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Bifocal contact lens options continually broadened with disposable modality

Issue: September 2001

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Many of today’s presbyopes have grown up with contact lenses and do not want to be encumbered with spectacles in middle age. In response to this baby boomer demand, there has been a subsequent “boom” in the development of bifocal contact lenses.

“In general, patients want sight without glasses if they can have it, or less dependence on glasses,” said Walter Choate, OD, who practices in Madison, Tenn. “The market clearly indicates that patients want bifocal lenses to work.”

Disposable bifocal contact lenses combine correction and convenience for presbyopic patients who wish to avoid glasses. This growing market now includes a recently launched daily disposable, the CIBA Vision Focus Dailies Progressives lens. Also in the pipeline are new disposable bifocal products from CooperVision and Specialty UltraVision.

The latest in disposable bifocals

On June 29, CIBA Vision introduced its Focus Dailies Progressives, the world’s first daily disposable contact lenses for presbyopic correction. The lenses are available in +5.00 D to –6.00 D in 0.25-D steps. They also feature an 8.6-mm base curve and a 13.8-mm diameter. Like CIBA’s Focus Progressives 1-2-week lens, this lens features a multi-addition progressive power profile with a smooth, continous increase in power.

“It’s a very good lens,” said Powers Griffin, OD, a practitioner based in San Clemente, Calif. “I’ve done as well with it as I have with CIBA’s 2-week progressive lens, which I’ve been using for about a year and a half. This is the same lens design, it just has a 1-day replacement schedule.”

Dr. Griffin said that although he has only been using Focus Dailies Progressives for about a month, he has enjoyed a high level of success with them, and so have his patients. “They like the convenience and the health of the daily disposable,” he said. “There doesn’t seem to be any difference in the vision compared with the 2-week progressive lens.”

Fitting Focus Dailies Progressives

Dr. Griffin said the first step in fitting a patient with Focus Dailies Progressives is determining whether he or she is a viable candidate for the lens. “The lens does not work well for some patients, such as someone with a lot of astigmatism,” he said.

Dr. Griffin said he rules out any ocular surface diseases or other health problems. “You have to make sure he or she is a good contact lens patient to begin with,” he said. “The eyes need to be healthy.”

Dr. Griffin said he usually begins with a binocular approach in fitting the lenses, but switches to a “modified monovision” fitting when necessary. “I usually attempt to do it equally on both eyes, but if patients just cannot read normal-sized print or if they cannot see adequately at a distance, then I’ll start to change the prescription,” he said. “Then, I’ll actually put more of a distance lens in the dominant eye and more of a reading lens in the non-dominant eye.”

It is important to help the patient adjust to this, Dr. Griffin said. “In that situation, we explain to the patient that his or her vision will be unequal,” Dr. Griffin said. “It’s not going to be the same from the right eye to the left eye.”

Less adjustment time

One notable advantage to the Focus Dailies Progressives Lens, Dr. Griffin said, is the fact that it seems to require less adjustment time than some other products.

“You can usually tell within 5 or 10 minutes of putting the lens in how successful it is going to be with the patient,” he said. “With some of the other lenses, it takes a little longer to settle in the eye, or for the eye to adapt to the bifocal. But this lens tends to adapt a little faster, so you can more quickly determine whether the lens is right for the patient.”

Just to be safe, however, Dr. Griffin recommends a trial period for the lenses.

“Sometimes, it takes two or three visits to nail down exactly what the final prescription will be,” he said. “It can look one way in my office, but different in a patient’s workplace, with different lighting, for example, or computers.”

When patients are satisfied with how the lenses look in his office, Dr. Griffin then puts the lenses to a “real world test.”

“I bring them back in a few days and see how it worked out,” he said, “and I tweak the prescription depending on how they did.”

New products in the works

Among the highly anticipated new products is Cooper Vision’s Frequency 55 Multifocal, which is due to be launched at the end of 2001.

“I’m very excited about this product,” said Lee Rigel, OD, of East Lansing, Mich. “I’ve used this type of design before with a certain amount of success, and with every new design, we will increase the number of successful patients fit with bifocal lenses.”

CooperVision Senior Marketing Manager Mike Covey, MOptom, FAAO, said the company is currently conducting a limited rollout of the product. “We’ve done some initial clinical trials on a significant number of patients,” he said. “We have every indication that this is a great product.”

Mr. Covey said the Frequency 55 Multifocal is a “system of lenses,” with one lens designed for the dominant eye and one for the non-dominant eye.

Mr. Covey said the “multi-zoned inverse geometry design” will allow the patient to achieve clear distance vision through the dominant lens and clear near vision through the non-dominant lens with significant improvements compared to monovision. “When you combine the two lenses, they are working together, and we end up getting a binocular system,” Mr. Covey said. “The acuity that we expect, based on the early trials, is 20/20 both distance and near in the majority of patients.”

The new multifocal product compares favorably to monovision, Mr. Covey said. “There is a greater degree of stereopsis and a better balancing of the eyes. The brain has to deal with the same degree of disparity it gets with monovision,” he said.

Specialty UltraVision also has plans to launch a new progressive, disposable lens in the near future. The company currently has a disposable bifocal lens on the market. “The product is still available,” said Specialty UltraVision spokesperson Debby MacDonald. “But Specialty UltraVision is redesigning a new, enhanced progressive multifocal lens product, which will be launched in the next 6 to 9 months.”

The Acuvue Bifocal

For some practitioners, the Acuvue Bifocal remains the lens of choice for presbyopic vision correction. These optometrists prefer the Acuvue lens’ multizone concentric design for both fit and acuity.

“Different designs work for different patients,” Dr. Choate said. “But if I had to choose one as a workhorse, I would put the Acuvue up there.”

Dr. Choate said he would choose the lens because of its multiple add powers. “It has several different add powers, so we can specify bifocal powers,” he said.

Dr. Choate typically fits these lenses by first determining the dominant eye, using an alternate +2 test. “We hold a +2 lens over each eye independently to determine which eye is the dominant eye. We tend to maximize the dominant eye for distance and the non-dominant eye for reading.”

This is distinctly different from monovision, Dr. Choate said. “It’s not monovision, because even if you maximize the reading vision in the non-dominant eye, typically you are not going to blur that eye any more than 20/30 or 20/40 at distance,” he said. “So you keep it at a range where the two eyes can typically be used together. And the patients enjoy more balanced binocular vision that way.”

Dr. Rigel said he has had a great deal of success with a similar method, which he calls a “modified bifocal approach.” “We maximally correct the dominant eye for distance and undercorrect the reading add just a little bit,” he said. “On the other eye, we would maximally correct for up close, undercorrecting the distance prescription a little bit. I’ve had the most success with this method of prescribing.”

LifeStyle’s MV-2 Bifocal

LifeStyle’s MV-2 Bifocal, a 30-day replacement lens, features a “cast-molded center-intermediate” design. The distance and near lenses work in unison to provide distance, intermediate and near vision for presbyopes with add requirements of up to +2.50 D.

Sandy Parlato, FNAO, a contact lens technician in Rochester, N.Y., has fitted more than 50 patients with the MV-2 Bifocal. “I have quite a few people wearing them, and they’re very happy with it,” Mr. Parlato said. “People who need reading glasses seem to like it.”

Mr. Parlato said he uses a modified monovision approach in fitting the MV-2 Bifocal. “The distance is in the dominant eye, and the intermediate is in the dominant eye,” he said. “In the other eye, you are getting the close work and the intermediate.”

Mr. Parlato emphasized the importance of “intermediate” vision. “The difference between this type of bifocal and a regular single-vision lens is that with a single-vision lens, the intermediate is usually missing,” he said. “With this lens, patients are getting the ‘computer distance,’ or intermediate distance, that they need.”

Mr. Parlato said if the lens is fitted properly, most patients adjust well to it. “It’s not for everybody – there are people who just can’t tolerate their vision not being clear in one eye for distance all the time,” he said. “But most people can, if it’s done properly. Their brain usually takes over.”

The “personality profile”

Is there an ideal disposable bifocal contact lens patient? According to some practitioners, successful candidates definitely share some common traits.

“I would say present contact lens wearers are perhaps better candidates,” Dr. Rigel said. “Early presbyopes and presbyopes who have more than 1 D of either hyperopia or myopia are good candidates, as are some monovision failures.”

Dr. Choate said bifocal lens patients generally seek convenience and comfort. “A good candidate is a patient who hates glasses, has light to moderate near-demand and is physically active. Really, the baby-boom generation is the perfect group to target for this product,” he said.

The single most important quality in a bifocal contact lens candidate, Dr. Rigel said, is motivation. “Whatever category of vision correction they fit into, they have to be motivated,” he said.

Having realistic expectations at the outset also helps, he added. “If a patient expects to see perfectly, the way he or she did at age 20, that patient might not be satisfied with disposable bifocals,” he said. “But if the patient is easily adaptable and is not terribly visually critical, he or she is certainly a better candidate.”

A “toolbox of products”

With the growing number of disposable bifocal contact lenses available, most practitioners have found a brand they prefer. However, optometrists should not make the mistake of limiting their armamentarium.

“Every soft contact lens, multifocal or bifocal design, works on some people,” Dr. Choate said. “The challenge for us is to put together a toolbox of products that allows us to fit a variety of different eye shapes, corneal sizes, prescriptions — the whole nine yards.”

There is no single perfect lens for every eye, Dr. Choate said. “Everybody wants to have just one lens that works,” he said. “But there isn’t one lens that works for everybody. You’ve got to have your hands on all of them.”

For Your Information:

• Walter Choate, OD, practices in Madison, Tenn., and is a member of the Editorial Board of Primary Care Optometry News. He can be reached at 607 Due West Medical Bldg., Ste. 111, Madison, TN 37115; (615) 868-4262; fax: (615) 860-2016.
• Powers Griffin, OD, practices in San Clemente, Calif. He can be reached at 140 Avenida Del Mar, San Clemente, CA 92672-4016; (949) 492-1853; fax: (949) 495-9238.
• Lee Rigel, OD, practices in East Lansing, Mich. He can be reached at 310 W. Lake Lansing Road, East Lansing, MI 48823-1363; (517) 337-8182; fax: (517) 332-0038.
• Mike Covey, MOptom, FAAO, is senior marketing manager for CooperVision. He can be reached at 200 Willowbrook Office Park, Fairport, NY 14450; (716) 264-3274; fax: (716) 264-3279.
• Debby MacDonald can be reached at Specialty UltraVision, 307 Orchard City Drive, Campbell, Calif., 95008; (408) 341-0700; fax: (408) 341-0717.
• Sandy Parlato, FNAO, is a technician at Parlato Eye Associates in Rochester, N.Y. He can be reached at 1225 Ridge Road West, Rochester, NY, 14615; (716) 663-4320.
• Drs. Choate, Griffin, Rigel and Mr. Parlato have no direct financial interest in the products mentioned in this article, nor are they paid consultants for any companies mentioned.
• Focus Dailies Progressives are available from CIBA Vision (a Novartis company), 11460 Johns Creek Pkwy., Duluth, GA., 30097-1556; (800) 241-5999; fax: (800) 845-8842; Web site: www.cibavision.com.
• Frequency 55 Multifocals will be available from CooperVision Inc., 200 WillowBrook Office Park, Fairport, NY, 14450; (800) 341-2020; fax: (888) 385-3274; Web site: www.coopervision.com.
• Specialty UltraVision can be reached at 307 Orchard City Drive, Campbell, CA 95008; (408) 341-0700; fax: (408) 341-0717; Web site: www.ultravision.com.
• Acuvue Bifocals are available from the Vistakon Division of Johnson & Johnson Vision Care Inc., 7596 Centurion Parkway, Jacksonville, FL, 32256; (904) 443-1726; fax: (904) 443-1043; Web site: www.acuvue.com.
• MV-2 Bifocals are available from LifeStyle Company, 712 Ginesi Dr., Morganville, NJ, 07751; (732) 972-8585; fax: (732) 972-9205; Web site: www.lifestylecompany.com.