By Amy Hellem
Fitting presbyopes can be a challenge for both doctor and patient. What’s more, finding a solution that works almost always involves patience and a teamwork approach. Custom progressive hybrids can be an outstanding solution, provided candidates are properly selected, educated and fit.
The following strategies have helped doctors achieve great success when transitioning their own patients into SynergEyes Progressives:
1. Start with the easy cases: Don’t go after the tough corneas at first, warns Brooke Kaplan, OD. “They are the worst eyes to learn on.” Instead, try the thirty-eight to forty-year-old toric patient who is starting to have a little bit of trouble up close. “Set yourself up for success to begin with,” she says. These are the patients who are going out and telling their coworkers and friends, she adds.
2. Think beyond astigmatism: If patients aren’t getting the clarity they’d like from a soft multifocal, consider Duette Progressive—even in patients without astigmatism. Erin Sullivan, OD, says the fitting process with empirical ordering is so easy and has cut down chair time so much that she’s now offering the lens to patients who don’t have astigmatism so that they can enjoy better optics too.
3. Ask yourself how well a soft multifocal will work in your patient: If you don’t think vision will be up to par, consider presenting a Duette Progressive instead. “Anytime that I have a patient that has a small amount of astigmatism or larger amounts of astigmatism, the tendency is for a soft Progressive multifocal lens to not work very well,” says Brian Dembo, OD, PC.
By presenting Duette Progressive, Dr. Dembo’s recommendation is consistent with his practice philosophy, which is to give every patient the best visual outcome possible.
4. Set expectations early on: Make sure patients understand what a simultaneous vision lens is, what it does, and how it works. “We try to set expectations before the patient actually gets the lens on their eye,” says Dr. Dembo, who uses the analogy that when adapting to multifocal optics, it’s like looking through a screen—until it eventually disappears into the background.
5. Explain the benefits of the rigid center: When discussing the hybrid design to soft lens wearers, make sure they understand the benefits and purpose of the rigid center. Brian Brightman, OD, explains to them that, when you use a rigid center optic lens, you get better optics. “The soft contact lenses never have been able to do that because they are not rigid materials,” he adds. With the hybrid lens, the patient receives rigid material vision, with the comfort they are used to with the soft contact lens.
6. Be open about timeframes: When you talk to patients about how they’ll need time to get used to the Duette Progressive, many will want you to be more specific. Dr. Sullivan’s line is, “If you give me four days, I’ll give you 85%.” She says this is how long it generally takes to learn to handle the lens. Then, in the days that follow up until about day 10, the brain will also adapt and they’ll get that final 15%.
7. Learn how to center the lens: Centration is key with the Duette Progressive. “The optics have got to be centered,” warns Dr. Sullivan. Otherwise, it will affect the vision and patients will experience some blur. “Really tune in on that centration,” she adds. “And once you know a couple of techniques to get that moved over, people do very well.”
8. Help patients to accept reality: Dr. Kaplan’s patients have been extremely happy with the visual outcomes from Duette Progressive. “We have had patients that their work experience has been so beneficial—not having to grab the over the counter readers in three different powers to get through the day,” she says.
But, Dr. Kaplan warns that it’s still very important to set realistic expectations by explaining that you can’t make an eye 20 years old again and there is no perfect solution. However, she adds, “this is the closest to optimal vision that we can get.”
9. Empower the patient: Help your patient take ownership of the adaptation process by putting them in charge. Say things like, “Be patient with yourself,” advises Dr. Pfeil. By empowering the patient, they become personally driven to succeed, which is a win-win for everyone.
Amy Hellem is an independent writer and researcher who specializes in ophthalmology and optometry. Previously, she served as editor-in-chief of Review of Optometry and Review of Cornea & Contact Lenses and directed the custom publishing division for Review of Ophthalmology.