CONTACT LENS FOR

PRESBYOPES
OPTOM FASLU MUHAMMED
PRESBYOPIA

 A large % of population needs correction for

Presbyopia
 100 million presbyopes in india & 10 million

adding every year

 It’s a part of normal ageing process,where the
eye loses its ability to easily focus on near objects

 So, need near correction.

CORRECTING OPTIONS
 Single Vision Reading Glasses,Bifocals,Trifocals
OR Multifocal With Contact Lenses On The Eye
There Are 2 Options to Correct Near Vision With
Spectacle Over Contact lens
 OPTION 1: Fit CL For Distance; Don’t
Overcorrect
* Determine Near Addition Over CL On Trial Frame
*Prescribe Reading Glass Over CL
 OPTION 2 : Ideal For Pt’s Who Do
Near/Intermediate Work All Day
*Give near add on CL
*Give Minus Power For Distance In The Form Of
Spectacles For Driving And Other Distance Task
PATIENT SELECTION
 Highly motivated
 Those who have adequate tear film & no lid

disease/ abnormality
 Whose jobs don’t require fine v a
 Affordability
CL PRESBYOPIA CORRECTION
 MONOVISION CORRECTION

 ALTERNATING/TRANSLATING VISION LENSES

 SIMULTANEOUS VISION LENSES

Eye Dominance Test
 Equipment required:  your arms and hands, and an
object about 10 feet (3 meters) away

 Procedure:  Extend both arms in front of your body and place

the hands together so as to make a small triangle between your
thumbs and the first knuckle (see image). With both of your eyes
open, look through the triangle and focus on a specific small
object. Close your left eye. If the object remains in view, you are
right eye dominant. If your hands appear to move off the object
and move to the left, then you are left eye dominant.
MONOVISION
 ONE EYE IS CORRECTED FOR DISTANCE
VISION OTHER EYE FOR NEAR VISION
 IT’S THE EASIEST & AN EFFECTIVE MEANS

OF CORRECTING PRESBYOPIA
 SUCCESS RATE IS AS HIGH AS 70%
PRINCIPLE
 The visual system can suppress the central focus
image thus enable the object of interest to be
seen clearly .
FITTING PROCEDURE
 Determine the distance & near corescription
 Determine the dominant and non-dominant eye
 Fit The Dominant With The Distance POWER

Prescrptn And Non Dominant Eye For Near Power

Prescrptn
 EG:-4.00 DSPH (OU)
ADD +1.50 DSPH (OU)
Dominant Eye With -4.00 DSPH(DISTANCE) & Non
Dominant With -2.50 DSPH (NEAR )
 Use disposable lens and give an office trial.
Record BVA for distance and near
 Don’t attempt uniocular VA now
 The eye with near power’ll read less for distance

and eye with distance power’ll read less for near

 Explain fitting technique now
 Some pt’s may need sum adaptatn time & may be

dissatisfied with reduction of stereopsis

 Follow up,and fit the final lens
TIPS-MONOCULAR VN FITTING
 Adaptation time-atleast 2 wks
 Advise-continue normal activities if possible
 No night driving
 Don’t compare eyes
 Set pt’s expectations
 Educate visual improvement overtime
BIFOCAL/MULTIFOCAL CL
 Translating Vision types
Like executive type bifocal spectacle lens
Pt when look down gaze lower lid lifts the near
segments up, towards the pupil /the visual axis thus
the pt see clear for near
 Popular in RGP
 Near and far can’t be seen clearly same time
ADVANTAGES
 Sharp near/far vision
 When it works well,it’s very successful
 Works Better In Rgp & Less Successful/Common

In Scl
DISADVANTAGES
 Takes longer in adaptation
 Comfort is less due to thick design
 Dependence on eye -lens relationship
SIMULTANEOUS VN
 Distance & near images focused on retina
simultaneously
 Brain’ll be select/concentrate on one /other will be

ignored
 Like looking via net across the window @ distance

object
ADVNTGES
 Sharp near and far vision

DISADVNTGES
 Compromised intermediate vision
 Ghosting(doubling) is sometimes a

problem
3 TYPES
1.CONCENTRIC DESIGN
Concentric segment show sharp demarcation b/w
distance and near powers

2 TYPES

Center near
Center distance
2.Diffractive bifocal
Made up of concentric rings, Something like a
fresnel prism
Higher the addition more no; of rings
3.Aspheric Designs
Prog.Addition type of lens formed with alteration in
ant. & Post. Curvature of lens
Power is uniformly increase/decreases in
periphery due to asphericity
MODIFIED MONO VISION
 One eye is fitted with distance correction and
other eye is bifocal lens
 Improves binocularity & stereo acuity which may

be reduced in mono Vn
 Tried in pt’s who are sensitive to distance vn
UNSUCCESSFUL CL FITTING
-PRESBYOPES
 High myopes
 Pts with busy schedules
 Dry eyes
 Flat corneas
 Laxity of lower lid
 High astigmatism
 External ocular disease / abnormality
THANK YOUUUU