Bausch & Lomb Boston Multivision GP Contact Lenses - Manual (Page 4)

Lens surface dry spots:The presence of discrete non-wetting areas on a new or recently modified or polished
lens are usually due to the persistence of hydrophobic products used during lens fabrication.These hydropho-
bic contaminants have a greater affinity for BOSTON®ES (enflufocon A) polymers and if not removed with the
BOSTON® Laboratory Lens Cleaner, the lenses should be returned to the Authorized BOSTON®
Manufacturer for a special solvent cleaning.
Other causes of loss of surface wettability include:surface contamination with cosmetics, hair spray, skin
preparations;inadequate tear lubrication;incomplete blinking;the use of incompatible preserved care solu-
tions;and dry lens storage.
Recurrent lens warpage:This may be due to repeated, excessive compression of lenses during handling
(especially low-minus lenses having a less-than-recommended center thickness) or excessive flexing of minus
lenses on astigmatic corneas. Carefully reviewing the proper technique for lens handling and increasing the
center thickness by 0.02 to 0.04 mm to reduce lens flexure will minimize recurrent lens warpage.
Unstable vision:This problem may be due to excessive blink-induced lens flexure resulting from a steep fit.
Unstable vision may also result from excessive blink-induced lens mo vement.
Reduced contact lens-corrected vision:Reduced vision correction unrelated to changes in refractive error may
be due to lens warpage, front surface deposits, or switched lenses.
Repeated lens breakage: Lens breakage problems may be due to careless handling or storage procedures (see
Patient Instructions booklet) or the use of lenses having less-than-recommended center, edge or junction thick-
n e s s, especially for patients having poor manual dex t e ri t y.
MODIFIEDMONOVISION FITTING TECHNIQUE*
For BOSTON® MultiVision the definition of modified monovision is where one lens is corrected in the normal
manner (full correction for distance) while the other lens is prescribed with a slight amount of plus power (+0.5D
to +0.75D) over the normal distance correction.This additional plus power should increase near vision acuity in
that eye and overall.
*A mild over correction of +0.50 diopters will enhance the near nominal add without degrading the distance vision
significantly.
NOTE: Modified Monovision correction should not be used when it is in conflict with the visual requirements for
federal or state licensing.
1. Patient Selection
A.Modified Monovision Needs Assessment
For a good prognosis the patient should have adequately corrected distance and near visual acuity in each
eye. The amblyopic patient may not be a good candidate for modified monovision with the BOSTON®
MultiVision (enflufocon A) Contact Lens.
Occupational and environmental visual demands should be considered.If the patient requires critical vision
(visual acuity and stereopsis), it should be determined by trial whether this patient can function adequately
with modified monovision.Modified monovision contact lens wear may not be optimal for such activities as:
(1) visually demanding situations such as operating potentially dangerous machinery or performing other
potentially hazardous activities;and
(2) driving automobiles (e.g., driving at night). Patients who cannot pass their state drivers license require-
ments with modified monovision correction should be advised not to drive with this correction, OR may
require that additional over-correction be prescri b e d .
B. Patient Education
All patients do not function equally well with modified monovision correction. Patients may not perform as
well for certain tasks with this correction as they have with bifocal reading glasses. Each patient should
understand that modified monovision, as well as other presb yopic contact lenses, or other alternatives, can
create a vision compromise that may reduce visual acuity and depth perception for distance and near tasks.
During the fitting process it is necessary for the patient to realize the disadvantages as well as the advan-
tages of clear near vision in straight ahead and upward gaze that modified monovision contact lenses prov i d e.
2.Eye Selection
Generally, the nondominant eye is corrected for near vision.The following test for eye dominance can be used.
A.Ocular Preference Determination Methods
Method 1 - Determine which eye is the "dominate eye." Have the patient point to an object at the far end of the
r o o m .C over one eye. If the patient is still pointing directly at the object, the eye being used is the dominant
(sighting) eye.
Method 2 - Determine which eye will accept the added po wer with the least reduction in vision.Place the
appropriate plus power trial spectacle lens in front of one eye and then the other while the distance refrac-
tive error correction is in place for both e yes. Determine whether the patient functions best with the plus
power trial lens over the right or left eye.
B. Refractive Error Method
For anisometropic corrections, it is generally best to fit the more hyperopic (less myopic) eye for distance
and over-plus the more myopic (less hyperopic eye) to increase near correction.
C.Visual Demands Method
Consider the patient’s occupation during the e ye selection process to determine the critical vision require-
ments. If a patient’s gaze for near tasks is usually in one direction, correct the eye on that side for near.
Example:
A secretary who places copy to the left side of the desk may function best with the near lens on the left eye.
3.Near Add Determination
Always prescribe the lens po wer for the near eye that provides optimal near acuity at the midpoint of the
patient’s habitual reading distance. However, when more than one power provides optimal reading perfor m-
ance, prescribe the least plus (most minus) of the powers.
4. Trial Lens Fitting
A trial fitting is performed in the office to allow the patient to experience modified monovision correction.
Lenses are fit according to the directions in the general fitting guidelines and base curve selection described
earlier in the guide.
Case history and standard clinical e valuation procedure should be used to determine the prognosis.
Determine which eye is to be corrected for distance and which eye is to be corrected for near. Next, determine
the appropriate amount of additional plus po wer for the near vision eye. With trial lenses of the proper power
in place, observe the reaction to this mode of correction.Immediately after the correct power lenses are in
place, walk across the room and ha ve the patient look at you.Assess the patient’s reaction to distance vision
under these circumstances. Then have the patient look at familiar near objects such as a watch face or finger-
nails. Again assess the reaction.As the patient continues to look around the room at both near and distance
objects, observe the reactions. Only after these visual tasks are completed should the patient be asked to
read print.Evaluate the patient’s reaction to large print (e.g.typewritten copy) at first and then graduate to
news print and finally smaller type sizes .
After the patient’s performance under the above conditions is completed, tests of visual acuity and reading
ability under conditions of moderately dim illumination should be attempted.
An initial unfavorable response in the office, while indicative of a guarded prognosis, should not immediately
rule out a more extensive trial under the usual conditions in which a patient functions.
5.Adaptation
Visually demanding situations should be a voided during the initial wearing period.A patient may at first experi-
ence some mildly blurred vision, dizziness, headaches, and a feeling of slight imbalance. You should explain
the adaptation symptoms to the patient.These symptoms may last for only minutes or for several weeks. The
longer these symptoms persist, the poorer the prognosis for successful adaptation.
To help in the adaptation process, the patient can be advised to use the lenses first in a comfortable familiar
environment such as in the home .
Some patients feel that automobile driving performance may not be optimal during the adaptation process.
This is particularly true
when driving at night.Before driving a motor vehicle, it may be recommended that the patient be a passenger
first to make sure that their vision is satisfactory for operating an automobile. During the first several weeks of
wear (when adaptation is occurring), it may be advisable for the patient to drive only during optimal driving condi-
tions. After adaptation and success with these activities, the patient should be able to drive under other condi-
tions with caution.
6.Other Suggestions
The success of the modified monovision technique may be further improved by having your patient follow the
suggestions below.
• Having a third contact lens (distance po wer) to use when critical distance viewing is needed.
• Having supplemental spectacles to wear over the modified monovision contact lenses for specific visual
tasks may improve the success of modified monovision correction.
• Make use of proper illumination when carrying out visual tasks.
Success in fitting modified monovision can be improved by the following suggestions.
• Reverse the distance and near e yes if a patient is having trouble adapting.
• Refine the lens powers if there is trouble with adaptation.Accurate lens power is critical for presbyopic
patients.
• Emphasize the benefits of the clear near vision in straight ahead and upward gaze with modified monovision.
*The decision to fit a patient with a modified monovision correction is most appropriately left to the eyecare
practitioner in conjunction with the patient after carefully considering the patient’s needs.
*All patients should be supplied with a copy of the Patient Instructions.
PATIENT LENS CARE DIRECTIONS
Eyecare practitioners should review with the patient all lens care directions, including both basic lens care infor-
mation and specific instructions on the lens care regimen recommended for the patient:
General Lens Care
(First Clean and Rinse, Then Disinfect Lenses)
Basic Instructions:
Always wash, rinse, and dry hands before handling contact lenses.
• Always use fresh unexpired lens care solutions .
• Use the recommended system of lens care, chemical (not heat) and carefully follow instructions on solution
labeling.Different solutions often cannot be used together, and not all solution are safe for use with all lenses.
LABORATORY LENS CLEANER
Residue left by body oils, household solvents, and personal care products may be removed with an enhanced
cleaning agent such as BOSTON Laboratory Lens Cleaner . This clear, colorless surfactant is for laboratory and
in-office use only. When lenses are received from the Authorized BOSTON Manufacturer, they should be cleaned
with BOSTON Laboratory Lens Cleaner prior to use of the BOSTON Care System and an overnight soak.
Lenses exhibiting a nonwetting surface should be cleaned with BOSTON Laboratory Lens Cleaner as a method
of first choice. The BOSTON Laboratory Lens Cleaner is intended for PROFESSIONAL USEONLY. It is not avail-
able for resale or distribution to patients .
Do not alternate or mix lens care systems unless indicated on solution labeling or instructed by the eyecare prac-
titioner.
• Do not use saliva or anything other than the recommended solutions for lubricating or rewetting your lenses. Do
not put lenses in the mouth.
• Lenses should be cleaned, rinsed, and disinfected each time they are removed.Cleaning and rinsing are nec-
essary to remove mucus and film from the lens surface . Disinfecting is necessary to destroy harmful germs.
• Always remove, clean, rinse, and disinfect lenses according to the schedule prescribed by the eyecare practi-
tioner. The use of an enzyme or cleaning solution does not substitute for disinfection.
The lens care products listed below are recommended by Polymer Technology for use with the BOSTON®
MultiVision Contact Lens. Eyecare practitioners may recommend alternate products that are appropriate for the
patient’s use with his or her lens(es).
LENS CARE TABLE
Product Lens Care System
Purpose Chemical (Not Heat)
Clean BOSTON Advance® Cleaner or Original BOSTON® Cleaner
Disinfect BOSTON Advance® Comfort Formula Conditioning Solution or Original BOSTON®
Conditioning Solution
Store BOSTON Advance® Comfort Formula Conditioning Solution or Original BOSTON®
Conditioning Solution
Multi-Action BOSTON Simplicity® Multi-Action Solution
Lubricate/Rewet BOSTON® Rewetting Drops
Weekly Enzymatic BOSTON® One Step
Cleaner Liquid Enzymatic Cleaner
BOSTON, BOSTONAdvance and Boston Simplicity are registered trademarks of Polymer Technology, a
Division of Wilmington Partners, L.P.
• Note:Some solutions may have more than one function, which will be indicated on the label.Read the label
on the solution bottle, and follow instructions.
• Clean one lens first (always the same lens first to a void mix-ups), rinse the lens thoroughly as recommended
by the eyecare practitioner to remove the cleaning solution, mucus, and film from the lens surface, and put
that lens into the correct chamber of the lens storage case. Then repeat the procedure for the second lens.
• After cleaning, disinfect lenses using the system recommended by the manufacturer and/or the eyecare
practitioner.