ultra for presbyopia fitting guide

Ultra for Presbyopia Fitting Guide: A Comprehensive Plan

Bausch + Lomb’s Ultra for Presbyopia offers a broad parameter range for efficient fitting, addressing diverse presbyopic needs with silicone hydrogel technology.

Presbyopia, the age-related loss of near focusing ability, impacts a significant portion of the population, often beginning around age 40. While spectacles remain a common solution, contact lenses offer an appealing alternative for many, providing a wider field of vision and enhanced cosmetic appeal. However, correcting presbyopia with contact lenses presents unique challenges. Traditional single-vision lenses become inadequate, necessitating multifocal or monovision options.

Multifocal lenses incorporate multiple power zones to provide clear vision at various distances. Monovision involves fitting one eye for distance and the other for near, leveraging the brain’s ability to adapt and select the appropriate image. A substantial number of presbyopic patients currently do not receive contact lens correction, highlighting the need for improved fitting methodologies and lens designs like Bausch + Lomb Ultra for Presbyopia.

Understanding Bausch + Lomb Ultra for Presbyopia

Bausch + Lomb Ultra for Presbyopia is a monthly replacement silicone hydrogel contact lens specifically engineered to address the visual needs of presbyopes. It’s part of the Ultra family, known for its extensive parameter range, facilitating same-day fitting. This lens combines the company’s MoistureSeal™ technology for lasting comfort with a unique optical design to deliver clear vision at all distances.

The lens aims to overcome the challenges associated with traditional multifocal designs, offering a balance between distance, intermediate, and near vision. Its availability in an expanded parameter range since its initial launch demonstrates Bausch + Lomb’s commitment to accommodating a wider spectrum of prescriptions and visual requirements, improving fitting success rates.

Lens Material and Design Features

Bausch + Lomb Ultra for Presbyopia utilizes a silicone hydrogel material, known for its high oxygen permeability, promoting corneal health and comfort during extended wear. The lens incorporates MoistureSeal™ technology, a moisture-retaining polymer, to minimize dryness and maintain hydration throughout the day.

Its multifocal design features a unique optical profile, incorporating multiple zones to provide clear vision at distance, intermediate, and near. This design aims to reduce the common visual compromises often experienced with conventional multifocal lenses. The lens’s aspheric surface further contributes to sharper vision and reduced aberrations, enhancing overall visual quality for presbyopic patients.

Available Parameters and Range Expansion

Bausch + Lomb Ultra for Presbyopia initially launched with a comprehensive parameter range, and has since undergone expansions to accommodate a wider spectrum of prescriptions. Base curves typically range from 8.4mm to 9.0mm, with diameters of 14.2mm. Power ranges generally span from +0.50D to +6.00D, with add powers available in +0.75D, +1.00D, +1.25D, +1.50D, +1.75D, and +2.00D increments.

Recent expansions have focused on increasing the availability of higher add powers and toric options, addressing the needs of more complex presbyopic corrections. This commitment to range expansion demonstrates Bausch + Lomb’s dedication to providing fitting solutions for a diverse patient population, maximizing successful lens fits and patient satisfaction.

Initial Patient Assessment

A thorough patient assessment is crucial for successful Ultra for Presbyopia fitting. Begin with a detailed case history, focusing on visual demands at all distances – near, intermediate, and far. Inquire about current spectacle and contact lens wear, including any adaptation issues. Assess ocular surface health, paying close attention to tear film quality and quantity, as dryness can impact contact lens comfort and performance.

Evaluate pupil size in varying lighting conditions, as this influences lens design selection. Document any pre-existing ocular conditions or systemic medications that may affect contact lens wear. A comprehensive assessment lays the foundation for a personalized fitting approach, maximizing the likelihood of optimal vision and comfort;

Spectacle Refraction Update

Prior to initiating a Ultra for Presbyopia contact lens fitting, a current and accurate spectacle refraction is paramount. Refraction should be performed under standardized conditions, ideally after cycloplegia if appropriate, to minimize accommodative spasm. Confirm the spherical, cylindrical, and axis values, and meticulously determine the best vision correction.

Pay particular attention to the near addition, as this directly influences the contact lens add power selection. Document both distance and near spectacle prescriptions clearly. A recent refraction ensures the contact lens fitting starts with a solid baseline, optimizing the chances of achieving clear vision at all distances and minimizing unnecessary adjustments during the fitting process.

Add Power Determination

Accurate add power determination is crucial for successful Ultra for Presbyopia fitting. Begin by subtracting 0.75D to 1.00D from the spectacle add power to estimate the initial contact lens add. This accounts for the minus power effect of the contact lens being closer to the eye.

Consider the patient’s visual demands and lifestyle. Higher add powers may be needed for intensive near tasks. Utilize a near addition chart to refine the add power, ensuring comfortable and clear vision at the patient’s typical reading distance. Document the chosen add power meticulously, as it forms the foundation for the trial lens selection and subsequent fitting refinements.

Corneal Topography and Evaluation

Corneal topography is a vital component of the Ultra for Presbyopia fitting process, especially for patients with astigmatism or irregular corneas. Mapping the corneal surface helps identify areas of steepening or flattening, guiding lens selection and minimizing potential complications.

Evaluate corneal health, noting any signs of dryness, staining, or irregularities. Assess the tear film quality and quantity, as a stable tear film is essential for contact lens comfort and clear vision. Utilize topography data to determine the best lens orientation and axis for optimal visual acuity and reduced distortion. This comprehensive evaluation ensures a safe and effective lens fit.

Trial Lens Selection – Step 1

Step 1 in the Ultra for Presbyopia trial fitting involves a strategic lens selection based on the refraction and corneal evaluation. Begin by choosing trial lenses that closely match the patient’s spectacle refraction, considering both distance and add power. Utilize the available parameter range to select a base curve and diameter appropriate for the corneal curvature.

For initial fittings, prioritize a spherical power close to the spectacle refraction, and a moderate add power. Having a range of add powers available is crucial for refinement. Remember to account for any astigmatism present and select toric trial lenses if necessary, ensuring optimal visual performance.

Determining Dominant and Non-Dominant Eye

Accurately identifying the dominant and non-dominant eye is crucial for optimizing Ultra for Presbyopia lens fitting, particularly when considering strategies like monovision. Several methods can be employed, including the hole-peg test or asking the patient which eye they naturally use for aiming or viewing through a small aperture.

The dominant eye typically handles distance vision, while the non-dominant eye can be prioritized for near tasks. This distinction informs the initial power and add selection during trial fitting. Understanding ocular dominance allows for a more personalized approach, maximizing binocular vision and minimizing potential adaptation challenges.

Selecting Initial Power and Add

When initiating the Ultra for Presbyopia fitting process, start with the patient’s most recent spectacle refraction as a baseline. For the dominant eye, utilize the full distance correction. The non-dominant eye’s initial power can be slightly reduced, anticipating potential monovision strategies.

Add power selection is guided by the patient’s reported near addition. Begin with a moderate add power, typically +1.50D to +2.00D, and adjust based on subjective responses during trial lens wear. Consider the patient’s visual demands and lifestyle when determining the appropriate starting add. Careful initial selection streamlines the refinement process.

Trial Lens Fitting – Step 2

Following initial lens application, allow the patient a minimum of 15-20 minutes for adaptation to the Ultra for Presbyopia trial lenses. Encourage normal visual activities – reading, computer use, and distance viewing – to assess performance across various distances.

Inquire about immediate comfort and clarity. Begin with distance vision assessment, then progress to intermediate and near tasks. Document subjective responses meticulously. This step is crucial for identifying any initial discrepancies requiring adjustment. Over-refraction, if needed, should be performed binocularly to fine-tune the prescription and optimize visual acuity at all distances.

Over-Refraction Techniques

Over-refraction with Ultra for Presbyopia trial lenses is a vital step for refining the fit. Begin binocularly, using small increments (+/- 0.25D) to address any residual refractive error. Focus on optimizing clarity at each distance – far, intermediate, and near – individually.

Pay close attention to patient feedback regarding comfort and visual quality. If distance vision is unsatisfactory, adjust the spherical power. For intermediate or near issues, modify the add power. Document all changes carefully. Remember, the goal is to achieve optimal binocular balance and minimize complaints of glare or halos, ensuring a comfortable and functional visual experience.

Fitting Adjustments – Distance Vision

Achieving clear distance vision is the foundation of a successful Ultra for Presbyopia fit. If the patient reports blurriness, begin by adjusting the spherical power in 0.25D increments. Over-refraction is crucial here; assess binocular acuity after each change.

Consider the patient’s existing spectacle refraction as a starting point, but don’t hesitate to deviate based on subjective responses. Ensure symmetrical refraction between both eyes. If significant discrepancies exist, investigate potential corneal astigmatism. Prioritize distance clarity before proceeding to intermediate and near adjustments, establishing a solid visual base.

Adjusting Power for Clear Distance

Fine-tuning distance acuity with Ultra for Presbyopia involves meticulous power adjustments. Begin with small increments – 0.25D spherical changes – and thoroughly evaluate binocular vision after each modification. Utilize a distance visual acuity chart, ensuring proper lighting and viewing distance.

If under-correction is observed, increase the plus power; conversely, reduce it for over-correction. Monitor for induced astigmatism or aberrations. If significant changes are needed, reassess the corneal topography. Remember, the goal is crisp, comfortable distance vision without compromising intermediate or near performance. Document all adjustments meticulously for accurate tracking.

Fitting Adjustments – Intermediate Vision

Optimizing intermediate clarity with Ultra for Presbyopia requires a focused approach. Assess intermediate vision at a typical working distance – approximately 18-24 inches – using a relevant chart. Adjustments often involve modifying the add power or slightly altering the distance power.

Consider a slight reduction in plus power if intermediate vision is blurry, or a small increase if it’s clear but distance vision suffers. Evaluate binocularity carefully; imbalances can significantly impact intermediate performance. Encourage the patient to simulate common tasks like computer use to gauge real-world effectiveness. Document all changes and patient feedback thoroughly.

Optimizing Intermediate Clarity

Achieving optimal intermediate clarity with Bausch + Lomb Ultra for Presbyopia demands meticulous refinement. Begin by confirming the patient’s typical working distance – crucial for accurate assessment. Utilize a standardized intermediate vision chart, positioned accordingly. Small adjustments to add power are often key; a +0.25D change can yield significant improvements.

If blur persists, consider a slight tweak to the distance power, prioritizing binocular balance. Encourage the patient to actively participate, reporting their experience during simulated work tasks. Document all modifications and subjective responses. Remember, intermediate vision is often a compromise, balancing clarity with comfortable distance and near performance.

Fitting Adjustments – Near Vision

Refining add power for near tasks is paramount with Ultra for Presbyopia. Begin by assessing near visual acuity at the patient’s typical reading distance. Incremental adjustments of +0.25D to the add power are recommended, monitoring for improvements without compromising distance or intermediate vision. If excessive plus power induces accommodation, reduce the add slightly.

Consider the patient’s lifestyle; demanding near work may necessitate a higher add. Subjective refinement is crucial – ask the patient to read various font sizes and assess comfort. Document all changes meticulously. Remember, a slight over-minus refraction can sometimes enhance near vision comfort, but avoid inducing asthenopia.

Refining Add Power for Near Tasks

Ultra for Presbyopia requires precise add power refinement for optimal near vision. Start with the initial add determined during assessment, and have the patient perform typical near tasks – reading, computer work, etc. Ask about clarity and comfort. Incremental adjustments of +0.25D are key; too much add causes blur and fatigue, too little strains accommodation.

If the patient reports difficulty with intermediate distances after a near add increase, slightly reduce the add. Consider binocular balance; adjustments in one eye may necessitate changes in the other. Document each adjustment and the patient’s subjective response. Patient feedback is invaluable for achieving truly personalized vision correction.

Binocular Balance Assessment

Ultra for Presbyopia fitting demands careful binocular balance assessment. After distance and intermediate refinement, evaluate how the eyes work together at near. Utilize cover testing to identify any phorias or tropias induced by the lenses. A small induced phoria is often acceptable, but larger deviations require adjustment.

Monocular and binocular acuity checks at near are crucial. Disparities in acuity suggest imbalance. Consider modifying the add power in one eye to achieve symmetry. Patient reports of headaches, eye strain, or difficulty with depth perception signal potential binocular vision issues needing attention. Prioritize comfortable, efficient binocular function.

Addressing Complaints of Glare or Halos

Ultra for Presbyopia patients occasionally report glare or halos, particularly at night. First, confirm a well-centered fit; decentration can exacerbate these symptoms. Evaluate lens surface wettability – dryness contributes to light scattering. Consider a different lens care solution or artificial tears to improve comfort and hydration.

If the issue persists, slightly reduce the add power, as excessive addition can sometimes cause these visual disturbances. A different lens design parameter, like base curve or diameter, might also be necessary. Rule out other causes like corneal irregularities or dry eye disease. Thoroughly investigate and address these concerns for optimal patient satisfaction.

Monovision Fitting Considerations

Monovision with Ultra for Presbyopia involves fitting one eye for distance and the other for near vision. It’s suitable for presbyopes accepting some compromise in intermediate vision. Thorough patient counseling is crucial, explaining potential benefits and drawbacks, including reduced depth perception.

Start by determining the dominant eye for distance correction. A trial period with diagnostic lenses is essential to assess tolerance and visual performance. Carefully over-refract both eyes to optimize clarity at each focal point. Monitor for adaptation issues, and be prepared to adjust parameters or revert to a multifocal approach if monovision isn’t successful.

When to Consider Monovision

Monovision with Ultra for Presbyopia is a viable option for presbyopes who prioritize either distance or near vision, particularly those with significant astigmatism or limited multifocal adaptation. It’s also suitable for patients actively involved in specific activities demanding sharp vision at one distance, like computer work or driving.

Consider monovision if multifocal attempts fail to deliver satisfactory vision or comfort. Discuss lifestyle and visual demands thoroughly. Patients needing good binocularity for tasks like depth perception may not be ideal candidates. A comprehensive assessment of patient expectations and willingness to adapt is paramount before proceeding.

Optimizing Monovision Parameters

Optimizing monovision with Ultra for Presbyopia requires careful refinement. Start with a conservative approach, typically +0.75D to +1.00D difference between the distance and near eye. Thorough over-refraction is crucial, assessing both distance and near acuity.

Consider the patient’s dominant eye for distance correction. Trial lenses are essential to evaluate binocularity and potential suppression. Monitor for symptoms like headaches or asthenopia. Incremental adjustments, guided by patient feedback, are key. Don’t hesitate to explore intermediate add powers to enhance comfort and functionality, especially for digital device use.

Patient Education and Expectations

Successful Ultra for Presbyopia fitting hinges on realistic patient expectations. Clearly explain the concept of multifocality or monovision, emphasizing potential adaptation periods. Discuss possible visual compromises – slight reductions in contrast sensitivity or glare – and how these may impact daily activities.

Highlight the importance of consistent wear and proper lens care. Explain potential troubleshooting steps for common issues like dryness or fluctuating vision. Emphasize the need for follow-up visits to fine-tune the fit. Manage expectations regarding reading speed and depth perception, particularly with multifocal designs.

Troubleshooting Common Fitting Issues

Common challenges with Ultra for Presbyopia include adaptation difficulties, glare, and fluctuating vision. For adaptation, encourage consistent wear and reduced initial daily wear time. Address glare complaints by evaluating lens fit and considering alternative designs or materials. Fluctuating vision often stems from dryness; recommend lubricating drops and assess tear film health.

If distance vision is compromised, refine the distance power. Intermediate or near vision issues require add power adjustments. Binocular balance imbalances necessitate careful refraction and potential monovision adjustments. Always revisit corneal topography to rule out underlying issues. Patient feedback from online surveys can also guide troubleshooting.

Addressing Issues with Adaptation

Adaptation to Ultra for Presbyopia can sometimes be slow. Encourage patients to wear lenses consistently, even if vision isn’t immediately perfect. Start with part-time wear, gradually increasing duration. If discomfort persists, check lens fit, centration, and edge lift. Rule out corneal irregularities with topography.

Dryness is a frequent adaptation hurdle; recommend artificial tears and assess tear film function. Explain that some initial blur is normal as the brain adjusts to multifocal vision. Reassure patients and schedule a follow-up to monitor progress. Online survey data suggests patience is key; adaptation improves with continued wear.

Managing Dry Eye Symptoms

Dry eye significantly impacts Ultra for Presbyopia adaptation. Thoroughly assess tear film quality and quantity before fitting. Recommend preservative-free artificial tears for frequent use, especially during initial wear. Consider punctal plugs if dryness is severe and unresponsive to drops.

Educate patients on environmental factors exacerbating dryness – air conditioning, prolonged screen time. Encourage blinking exercises and adequate hydration. Lipid layer deficiency is common; suggest warm compresses and lid hygiene. If symptoms persist, investigate underlying causes like blepharitis or meibomian gland dysfunction. Address dry eye proactively for successful lens wear.

Follow-Up Visits and Refinement

Schedule a follow-up visit one to two weeks after initial dispensing of Ultra for Presbyopia. Assess visual acuity at distance, intermediate, and near, noting any complaints. Over-refraction is crucial to fine-tune the prescription. Evaluate binocular vision and address any imbalances;

Patient feedback is paramount; actively solicit their experiences. Minor adjustments to power or add may be necessary. Consider a trial period with slightly different parameters. Document all changes meticulously. Subsequent visits may be scheduled at one and three months to ensure long-term comfort and vision quality. Consistent monitoring optimizes success.

Online Survey Results and Patient Feedback

Bausch + Lomb conducted an online survey evaluating patient experiences with Ultra for Presbyopia lenses. Results indicated high satisfaction with near and intermediate vision, particularly regarding reduced glare and halos. Many patients reported improved comfort compared to previous multifocal lenses.

Qualitative feedback highlighted the ease of adaptation and the natural vision provided. Some users desired minor adjustments to add power for specific tasks. Practitioners should actively gather patient feedback during follow-up visits to personalize the fitting process. This data informs ongoing lens development and fitting protocols, ensuring optimal visual outcomes.

Long-Term Lens Care Recommendations

Ultra for Presbyopia, being a monthly replacement lens, necessitates diligent care for optimal health and vision; Patients should be thoroughly instructed on proper handling, cleaning, and storage procedures using recommended multipurpose solutions. Emphasize the importance of avoiding tap water for rinsing and cleaning.

Regularly reinforce the monthly replacement schedule to prevent protein buildup and maintain lens clarity. Educate patients about recognizing signs of lens damage or discomfort, prompting immediate removal and professional evaluation. Consistent adherence to these recommendations ensures long-term comfort, visual acuity, and ocular health while using Ultra for Presbyopia.

Resources for Practitioners

Bausch + Lomb provides comprehensive support for practitioners fitting Ultra for Presbyopia. Access detailed fitting guides, parameter charts, and clinical data through the company’s professional website. Dedicated customer service representatives are available to assist with complex cases and ordering inquiries.

Furthermore, educational webinars and in-office training programs are offered to enhance proficiency in multifocal lens fitting techniques. Online resources include patient education materials, aiding in effective communication regarding lens care and expectations. Utilizing these resources ensures practitioners are well-equipped to deliver optimal presbyopic vision correction with Ultra for Presbyopia.

Bausch + Lomb Ultra for Presbyopia represents a significant advancement in contact lens technology for presbyopia correction. Its broad parameter range, combined with a comfortable silicone hydrogel material, facilitates successful fittings for a diverse patient population. By following a systematic approach – encompassing thorough assessment, careful trial lens selection, and diligent follow-up – practitioners can consistently achieve optimal visual outcomes.

Ultimately, Ultra for Presbyopia empowers patients to regain clear vision at all distances, enhancing their quality of life. Continued education and utilization of available resources are key to maximizing the benefits of this innovative lens system.