How to Confidently Fit and Prescribe Multifocal Contact Lenses

Presbyopia is inevitable, but contact lens dropout doesn’t have to be. As optometrists, we often underestimate just how influential our 40–60-year-old patients can be. These are the key decision-makers in their households and communities—the parents, professionals, and spouses who will happily refer friends and family when we get it right.

So how do we deliver consistent success with presbyopes? The answer is simple: fit and prescribe multifocal contact lenses with confidence.

Why Multifocal Contact Lenses Matter

While monovision has its place, especially for long-time wearers who insist on it, multifocals provide better overall visual function. They preserve depth perception, support intermediate vision, and create a more natural binocular experience.

And let’s be honest: monovision patients rarely buy progressive glasses from us. Multifocals, on the other hand, complement progressive eyewear and strengthen our role as their primary eye care provider.

Step 1: Change Your Mindset

The first key to success is mindset. If you aren’t fitting multifocals openly and enthusiastically, your patients won’t feel confident in them either. Trust the process, trust the technology, and set realistic expectations:

• Multifocals deliver 80–95% visual function throughout the day

• They may be more challenging in dim light or at night

• Occasional use of readers for fine print is okay

Patients don’t expect perfection. They expect functional vision that allows them to live their lives.

Step 2: Start With a Fresh Refraction and Fitting Guide

This is where many colleagues go wrong. Every manufacturer emphasizes two basics:

1. Start with a fresh refraction

2. Follow the fitting guide

The fitting guide is a playbook built on extensive research and beta testing. Use it. It’s your roadmap to success.

Step 3: Celebrate the Wins

When patients first put on their multifocals, don’t rush. Give the lenses time to settle while you move to another part of the exam. Then assess binocularly:

• Test distance vision on the Snellen chart. Celebrate 20/25, 20/20, or even 20/15.

• Test near/intermediate vision with their phone or tablet, not just a near card. This makes it functional and real.

• Check device settings: brightness, font size, and contrast all affect satisfaction.

Always frame success around real-life performance, not perfection.

Step 4: Adjust Thoughtfully

If patients struggle:

• Determine dominance with the blur method or triangle isolation

• Adjust based on the fitting guide (refraction, add powers, or both)

• Allow time for neuroadaptation, sometimes stepping out of the room is enough

And remember: if one brand doesn’t work, don’t hesitate to try another multifocal design. We have strong options from all major manufacturers today.

Step 5: Encourage Iteration

Some patients need refinement visits, and that’s okay. Encourage them to come back, make adjustments, and keep dialing it in. The goal is long-term success, not instant gratification.

Why This Matters

When you fit multifocal contact lenses successfully, you:

• Satisfy your presbyopes’ visual needs

• Reduce dropout and keep patients in contacts longer

• Differentiate yourself from colleagues who avoid multifocals

• Unlock a powerful referral engine in your community

Get it right with one 45-year-old mom, and you’ll likely see her kids, her husband, her coworkers, and her friends.

Final Thought

Prescribing multifocal contact lenses isn’t just about optics. It’s about confidence, communication, and consistency. When you set realistic expectations, follow the fitting guide, and celebrate functional vision, you transform presbyopes into some of your happiest, and most loyal patients.

So let’s own this opportunity. Fit multifocals with confidence, and watch your patients (and your practice) thrive.