me, I don't know what they were--bofocal? single vision mono vision, I only knew that I could see like nothing...certainly not to drive home. So I left them there and he ordered one bifocal and one far distance regular (both these are RPGs, if that changes your thinking on this). Yesterday when I went, he had me put the bifocal in the right eye (which was previously my far distance eye) and the far lens in the left. This was hopeless. I was like a horse rearing its head, I could not get anything near to swim into focus. So he had me switch them, the bifocal to the left, the far distance to the right. The right one was identical to my old right lens (although, not 15 years old!). The left one was weird. If I hold my head a certain way, and if I hold a book up close to my face and turn my left side of my face toward it, I can read. I can sort of read the computer screen. But the blurry-for- near right lens kinda washes out the effect of the left lens, if you know what I mean. I can read great if I cover my right eye with my hand. But who is going to do that? But the one big problem I am having is intermediate. In other words, as an editor, I have to be able to lay pages out on a desk, sitting and looking down at them. I need to be sitting up--not hunched over (or that will create another sort of problem, neck and back strain) and be able to see clearly. This I cannot do with these lenses. I can sort of make stuff out, but "sort of" is not okay for an editor. I have to be able to catch a letter--a period- -everything out of place. That is what an editor does. So he sent me home with these to see if I would adjust. Today is my first full day, and I am feeling a little dizzy and eye-strainy. So my question is, will he be able to tweak the left bifocal so that I can see that further distance to the surface of the desk from sitting up? Can he scale back the far vision in the right single vision lens, and can he increase the intermediate and far vision in the bifocal left lens? (Keep in mind, I went in, in the first place, with my old lenses with two problems: could no longer read close up and also eye strain in the right eye. I still have the eye strain in the right eye.) I have two days and then I go back. So your input is really appreciated. Thanks. >> I'd say that 75% of my patients have nearly equivalent distance >> >vision with the PV Multi's as they had with their single vision lenses [quoted text clipped - 21 lines] > >LB, O.D. >Issues with RGP multifocal fitting.< It's good you know which eye is best suited to be the near lens if you are doing "bofocal", if you need to go that route. (I Like "multi-sivi" for multifocal-single vision.) Well, there are two things that come to mind: If you wore RGPs previously, if the fit was not optimum, either causing cornea molding or with incorrect power, you might have to wait a couple of weeks without lenses and re-start. If all was well....... IF head movement causes so significant changes in optics, then the fit isn't right. It does indicate that if it can be adjusted so that the good vision is the predominant vision, then great! Your almost there. IF not, then there are different RGP multifocal lens designs to try, and do try it in both eyes! That's the best way to assure good intermediate vision along with near and distance. From my last post, I wrote about how many trials before clear success or not success. That was assuming soft. Sorry. For RGPs, expect a little more tweaking as there are many more things to tweak. That also means perhaps a *better* chance at getting what you need! That your doctor has experience with RGP multifocals is a good sign. Not many of us fit those lenses. Even if he's "practicing" --learning, the lab consultants are often great help at troubleshooting lens fitting and designs. Be patient and communicate your needs and concerns. My RGP multifocals provide me with outstanding vision at all distances. Unfortunately, I cannot seem to get comfortable wearing them. I will try again! LB, O.D. Thank you so much for responding. OK, here are the answers to your questions. I have had Hard lenses since age 15 with very extreme myopia, and then my eye doctor started inventing oxygen perms (polycon). So since those came to be, I have had whatever he was working on. I would wear lenses from first thing in the morning till bedtime. 12 years ago, I noticed strain because I "saw too well", so he grabbed one, ran in the next room (he had his own lab, bless him; boy was I spoiled. There was never a time wait for me.) and then came back with one of the lens a lower prescription. Bingo, perfect. About a year ago, I noticed that I had a lot of strain reading close AT ALL. And discovered my eye doctor had retired. So, to answer your question, yes, my previous lenses fit just fine, BUT I can no longer read with them. For the last half year, I have popped them out and put on glasses to do my editing (from home) but I need a full-time contact solution so I have the option of not working from home which begets less money. Plus, I HATE wearing glasses. So, since I posted earlier, I found the confusion in my head from all this blurry vs clear vs whatnot was making my so dizzy and nauseaus that I was going to go back Friday and tell him I give up. I originally thought he would just give me monovision as I had before, only "more so"...but he gave me the one bifocal and it is driving me nuts. I don't know what his reasoning is behind just one vs both. Do you think if it was both, I would be less dizzy and nauseaus? Or more so? Please note, my presbyopia is such that my last 12 year's lenses don't work for reading, BUT, it is not so advanced in that I can put on the lowest strenght dollar store readers over contacts or just put on my regular glasses and barely even needing to slide them down at all, all of course temporary solutions. So maybe that was why only one bifocal? My eyes are like -11.5 or -12.something, so you can see how myopic I am. Anyway, is it normal to experience this kind of nausea/dizziness on Day 1? It was so bad, I have already popped them out and can't bring myself to think of putting them back on tomorrow. Your thoughts? >>Issues with RGP multifocal fitting.< > [quoted text clipped - 29 lines] > >LB, O.D. "It's good you know which eye is best suited to be the near lens if you are doing "bofocal", if you need to go that route. (I Like "multi-sivi" for multifocal-single vision.)" Hey, no fair--there is no edit feature to this bulletin board! Believe me, when I saw that mistake after I had posted it....sigh....I can spell, I just can't TYPE!! I am a candidate for a Clear Lens Extraction (in one eye only), - 13 or more in one eye, maybe +.5 in the other, at most. I'm 56, so I'm at a Plus 2 for reading. If Multi-focals require tweaking and don't always fit right, wouldn't it be extremely dangerous to get a multifocal IOL? After all, once its in there, it is permenent. >> I'd say that 75% of my patients have nearly equivalent distance >> >vision with the PV Multi's as they had with their single vision lenses [quoted text clipped - 33 lines] > > LB, O.D. It's not "extremely dangerous" to get multifocal IOLs, but it is optically a bad idea in my opinion. You always have at least 50% of th incoming light out of focus, no matter what your viewing distance is. In your case, I'd bemore concerned with the possiblilty of retinal detachment in that highly myopic eye, so I'd consder one of the new posterior chamber lenses (they leave your own crystalline lens in tact). They are very new, and do require a skilled surgeon (preferably one who has implanted at least 10 of them). w.stacy, o.d. > I am a candidate for a Clear Lens Extraction (in one eye only), - 13 or more > in one eye, maybe +.5 in the other, at most. I'm 56, so I'm at a Plus 2 for > reading. If Multi-focals require tweaking and don't always fit right, > wouldn't it be extremely dangerous to get a multifocal IOL? After all, once > its in there, it is permenent. I understand those lenses are out of the question for someone my age. For one, I've lost most of my accomodation, and second, I'm likely to get cataracts in any event. Just came from a visit to my opthamologist. My vision in the left eye is -14.75 and -2.5 (I think she said I had a slight astigmatism). We are looking at a minus 13 or 14 disposable or extended wear contact lens. She thinks they have to be specially ordered as most companies only make them off-the-rack to minus 12, and I am no longer getting the best vision from the minus 12. We are trying to see if I can tolerate a higher power lens as far as wearing it (I'm becoming fairly intolerant to other lenses) and to see just how good my vision can get. I'm thinking I'll most likely have a CLE at some point in the future. > It's not "extremely dangerous" to get multifocal IOLs, but it is optically > a bad idea in my opinion. You always have at least 50% of th incoming [quoted text clipped - 13 lines] >> fit right, wouldn't it be extremely dangerous to get a multifocal IOL? >> After all, once its in there, it is permenent. > Just came from a visit to my opthamologist. My vision in the left eye > is -14.75 and -2.5 (I think she said I had a slight astigmatism). We are > looking at a minus 13 or 14 disposable or extended wear contact lens. She > thinks they have to be specially ordered as most companies only make them > off-the-rack to minus 12, and I am no longer getting the best vision from > the minus 12. There a dozens of lenses available in your prescription, including some of the newer plastics. Even with correcting your astigmatism. Stocked lenses, too, although there are some that will require a couple of weeks to get them in your hands. If she's not aware of them, ask her to consult with someone who is. LB, O.D. I read with interest your response here, as I await my first pair of bifocal RPG lenses. If you saw my new thread, I too am in the same situation--also 48 years old, and strong myopia with perfect 20/20 correction with RPGs but over the last year presbyopia has progressed so I can't really read for work (close reading, I am an editor). My new optometrist tried a pair of I-don't-know-whats last week and I couldn't see well either near nor far. He is now ordering one bifocal lens and one regular lens just for distance vision. I guess that's a kind of funky version of monovision? I hope you will give me input when I get them if they aren't "perfect" right from the start (which I don't expect they will be.) >> Apparently the Purevision Multfocal only come in BC 8.6. My old lenses >> had a BC of 8.4. Could this account for my bad distance vision? [quoted text clipped - 43 lines] > >> Thanks--Ted > Hello group, > I'm 48 y.o. and have been wearing Acuvues for years at -6.50 with 8.4 [quoted text clipped - 3 lines] > reading glasses over the last year so now I am trying out multifocal > lenses. [big snip] > Maybe I'm simplifying but it almost seems like if I wore regular old > Acuvues at a -5.75 I'd get the same vision (good close and mid, bad > distance) as these high tech Multifocals. > > Is my experience typical? There are no good experiences and no good solutions. When presbyopia sets in, it's a question of what you are willing to live with. I was happy with contacts for distance and OTC reading glasses over them for near. There are other options. One that isn't recommended for most is contacts for near and distance glasses for far. Depending on strength (mostly having to do with how close you need to see for your work), you may be able to do all your indoor tasks (eating, reading, watching tv and walking around the house) without glasses, and just use the glasses for outside (driving, walking, sightseeing, etc.). For most people, presbyopia just gets worse with increasing age. What works for you now may not work in a few years.  SignatureDan Abel dabel@sonic.net Petaluma, California, USA > There are no good experiences and no good solutions. When presbyopia > sets in, it's a question of what you are willing to live with. Exactly! >Hello group, >I'm 48 y.o. and have been wearing Acuvues for years at -6.50 with 8.4 [quoted text clipped - 3 lines] >reading glasses over the last year so now I am trying out multifocal >lenses. Although usually used with higher add powers, you should ask the CL fitter about translating RGPs. If they can get the lens to move and position properly you should experience very good if not excellent far and near vision. Robert Martellaro ~~~~~~~~~~~~~~~~~~ Optician/Owner Roberts Optical Wauwatosa Wi. ~~~~~~~~~~~~~~~~~~ "An expert is a person who has made all the mistakes that can be made in a very narrow field." - Niels Bohr |
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