1-Day Acuvue Moist Multifocal: Pearls and Patient Experiences

AdminWolf

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1-Day Acuvue Moist Multifocal: Pearls & Patient Experiences
An Interactive Discussion

with

Melissa Barnett, OD, FAAO
UC Davis Eye Center
Sacramento, CA

Mark Wells, OD, DABO
Cheyenne Vision Clinic
Cheyenne, WY

Kurt Moody, OD, FAAO, FBCLA
Global Platform Director, R&D
Johnson & Johnson Vision Care Inc.
 
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AdminWolf

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btw, i'm highly biased when it comes to 1DMMF as it has become my habitual lens, ever since it hit the market earlier in the year. What a drag it is getting old! :)
 

AdminWolf

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BTW, the big thread about this lens -- including member experience lives right here, if you missed it. See you all on Tuesday (including you, Paul, the resident multifocal skeptic.... :))
 

Paul Farkas

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BTW, the big thread about this lens -- including member experience lives right here, if you missed it. See you all on Tuesday (including you, Paul, the resident multifocal skeptic.... :))


Ad...your mother was the first that I knew if to wear mono vision over 35 years ago.

She is now a happy monovision wearer with lens implants after surgery.

The interesting discussion how many patients were moved out of mono vision now that there are multi focals that work? With a discussion Tuesday evening.
 

Mike Alvarez

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Ad...your mother was the first that I knew if to wear mono vision over 35 years ago.

She is now a happy monovision wearer with lens implants after surgery.

The interesting discussion how many patients were moved out of mono vision now that there are multi focals that work? With a discussion Tuesday evening.
It's tough to move a happy monovision patient to bifocal contacts. I have a very high failure rate doing that. However, I'll often switch a monovision patient to modified monovision with a low or medium add in each eye on top of the usual monovision correction.
 

AdminWolf

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Ad...your mother was the first that I knew if to wear mono vision over 35 years ago.

She is now a happy monovision wearer with lens implants after surgery.

The interesting discussion how many patients were moved out of mono vision now that there are multi focals that work? With a discussion Tuesday evening.

It should be an interesting talk. I realize you're our resident MF skeptic dad, based on your experience.

However tech does move on; and there is a universe of people out there like me -- emerging presbyopes who never tried monovision and just want to keep wearing our 1-days as we always have. I am very curious to hear how people are doing with this population.
 

Paul Farkas

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It should be an interesting talk. I realize you're our resident MF skeptic dad, based on your experience.

However tech does move on; and there is a universe of people out there like me -- emerging presbyopes who never tried monovision and just want to keep wearing our 1-days as we always have. I am very curious to hear how people are doing with this population.

The skeptic will attend as part of the audience with an open mind. I have not touched a patient in over 20 years. There should have been some improvements since I left practice. Practitioners who I respect say the multifocal contact lenses work provided you have the proper patient, superior product and skill.

My skepticism is a result of 30 years prior to leaving clinical practice. Contact lens bifocals began early with PMMA and RGP lenses. Even if these contact lenses worked, they were so thick that even the hardiest patients rejected them because of the discomfort.

After that there were various multifocal hydrogel designs. Each were tried unsuccessfully and mono vision was the fallback that worked.

Adam you are living proof that the new multifocal works and ready for prime time. So I'm prepared to listen.

I urge as many of our members to attend this Webinar live so you can pose questions in real time to the presenters. Of course, those who can't make it can take advantage of the "On Demand " feature in this Webinar section of ODwire.org..

See you at the Webinar.
 

AdminWolf

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Adam you are living proof that the new multifocal works and ready for prime time. So I'm prepared to listen.

Indeed. I just finished orienting the speakers for tomorrow's show, there are going to be 3 of them plus me, it is not going to be a powerpoint-a-palooza, but much more of an interactive session with real tips, and they expect people to type some real questions. (Dr. Moody helped design the lens, so if he can't answer your question, no one can.)

One other interesting thing is that Vistakon did a survey of their clinicians to see how the lens is being accepted in the marketplace, issues, etc -- they are going to share the data tomorrow night, it is hot off the presses (so new it wasn't even in the powerpoint rehearsal deck today!)

Hope to see everyone there... these are the kinds of shows I love doing -- unpredictable. Register here.
 

Jeff Eger

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It's tough to move a happy monovision patient to bifocal contacts. I have a very high failure rate doing that. However, I'll often switch a monovision patient to modified monovision with a low or medium add in each eye on top of the usual monovision correction.


I am with Dr. Paul on this one,but I am willing to listen. Multifocal soft contacts work if you can glue them to the cornea.:)
 

Dan Haas

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I think this is an excellent lens, and I see great with it and my patients have liked it.

Regarding fitting it on monovision patients, I think there are real advantages, the main one being how great midrange vision is which is what I despise about wearing monovision, and night driving is much better.

To make it easy, I rarely use the low power so you now you only have 2 adds. The fitting guide and my experience is to use a mid and high on a mature presbyope, cheating the dominate eye for distance and midrange with the mid add and the non dominate eye for midrange and near with the high add. Done this way, I barely notice the distance blur on the high add lens and love the beautiful midrange. If you need better near, overplus the one eye a quarter or half, and make sure you tell us to hose the menu with our phone flashlight in the dark restaurant!

This, along with several other use'mtodayandthrowthemaway multifocals are terrific lenses that are what I've always wanted: easy to fit, great working, comfortable and safe lenses for presbyopia. If your not fitting a bunch of them you're missing a great opportunity.
 

Greg Luce

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Good stuff Dan,
I have been fitting the lens and find it better than some, about the same as some and sometimes not as good as some.
I know because a new multifocal wearer will get at least two designs fit. So far very close optics to air optic Aqua.

I am very interested in your description of "great" vision. Is this relative to older multifocal, monovision, spectacles or OTC readers...?

I have never experienced or had a patient have great night driving vision in any multifocal design combination, so I am always surprised when I hear about such visual outcomes.
 

AdminWolf

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I am with Dr. Paul on this one,but I am willing to listen. Multifocal soft contacts work if you can glue them to the cornea.:)

Man, what am I going to do with you guys?
Paul stares at me from across the desk, not believing his own eyes! :)
 

Scott Blahnik

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and the non dominate eye for midrange and near with the high add.
Dan-
This is not exactly the way it's presented in the guidelines but sounds much like the way Biofinity Multifocals are fit using the "D" and "N" lens. This may be the way to go in a monovision conversion, I may give it a go.
Thanks for the tip!
 

Dan Haas

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Dan-
This is not exactly the way it's presented in the guidelines but sounds much like the way Biofinity Multifocals are fit using the "D" and "N" lens. This may be the way to go in a monovision conversion, I may give it a go.
Thanks for the tip!
I'm not smart enough to fit cooper lenses, with the d and the n each coming in 4 add powers, how do I ever get it right with 8 to choose from? I also don't see well with them and have never liked them personally. The near center designs are really cool technology, increase the light and get great near vision helped by the pupil constriction, and the pupil dilation driving at night gives excellent night vision.

Think of it this way, you need $2.50 to read if you're and absolute presbyopia. With the av lens, the low is worth 75 cents in the dark, a buck with the lights on and $1.25 in the sun, the mid gets you a 50 cents more and the high $1.00 more. If you need $2.75, better over plus the non-dominate 50 cents.

The modified monovision approach isn't needed in lower adds but it's the only way to satisfy a mature presbyope, and we want these lenses, and we can afford them, and well pay your fee if you present them to us.

What's beautiful about these lenses is the midrange, I didn't know how much old farts missed this when I was younger and you don't either until it's all gone. I tell patients I see BETTER with my pal but I see YOUNGER with these great new contacts, and don'tcha wanna be young again??

I also tell them they don't work as well as 25 did, but at our age isn't it great to be 42 again? I also tell them it isn't a failure in bifocal contacts if you need a +1.0 otc reader to see something silly small designed by some smart ass myope kid.
 

AdminWolf

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I fit RGP multifocals and get better dist seeing than current soft multifocals,to date. Maybe this will work? Your dad's no dummy.:)
well i hope to see you at the show tonight, provocative questions are allowed!
 

AdminWolf

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How do I get connected .? It is 535 PM az time

show doesn't start for another hour (9 ET / 6 PT), you should have instructions in your e-mail box from when you registered, or just click here 15 minutes prior to start.

-- ad
 

AdminWolf

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Thanks everyone for coming out tonight, this presentation was great -- not slide-heavy, very informative.
 

Paul Farkas

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Dan Haas

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Good stuff Dan,
I have been fitting the lens and find it better than some, about the same as some and sometimes not as good as some.
I know because a new multifocal wearer will get at least two designs fit. So far very close optics to air optic Aqua.

I am very interested in your description of "great" vision. Is this relative to older multifocal, monovision, spectacles or OTC readers...?

I have never experienced or had a patient have great night driving vision in any multifocal design combination, so I am always surprised when I hear about such visual outcomes.
Greg:
I'm 56, distance refraction +0.75ds ou, and I put a +.75 mid on dominate os and and a +1.25 high on od.

Uncorrected, near is gone, I can't see the dashboard on Hans (my wonderful bmw 328 drop top) and distance is now blurred enough that night driving is challenging. With the above contacts, near is fine, the dash is beautiful, and distance is better than nothing and much better than wearing a single +2.25 on my od like I used to.

I drove home from Columbia last week in the rain, and did just fine, I really don't notice halos around lights and barely notice the slight blur on my right eye being slightly over plussed. My night driving vision is slightly better with a pal, but I'm willing to make the slight sacrifice in distance vision to wear contacts and I love the fact that the contacts work in any direction of gaze (young) while my pal forces me to read in down gaze (like an old fart).

I've always had terrific vision, and needed nothing until about age 43 so I'm very critical, I started using just a sv daily disp on my non dominate eye when I did my photography, but now I wear bifocal contacts on both eyes when I play. I usually work with a pal and play with the contacts. I can also see fine with biotrue one day multifocal, dailiesacplus multifocal, and several of the monthly bifocals. I rotate among all the manufactures personally, and feel wearing them myself helps me understand and fit them better.

Hope this helps, my BL rep told me I'm first in his area with dispensing of biotrue 1 day multifocal, which is also a great lens. I find the new av 1 day multifocal to be very similar and have had good success fitting both.
 
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AdminWolf

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If you missed the live presentation , it will be "On Demand " in a few days.

A very worthwhile hour.

One reason I still enjoy doing these live events is the sheer unpredictability. Just when you think you have it nailed down...

So it was a "dark and stormy night" last night in Portland, and two minutes after the webinar started, we had a power blip and brownouts here in the ODwire.org NewsPlex(TM) (ie, my basement.)

A couple of years ago, I installed heavy-duty sine-wave UPS units here for all the networking equipment and servers in the house. When I installed them, I kept thinking to myself ("self, this is ridiculous overkill. What are the odds of the power going out during a webinar?")

Looks like my paranoia finally paid off. :) So if you're listening to the archive and you notice that I sound a little distracted as i'm kicking the talks off, that's the reason -- I had red lights blaring in my face, with countdown timers telling me when the backup power would be all gone.

Fortunately, clean power was restored very quickly. But that was a fun couple of minutes....
 
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Greg Luce

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Wonderful description, thanks Dan! That is a bigger than expected plussing of the non-dom eye and I can understand why that is a wonderful dashboard lens.
There really are wonderful optical designs and now I have it from the horse's mouth that distance vision is better than nothing. Not exactly the "great" that is touted on a regular basis but I am OK with that.

Why not full time in the office? dryness, hassle, like glasses, all of the above...
 

Greg Luce

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One reason I still enjoy doing these live events is the sheer unpredictability. Just when you think you have it nailed down...

So it was a "dark and stormy night" last night in Portland, and two minutes after the webinar started, we had a power blip and brownouts here in the ODwire.org NewsPlex(TM) (ie, my basement.)

A couple of years ago, I installed heavy-duty sine-wave UPS units here for all the networking equipment and servers in the house. When I installed them, I kept thinking to myself ("self, this is ridiculous overkill. What are the odds of the power going out during a webinar?")

Looks like my paranoia finally paid off. :) So if you're listening to the archive and you notice that I sound a little distracted as i'm kicking the talks off, that's the reason -- I had red lights blaring in my face, with countdown timers telling me when the backup power would be all gone.

Fortunately, clean power was restored very quickly. But that was a fun couple of minutes....
Tied to drive home to Welches last night and after driving around tree after downed tree we finally got turned around by the sheriff. Did I mention how much I adore public safety officers and utility crews? There was no power except at the fire station with generator back up. We will try again tonight and I am sure the locals with big pick-em-ups and chain saws got the roads cleared, now just to get some of that clean energy.
 

AdminWolf

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Tied to drive home to Welches last night and after driving around tree after downed tree we finally got turned around by the sheriff. Did I mention how much I adore public safety officers and utility crews? There was no power except at the fire station with generator back up. We will try again tonight and I am sure the locals with big pick-em-ups and chain saws got the roads cleared, now just to get some of that clean energy.
Yeah, it is a mess here too, I only realized the extent of it driving my son to school this morning. We are lucky, we could have ended up with the shortest webinar in history...
 

Dan Haas

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Wonderful description, thanks Dan! That is a bigger than expected plussing of the non-dom eye and I can understand why that is a wonderful dashboard lens.
There really are wonderful optical designs and now I have it from the horse's mouth that distance vision is better than nothing. Not exactly the "great" that is touted on a regular basis but I am OK with that.

Why not full time in the office? dryness, hassle, like glasses, all of the above...
I can work with the contacts and sometimes do, but choose to use the best pal in the best frame with the best arc available. I use my personal glasses to demonstrate progressives and the advantages to wearing the good stuff. I think this teaches by example that no presbyope should ever be exclusively and eyeglass user or a contact lens user, and it also helps me introduce the concept of occasional/recreation contact lens use to patients which daily disposables are ideal for.
 
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AdminWolf

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the archive is up at the top of the page, if you want to listen & missed it last night. I wanted to get this one up in a hurry so people could listen to the fit guide instructions while talking in this thread.
 

Dan Haas

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In emerging presbyopes with low adds the same power makes sense. The modified monovision approach helps me get good reading in the mature presbyope.

Another great way to use this lens is with the challenging 55 year old emmetrope that would rather use their shitty otc reader than the dandy pal you just made for her. Tell her "I can fix you for $1 a day with this great new contact!" Put a +.75 high add on the non- dominate eye and you're done. Just a little distance blur, great midrange and near vision with the lens, distance still perfect with the uncorrected dominate eye. Much better than a +2.25 single vision lens that really blurs distance, screws up night driving, and leaves midrange blurred out of both eyes.
 

AdminWolf

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Good job fellas for willing these things to work...

You sound like Paul :)

For an emerging presbyope like me, this lens has been a godsend, particularly when working at the computer.

It let me keep wearing the moist lens that I've been in for decades, Charlie can speak to how easy it was to fit vs. the others that we tried in the past (all others flopped hard, either for comfort or vision.)

The time I really notice it is when I pop the SV lenses back in... ugh.
 

Matt Judd

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Oh oh Adam. Oh oh Adam.

Im gonna start sounding like LCT and say Im an expert, as I am when it comes to contact lenses. And a bunch of other things. Trust me when I say, there are way better lenses out there. People who I have on ignore are NOT EXPERTS :)

I am hoping this vistakon product is good. But having been essentially lied to about the Oasys for presbyopia, Im a bit gunshy.
 

AdminWolf

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Oh oh Adam. Oh oh Adam.

Im gonna start sounding like LCT and say Im an expert, as I am when it comes to contact lenses. And a bunch of other things. Trust me when I say, there are way better lenses out there. People who I have on ignore are NOT EXPERTS :)

I am hoping this vistakon product is good. But having been essentially lied to about the Oasys for presbyopia, Im a bit gunshy.

Well, I can only speak to my experience -- I think Charlie tried me in literally every 1-day MF that was out there. There were all busts, for me at least. There is something very different about the design of this lens, which is what the talk above gets into.
 
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Matt Judd

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Well, I can only speak to my experience -- I think Charlie tried me in literally every 1-day MF that was out there. There were all busts, for me at least. There is something very different about the design of this lens, which is what the talk above gets into.
I'm looking forward to seeing how it does. For current AV Moist wearers, is a no brainer
 

Greg Luce

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Thanks for the webinar, I learned two things that I will try.
1. the binocular modified loose lens over-refraction in where one eye is not occluded but fogged with +1.00 and the other eye is fine tuned.

2. because the lens design is specific to each power, a change from -3.00 mid to -3.25 mid is not just a power change but an image size change and depth of focus change. Not sure how much this matters but I will pay closer attention.

I am interested in trying #1 above.
 
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