Fitting Patients for Success With Multifocal Lenses

I am the owner and founder of Eyediology Vision in Providence, Rhode Island, which I opened cold 2 years ago. My staff and I offer full-scope optometric services, including an optical, with a special focus on cornea and contact lens management. Educating patients about the latest optometric technologies and treatment options is part of my mission, and I believe it’s worthwhile for every practitioner to incorporate patient education about multifocal contact lenses, as our profession is still underutilizing them. Last year, the Contact Lens Institute published the results of an online survey of more than 1,000 adults aged 18 to 64 who use vision correction, and 47.8% of those who wore glasses reported having a strong interest in contact lenses.¹

Between 60% and 70% of all my patients are contact lens wearers, and I’ve seen a steady increase in the number of my patients who opt for multifocal lenses, including both dailies and monthlies, from less than 5% to currently 15% of our total lens volume over the past 2 years. I attribute this growth in multifocal contacts to word-of-mouth referrals from our existing patients, many of whom I know share their positive experiences with these lenses with their friends and family members. I’ve had many patients express a desire to try contacts for their grandchildren’s wedding, or to have an easier time reading the menu while out to dinner with friends. It’s always a joy to see patients’ excitement when I can provide a solution to their visual challenges. Furthermore, I like to plant early seeds about presbyopia and multifocal lens solutions with young, emergent presbyopes in their mid-30s so that they anticipate changes to their vision over time and know that I have solutions ready for them when it happens.

Begin By Identifying Needs

I believe that the value multifocal contact lenses provides patients is the comfort, convenience, and clarity of vision they offer for a wide range of activities. Thus, my path to success with these lenses has been to get to know my patients’ daily visual needs, as rudimentary as that may sound. I ask them what they do for work, whether they like to be active, what hobbies they enjoy, how much time they spend on screens each day, how much they drive, etc. For presbyopes, I’ll also ask what kind of symptoms they experience throughout the day, such as visual fluctuations or dryness. This is not to say that I spend any extra chair time with presbyopes; I have this same conversation with all my patients about their vision correction options, starting with glasses and contacts and progressing to surgery, if indicated. It’s my habit to review every option with my patients.

New Technology Means Faster, More Accurate Fits

The exciting technological advances that contact lenses, and multifocals in particular, have undergone in recent years includes their ease of fitting. Thanks to revamped fitting guides and in-office techniques, the process of fitting multifocal contact lenses is faster and more accurate now than it used to be. Since I’ve adopted advanced-technology lenses, my first-time fitting rate has improved, and this accuracy saves me chair time that I can otherwise spend answering my patients’ questions and making sure they’re satisfied with their vision correction.

Fitting Patients for Success

I use the fitting guides for each multifocal contact lens I prescribe (by now, I have them memorized; I don’t pull them out each time). Our industry partners have done such thorough research to optimize the fits for multifocal lenses that I find the guides to be effective and very straightforward to follow.

I perform most of the contact lens fittings, and my technician trains patients on how to insert and remove multifocal contacts properly (see the sidebar, Dr. Bhagat’s Patient Instructions for Contact Lens Insertion and Removal). This training is important, as is setting patients’ expectations about the visual effects after insertion. In our experience, there are two important points to convey to patients to help them succeed with these lenses. First, most multifocal contact lenses should settle on the eyes for a few moments before the patient’s visual acuities are evaluated. Second, multifocal lenses in particular work best with bilateral use and with both eyes open. Again, we tell patients that the clearest vision comes after both lenses have settled for a few minutes.

When it comes to choosing between dailies versus monthlies, like most of my colleagues, I suggest dailies first. I describe their convenience, comfort, and low infection rates. Yet, almost 60% of all optometric patients wear planned replacement lenses,² and if I didn’t offer that option, then I would miss the chance to address those patients’ needs. I like to present both options to patients and review the pros and cons of each one.

To help patients experience the visual freedom of multifocal contacts, I frequently offer them a selection of trial lenses to take home and test in their daily environments. I believe that, not only do the lenses sell themselves, but as a small, independent provider competing against online retailers, the immediacy of giving my patients a tangible, take-home trial lens is a win for me and creates a level of loyalty.

Approaching Challenging Fits

In every practice, there are always patients who have complex visual needs that require extra attention, such as dry eye disease (DED), small pupil size, and reduced eyelid tonicity. Screening patients to identity these issues is important to finding the most appropriate lens to match their needs. However, these conditions don’t necessarily negate success with multifocal lens wear. I tell these patients the lenses are still worth trying, but these particular issues may be hurdles to a successful fit.

Of course, there is the occasional patient who discontinues using a multifocal contact lens, although it’s getting more rare thanks to the greater comfort and performance of recent lenses. In the past 2 years, I’ve only had one patient drop out of a multifocal contact lens. Fortunately, we have other options for these individuals. I believe encouragement and honesty go a long way toward helping people understand the treatment path I’ve planned for them.

Multifocal Fittings Can be Simple

The biggest piece of advice I would like to give my fellow practitioners is to not overcomplicate the lens fitting process. With the simplicity and effectiveness of the updated fitting guides, I think those who have not already adopted new-technology contact lenses will be surprised at how little chair time the process takes, even for busy, high-volume practices. Offering these lenses will not disrupt clinical flow and does not require hours invested in studying the fit guides and learning lens calculations. I find that offering multifocal contacts is not only simple, but a great way to grow the practice, especially due to the demand from presbyopes.

1. Delaney-Gesing A. New data reveals practice behaviors for retaining new and long-term CL wearers. Eyes On Glance. September 19, 2024. Accessed March 17, 2025. https://glance.eyesoneyecare.com/stories/2024-09-19/new-data-reveals-practice-behaviors-for-retaining-new-and-long-term-cl-wearers/?utm_medium=eoe:infinite-scroll.

2. Contact lenses market size, share & industry analysis, by modality (reusable and disposable), by design (toric, multifocal, and spherical), by material (soft, gas permeable {orthokeratology and scleral}, and others), by distribution channel (ophthalmologists, retail stores, and online stores), and regional forecast, 2024-2032. Fortune Business Insights. Accessed January 23, 2025. https://www.fortunebusinessinsights.com/industry-reports/contact-lenses-market-101775.