Advanced Techniques
Presbyopia

Presbyopes may be the single largest group of patients who have not been receiving the full benefits of contact lens wear. This may be at least partially attributed to a limited number of multifocal designs traditionally available for soft lenses. Also, positioning the reading addition in the proper position in relation to the pupil for both distance and near vision has been a source of difficulty. Much research has been done in an effort to improve soft lens multifocal designs.

What follows are some of the methods commonly used for providing the presbyope with contact lenses. Many of these approaches are used for the fitting of both rigid and soft lenses.

I Provide reading glasses to be worn over the contact lenses.
While this option generally provides the best vision of all for reading, it is often rejected by the patient who complains about having to wear any glasses at all in addition to the contacts.

II Provide two pair of contact lenses, one pair for reading only and one pair for distance.
For the most part this is largely a theoretical alternative and obviously not a practical one. It would require the patient to change lenses whenever switching the gaze from distance to reading for any period of time.

III Monovision is a popular and surprisingly successful alternative for the presbyope wishing to wear contact lenses. It involves placing a lens with the distance vision correction in the dominant eye and a lens with the near vision correction in the other eye. Most patients will adjust to them within a relatively short period of time even though there will always be one eye with blurred vision. Occasionally a bifocal lens is placed in the nondominant eye to aid with distance vision. It is generally recommended to trial frame the patient first with the distance prescription in one eye and the near prescription in the other thereby providing the patient with at least some idea of what to expect. The popularity of this fitting method can largely be attributed to its relative simplicity and low cost compared to the use of actual bifocal contact lenses.