1-DAY ACUVUE® MOIST MULTIFOCAL FITTING GUIDE
Step 1 - Distance Rx
- Start with new subjective refraction & push maximum plus for distance.
- Select patients with <1.00DC astigmatism
- Based on the distance RX (SPH/CYL), determine the corresponding spherical equivalent power by referring to the "Spherical equivalent values" table.
Step 2 - Dominant eye
- Viewing test chart binocularly un-occluded, place +1.00D alternately in front of each eye
- Dominant eye is where 'least comfortable' or 'most blurred' vision is reported
Step 3 - Reading add selection
- Determine the minimum required to give the patient a satisfactory near vision.
- Based on the magnitude of reading add, refer to one of the relevant LOW, MID or HIGH Add "Vertex distance & Lens fit selection "table, to determine initial trial lenses for both dominant & non-dominant eyes.
Step 4 - Settling Time
- Allow 10 minutes to settle
- Assess vision using real-world examples (view across the road, mobile phone)
- Patient to assess their far and near vision
- If acceptable, begin the trail
- If unacceptable, refer to the table to enhance distance or near vision
- Avoid making multiple changes on the initial visit if at all possible.
Step 6 - Adjustments: Distance Optimization
> Move to LOWER ADD in DOMINANT EYE
Step 7 - Adjustments: Near Optimization
> Add +0.25D to NON-DOMINANT eye
FITTING MOIST MULTIFOCAL CONTACT LENSES
Perform subjective refraction. Always start with a new refraction.
Determine the dominant eye using +1.00 blur test (sensory method)
- Assessing Sensory Ocular Dominance: Place a +1.00D trial lens in front of each eye alternately under binocular conditions. The eye with the lens in front when the patient reports greater visual blur is the dominant eye.
Calculated spherical equivalent. Ensure that patient's astigmatism is less than -1.00D.
Perform modified humphriss binocular balancing on the calculated spherical equivalent.
Modified humphriss binocular balance method:
- Fog the left eye with either +0.75DS or +1.00DS
- Perform best vision sphere assessment with +0.25D step for the right eye.
- Remove the fog lens from the left eye and fog the right eye.
- Repeat the best vision sphere assessment technique for the left eye.
Determine max plus spherical equivalent. Place +0.25D in front of both eyes to ensure max plus are obtained.
- In multifocal contact lens fitting, the spherical equivalent should be the "most plus" spherical. 0.25D can make a significant difference in the success of multifocal contact lenses!
Determine the minimum ADD based upon the patient's needs. Start with +0.50D lower than the initial ADD obtained from subjective refraction.
- Spectacles ADD ≠ Contact lens ADD
Select first Moist Multifocal trial lenses from fit guide. Apply vertex distance correction if greater than or equal to ±4.00D.
Allow ten minutes settling time.
- This would be a valuable time for practitioners to connect with patients - build rapport, patient education, manage expectation and settle spectacle purchase.
"Real world vision assessment"
- Focus on patient's lifestyle and daily tasks. Assess near vision with mobile phone etc.
Dispense lenses if px is happy with lenses otherwise perform vision enhancement - select second trial lenses from enhancement guide, if necessary.
Troubleshooting, if necessary.