Interest in multifocal contact lenses often coincides with a patient's lifestyle changes in addition to their prescription changes when, if you'll pardon the pun, they need that addition to see at near. Though they often begin wearing bifocal contact lenses in their early 50s, other first timers may be in their late 60s or 70s.

Like the teen-age contact lens wearer, these patients want to look good as well as have the visual freedom and expanded peripheral vision. So, how can you tap into this fast-growing market? We asked several practitioners to share some tips and talk about the prime candidates for multifocal contacts.

1. Current contact wearer

"The myopes who are and have been wearing contact lenses really want to wear bifocal contact lenses," says Paula Newsome, O.D. of Charlotte, N.C. She finds this occurs most often with her baby boomer patients who do not want to give up their contact lenses or wear reading glasses.

In Bethesda, Md., Marsha Kotlickly, O.D. finds that as her existing myopic contact lens wearers become presbyopic, they opt for bifocal contact lenses as well. "It's a natural transition when they have difficulty seeing clearly at near," says Kotlickly.

Bill Yoe, O.D., who practices in Columbus, Ga., agrees. Yoe, whose father is both an O.D. and M.D., has found in his 16 years of clinical care that the "current contact lens wearer is very motivated when I suggest bifocal contact lenses." This is often after the staff has prepped the patient and planted the seed by saying, "Dr. Yoe will evaluate you and talk with you about bifocal contact lenses."

2. Monovision wearer

"Patients in their early 50s, who have been wearing monovision contact lenses for 10 years, reach a point where they outgrow prescription options," says Kotlicky, who seldom prescribes monovision contacts. "I tell them they have been seeing only half their world and explain that the lack of depth perception interferes with night driving and their functioning." She further explains that monovision "reduces your visual attention and information processing." Adds Yoe, "I choose a modified monovision for many of my early presbyopes, but advise them that their biggest problems will be in driving and near work."

3. Wearer of contact lenses for distance and reading glasses for near

My own most memorable patient, from my 10 years as a Washington, D.C. practitioner, was a patient in his late 40s who was constantly complaining about the cost and inconvenience of having his suit jackets tailored with an extra pocket just for his half eyes. After I successfully fit this patient with bifocal contact lenses, tweaking one lens for optimal binocular vision clarity, he also ordered a spare set of bifocal contacts.

4. Contact lens dropouts

"When women have babies, they sometimes lack the time to wear contact lenses or have discomfort from them," notes Susie Kim, O.D., of Akron, Ohio.

Since some women now are giving birth later in life-just as their biological clocks are running out-multifocal contact lenses can provide an option when these early presbyopes return to contact lens wear.

Newsome adds, "Multifocal contact lenses can provide an opportunity to get those drop-out patients back into contact lenses when they return for an exam."

Ed Bennett, O.D., an assistant professor at the optometry school at the University of Missouri-St. Louis, says a phrase commonly heard in optometric offices is: "My last doc said bifocal contact lenses don't work and was very negative." He adds that other patients drop out because of "the loss of depth perception while wearing a monovision prescription."

5. Previous wearer, now post-LASIK presbyope or monovision aphake

"Many patients assume they will not wear contact lenses after a LASIK procedure," says Kotlicky. "What they don't realize is that there may be an atypical topography post-surgically which may also provide an extra challenge for a previous contact lens wearer who is now presbyopic. This may even be a plano or low minus distance prescription with an add in bifocal contact lenses."

In March, 2000, when Carl Kupfer, the then Ophthalmologist Director of the National Eye Institute, was requesting $462.8-million for his NIH Institute's budget on Capitol Hill, Congressman Porter from Illinois asked Kupfer if refractive surgery eliminates the need for reading glasses when patients are over 40. His emphatic response was, "No."

With the proliferation of refractive surgery ads in the area, metropolitan Washington behavioral optometrists are equally concerned about how to provide binocular vision both at distance and near for their post-refractive patients-as well as for many of their post-cataract surgical patients who are now in monovision.

Multifocal contact lenses may provide a viable option for these patients.

6. First-time wearer

"I just can't read, but, I see well in the distance," is often heard in Yoe's Georgia practice. His response? "I tell the patient that we can first try a monovision fit with one contact lens for reading and, after that we can try bifocal contact lenses." He also advises the patients that "sometimes it takes time to get used to the bifocals, and it is often necessary to make some modifications which require additional lab time because it is a more complicated prescription."

Kim says she is now seeing more first time wearers in her Ohio practice. She advises them that "with bifocal contact lenses, there may be a little compromise in the distance, but the reading will be good."

As for Bennett, "I ease them into the initial sensation by explaining it is normal to have some awareness for a while. If the patient has never worn any type of correction before, I do not hesitate to offer bifocal contact lenses as an option," he adds.

7. Non-wearer who has seen contacts advertised

As executive director of the RGP Lens Institute, Bennett credits advertising of the Acuvue brand of bifocal contact lenses with "bringing many patients into our offices." As with any soft material, some patients find that vision "is the limiting factor," he says.

Kim adds, "I prescribe mostly the Acuvue brand of bifocal contact lens with RGPs as my second choice."

Kotlicky says, "Patients want a choice, and I prescribe several types of RGP and soft bifocal contact lenses." As for Yoe and Newsome, they use both materials.

No matter what options doctors choose to offer their presbyopic patients, all agree that the number of people looking at multifocal contacts as an option is on the rise. It's a growing opportunity that these practitioners also say is a welcome one. EB