Johnson & Johnson - Vision Care, Inc

ACUVUE^® BIFOCAL

FREQUENTLY ASKED QUESTIONS

• What is the best way to maximize distance vision with the ACUVUE® Brand BIFOCAL Contact Lenses?
• What ADD power should I start with when I fit the ACUVUE® Brand BIFOCAL?
• When prescribing the ACUVUE® BIFOCAL why not go immediately to using unequal ADD powers for all patients?
• When will the +3.00 D ADD power be available in the ACUVUE® BIFOCAL?
• How do I explain the concept of Simultaneous Vision to my patient?

What is the best way to maximize distance vision with the ACUVUE® Brand BIFOCAL Contact Lenses?

The current ACUVUE® BIFOCAL Fitting Tips Guide is an excellent tool for problem solving and reconfirmation. The information found in the guide is based on data and opinions gathered from colleagues with a long history of clinical success with ACUVUE® Brand BIFOCAL.

When opportunities exist to improve distance vision with the ACUVUE® BIFOCAL, the clinician is best served by introducing a ± 0.25 D (±0.50 D) hand-held lens or flipper in front of the distance (dominant) eye while both eyes are open. If the subjective response reaches the desired goal, the spherical power of the contact lens should be adjusted accordingly. If the subjective response is not sufficient, then reduce the ADD power of the contact lens in the distance (dominant) eye.

Always attempt to keep the contact lens ADD powers as low as possible. The chart below may serve as a reference guide for expected ADD powers based on age.

EXPECTED ACUVUE® BIFOCAL ADD POWERS BY AGE*
Age	ACUVUE® BIFOCAL ADD POWER
40-46 47-52 53-59 60+	+1.00 D +1.50 D +2.00 D +2.50 D

* Nominal ADD powers are matched with material presented on pages 338-9 and 803-7 in Benjamin WJ (ed): Borish's CR(1998), W.B. Saunders Company, Philadelphia.

A patient's individual characteristics should be considered as well when the ADD power is determined. TOP

What ADD power should I start with when I fit the ACUVUE® BIFOCAL?

It is recommended that practitioners start with the lowest reasonable ADD power. The process for determining the initial ADD power should be:

1. Evaluate the refractive ADD power determined during the examination.

2. Use the following table to determine appropriate ADD power based on age.*

EXPECTED ACUVUE® BIFOCAL ADD POWERS BY AGE*
Age	ACUVUE® BIFOCAL ADD Power
40-46 47-52 53-59 60+	+1.00 D +1.50 D +2.00 D +2.50 D

3. Always round down if the patient is between ADD powers.

Examples:
48 year old with a +1.75 D spec ADD —> start with a +1.50 D ADD
54 year old with a +1.75 D spec ADD —> start with a +1.50 D ADD
54 year old with a +2.00 D spec ADD —> start with a +2.00 D ADD
48 year old with a +2.00 D spec ADD —> start with a +1.50 D ADD
56 year old with a +2.50 D spec ADD —> start with a +2.00D ADD

4. A patient's individual characteristics should be considered as well when the ADD power is determined.

* Nominal add powers are matched with material presented on pages 338-9 and 803-7 in Benjamin WJ (ed): Borish's CR (1998), W.B. Saunders Company, Philadelphia.
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When prescribing the ACUVUE® BIFOCAL, why not go immediately to using unequal ADD powers for all patients?

Typically, over 40% of patients successfully wearing the ACUVUE® BIFOCAL are using equal ADD powers. Success is maximized by beginning with equal ADD powers. Based on patient response, the practitioner can then modify distance and/or ADD powers in order to optimize the patient's performance.

As distance vision adjustments can be demonstrated without changing the contact lens, clinicians are advised to evaluate distance vision adjustments prior to removing the lens to adjust ADD power.
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When will the +3.00 D ADD power be available in the ACUVUE® BIFOCAL?

Clinical studies are currently under way to determine the opportunities and viability of broadening the parameter range for the ACUVUE® BIFOCAL. For now, if you determine that the patient requires additional ADD, be sure to evaluate:

• the possibility of having over-minused distance power in one or both eyes
• the viability of unequal ADD power
• the possibility that the ADD power (as compared to age) may be too high
• the possibility the patient is still adapting to simultaneous vision
  

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How do I explain the concept of Simultaneous Vision to my patient?

For several years, most ECP's have taken a scientific approach to this question. Patients are told that the function of a bifocal contact lens was "brain related." In this scientific approach, patients are also told they must "train" their eyes to use the different powers in their lenses or that the brain must "adjust" to the in-focus and out-of-focus images.

 An explanation that might be easier for the patient to comprehend might be telling them the adjustment process is similar to looking at a dog playing out in the yard through a screen door. As they look at the dog they are ignoring the screen, but if they focus on the holes in the screen they can still see the dog, but now their focus is on the near image of the holes in the screen. TOP