By Gina M. Wesley, OD, MS, FAAO 
Multifocal contact lenses provide youthful vision and freedom. Develop your skills at guiding your presbyopic patients into the multifocal CLs that are right for them.
With the aging of Generation X and the continuing needs of the large Baby Boomer population, the time is right to concentrate on your multifocal contact lens services.
About 5 percent of my contact lens patients wear multifocal contact lenses, and I see one to two of these patients per week (I have a smaller practice that sees only 150 total patients per month). Approximately $25,000 of my annual revenues come from multifocal patients including lens sales and fitting fees.The greatest profit is in charging higher fitting fees for the extra time spent in educating, counseling and chair visits needed for multifocal contact lenses. So, even though it’s only a small percentage of my overall wearers, it is very profitable.
Educate Presbyopic Patients On All Options
I educate presbyopic patients on all their corrective options, including contact lenses, if I feel their Rx could be successful in both multifocal contact lenses as well as progressive eyeglasses. I always tell them, “It’s my job to let you know what your options are, even if you’ve never thought about contact lenses.” This approach tends to spark new fits.
Develop Multifocal Fitting Protocol
Generally, my patients are introduced to multifocals during their comprehensive exam and fitted immediately. I may make one adjustment right away to the lens powers based on initial vision and feedback by the patient. I also have patients look at their phones and I take them out of the exam room to look outside at signs and other faraway images after I measure them on standardized charts. I find we can get a more realistic over-refraction, and I’m not afraid to change lens powers the very same day of the initial fitting.
Then, I have them back in a week. I don’t want to wait too long because if vision is not good, they will just give up. In my fitting policies and agreements (which the patient signs), we have two months to figure out and finalize their contact lens Rx. I’ve found by setting that deadline the few patients who dawdle on coming back in make it a priority. The last thing I want is someone who takes six months to fit because they wait two months between contact lens checks. This means a loss of revenue in potential sales because they will only want to buy a lens supply that will get them by until their next office visit. The protocol I follow for non-multifocal wearers is very similar. Usually, however, there are one to two more visits needed when fitting multifocal lenses.
Provide Trial Multifocal CLs
I provide patients with one pair if it’s a monthly lens, and, if it’s a daily replacement, I give them enough trials for 10 days. They are going to be back in for a check-in after one week, so they may be getting new trials at the next appointment anyway.
Put As Many As Possible In Daily Replacement
I am definitely working with and fitting as many daily-replacement multifocal contact lenses as I can. I prefer that modality for the convenience, health and compliance of my patients. If for some reason the fit and vision don’t work out, I am then moving into the SiHy one-month multifocal options, which right now are my number one prescribed option simply because there are more of them that can work for patients due to extended power parameters.I also fit RGP multifocal lenses when necessary.
Set Patient Expectations
I educate the patient quite a bit on what to expect so they aren’t disappointed. First, I let them know that the vision will not be the same as their eyeglasses. I explain the concept of simultaneous vision, in that there are multiple images being projected onto the retina and that the brain determines what it wants to “see.” This can result in some ghosting and glare and haloes for some patients. The other important factor to remember is that the best vision will be with both eyes together. If patients start comparing between the two eyes (one at a time), their vision will be reduced. I also tell them that each patient is different because of Rx and pupil size and daily vision activities; we don’t know exactly how they will do in multifocal contact lenses until we try. If all of these potential challenges are acceptable to a candidate, then we proceed.
I tell patients that their vision won’t be perfect, but my goal is to have them free from wearing over-the-counter reading eyeglasses at least 75 percent of the time. They may need to wear OTC readers if the print is tiny, they are in a dim restaurant or their eyes are tired. I also tell them the end point of the final vision is different for everyone: some people realize excellent vision both near and far, and some will have one area that is better than others. I will tailor their Rx to be ideal for what they desire, but that will be an ongoing dialog between the patient and I during the fitting process.
Lens Comfort Not the Issue–It’s Vision
I find that discomfort with these lenses is usually not the issue, it’s vision. I educate patients that we need to adjust the prescription most of the time to troubleshoot, and that will usually take care of the problem. If they do complain of comfort issues, I have to determine if it’s really comfort or if it’s that their vision is bothering them, leading to lens awareness because they are thinking about their contacts all the time. I have certain lens care solutions I prescribe if they are in monthly replacement lenses to help the cleaning and wear and care.
Patients Motivated to Find a Solution Will Pay More
I have noticed that with multifocal contact lenses cost isn’t as much of a concern as with single-vision lenses. Patients are so eager to find a solution to their near vision issues! We are very upfront in our fitting fees and the cost of theses lenses before the fitting takes place so there are no surprises. We let patients know that if they don’t like the multifocals, we can always transition them into monovision or into single-vision distance options, as well, and that is all covered under their professional fitting fee. We price our multifocal contact lenses 15 percent to 25 percent higher than traditional soft or SiHy lenses.
My professional fitting fee for multifocals is about three times higher than single-vision contact lenses given the necessary added time, education and rechecks.
Have Staff Support You in Serving Multifocal Patients
In my office, my lead technician is NCLE-certified. So, she has the training as well as my specific training protocol on how to handle multifocal fits. Chiefly, I’m the one who fits the patient, does the education, etc., and she can sometimes handle the follow-up checks. We are getting to the point, however, where she has been able to handle fitting patients in very straightforward cases (low myope, no astigmatism). This has helped greatly in our patient flow. I don’t see patients every day, but she is generally here every day, so her ability to fit some multifocal patients opens up more opportunities for patients to have their fit adjusted or finalized if needed.
Educate Multifocal CL Wearers About Progressive Eyeglasses
Presbyopic patients who wear multifocal contact lenses are already in PALs and the other half want to try multifocals first to see if they can delay going into PALs. I educate patients that a progressive pair of spectacles is only going to add to their vision options, and that I recommend them for all my multifocal wearers. Patients who want to try multifocal contact lenses and wait and see usually end up getting progressive eyeglasses at some point. About six out of 10 patients I fit in multifocal contact lenses end up choosing progressive eyeglasses as a vision option, whether it’s for part-time or full-time use. We also offer additional discounts with the professional fitting fees for our multifocal contact lens patients to purchase a pair of PALs, which encourages many to purchase.
Satisfied Multifocal Patients Stay In Contacts
I estimate that once fit, my multifocal patients are staying with that lens modality for three to four years on average. My practice is only four years old, so I don’t have any long-term data. I would estimate that 25 percent go from full-time multifocal wear to part-time over the course of two to three years. As their add power increases, they sometimes find wearing eyeglasses is better for certain activities (computer work, detailed near activities) and the multifocal contact lenses better for others (like leisure, recreation, social). As doctor, I can solve their problems, transition the presbyope into a satisfied patient and purchaser of both progressive eyewear and multifocal contact lenses.
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Gina M. Wesley, OD, MS, FAAO, is the owner of Complete Eye Care of Medina in Medina, Minn. To contact her: drwesley@cecofmedina.com.
