mi lensesProgressive Satisfaction Premium Lens OptionsIf there’s one thing we all want, it’s happy patients. Premium multifocals are one way to achieve this, be they spectacles, contact lenses or intraocular lenses (IOLs). The sale of these sophisticated devices will also add to the bottom-line. WRITER Alan Saks Shamir Autograph Intelligence Irrespective of your patient demographics, getting you and your team up to speed on the benefits of premium progressives is as essential as ensuring your clinical team maintain their continuing professional development. The technologies are not mutually exclusive. A patient who wears progressive spectacles most of the time might love a pair of premium multifocal contact lenses for social vision. A ‘full time’ multifocal contact lens wearer – or someone who copes 90% of the time with a premium multifocal IOL – might still derive great benefit from a premium occupational lens for top up reading and prolonged computer work. Others might prefer a customised progressive lens for watching TV while using their phone or reading a book in reduced lighting. The combinations are endless. There’s no question that the premium multifocal market continues to expand and grow. There are ever more, new, improved premium progressives from the major manufacturers, as well as the smaller independent labs. Free form technology, modern manufacture and milling processes allow an almost unlimited range of designs and combinations. Understanding the options is a key to success. A truck driver might be best suited to a long channel progressive design with no shoulder or intrusion in the distance, a good intermediate area for seeing instruments and GPS, and a usable reading area for breaks and general use. We might include a photochromic that is light for night driving, yet still activated behind the windscreen in bright daylight conditions. On the other hand, someone who spends the greater portion of their waking hours on computer screens and devices might need a shorter channel progressive with wide near and intermediate zones, while compromising on the distance portion, with a bit of a shoulder. There are many options in between. Having an in-depth knowledge of the available options, lens designs and channel depth for specific needs makes it easier to customise prescriptions for each patient. OFFER OPTIONSIf you don’t offer patients the options, you are not only rendering a great disservice, but are affecting your bottom-line too. Many of these patients, when offered, will opt for multiple pairs. Maybe an occupational lens for work, a driving progressive design for hitting the road, and another with a long channel for ‘slouching’ around. I wear multiple premium progressive options, including bloom-free occupationals for webinars, driving versions (for long drives, sometimes at night), and a sunglass version too (to see my GPS and read on the beach). I notice the benefits. Even though I wear one pair for 90% of my waking hours, the others all have their place. I prescribed many such combinations, for many happy patients over the decades. They were extremely loyal and can spend thousands on high end frames and lenses without blinking an eye. One of the first things my new patients would say is, “Wow, these are so much better than the last ones I had” – which were usually generic designs with no coatings, nor optimised for anything in particular. It goes without saying that all premium progressive spectacle lenses also include highend multicoats. We may also add a blue filter, polarisation, tints, photochromics and so on. RESEARCH AND INNOVATION: PAST AND PRESENTFor decades, researchers have investigated the complexities of visual function and incorporated these learnings into progressive optical designs. In the late 1970s, a young graduate mathematician, Gerhard Fürter, joined Carl Zeiss. He developed new progressive lens designs by performing time-consuming mathematical lens and area calculations. He also designed the required computer programs, back in the days of punch cards and mainframe computers, with limited computer power. His goal was to develop technology to help patients see better and more naturally; lenses they could wear comfortably and tolerate. Together with the head of the mathematics department, Hans Lahres, Carl Zeiss was granted patent EP0039497 that led to their innovative ‘Gradal HS’ (horizontal symmetry) progressive design, with key features to provide an equivalent visual impression for the right and left eyes, improving tolerance, comfort, and binocular vision. Aberrations were minimised, and resultant lenses were thinner and flatter, so wearers could see clearly and look good at the same time. Since then, Zeiss progressives have evolved and advanced dramatically and are popular among wearers. There have been many developments among other leading lens labs – both local and global – like Rodenstock, developing billions of lens surface combinations to optimise function in their multigressive designs. Tim Thurn, Medical & Professional Relations ANZ at Essilor, said, for his company, the words ‘premium progressive lenses’ are inextricably linked to lens personalisation. Further, he explained that a ‘customised’ lens takes the additional ‘as worn’ measurements such as tilt, wrap, back vertex distance and pantoscopic angle, and recalculates the progressive surface to ensure the wearer has their correct prescription. Lens personalisation adds unique patient characteristics to create a totally individual design for the patient. Varilux Xtrack Fit and Varilux Xclusive incorporate the patient’s Near Vision Behaviour (NVB), (see the May 2018 mivision CPD article for more on NVB). In a nutshell, NVB is governed by the intricate coordination of eye movements, including lowering of gaze, fixations, and saccades, designed to bring our image of words sequentially onto the fovea so we can read. Measuring it is no simple matter, with the average reading behaviour of an adult including 233 millisecond fixations and saccades of 6.3 characters. Three points related to the wearer’s posture are: • angle of down gaze, • lateral offset, and • reading distance. These are used to precisely place the wearer’s ‘arm’s length vision’ on the lens. The fourth item is the NVB ratio which is behavioural and describes how the wearer adjusts their gaze. Specialised measuring instruments and Apps are used to calculate these parameters in a practical dispensing situation, producing an outstanding level of personalisation and performance. According to Tim Thurn, “A great indicator of the performance of such lenses is how practices that use them performed during the pandemic. Not only did they maintain their progressive lens sales but, as lockdowns ended, their sales outstripped practices using standard progressive lenses. This is interesting in a market where, according to IBIS World Optometry and Optical Dispensing in Australia, March 2022, the average unit price of optical goods has fallen.” So, there’s some insight into the complexities that can be incorporated into premium progressives – it’s not just marketing, hyperbole or smoke and mirrors. PREMIUM MULTIFOCAL CONTACT LENSES There are a variety of contact lens (CL) options that modify spherical aberration across a lens to provide centre-near or centre-distance simultaneous vision, as well as extended depth of vision (EDOF) and ring segment designs. Some customisable rigid designs also include segments – which may he horizontal (like an executive bifocal) – or inverted ‘V’ shaped segments. Some use translating designs, where the lens moves up relatively on down gaze, while reading. For computer users, a simultaneous vision design is usually beneficial. There are also many who use varying degrees of monovision or blended vision to achieve the results they need. Often, a bit of modifiedmonovision is applied to enhance EDOF and simultaneous vision setups. The Big Four all provide proprietary premium multifocal CL designs in dailies, two-weekly and monthly options. Others, like Seed (distributed by Capricornia) and VTi (distributed by Contact Lens Centre Australia and Corneal Lens Corporation in New Zealand), use BHVI-developed EDOF designs in their premium multifocal CLs. Our local labs also provide a variety of other premium multifocal CLs in hard and soft materials. Of course, as mentioned, many CL wearers use top up spectacles, sometimes in premium progressive/occupational designs, to enhance near or distance vison, for driving, prolonged computer work, or fine, near vison. We’ve covered some of the other premium multifocal spectacle and CL options in previous editions of milenses. Take a look at some of the many options available in the following product feature. Premium Spectacle Lenses SeeMax Ultimate SeeMax Ultimate Like fingerprints, vision is unique. Thanks to Nikon’s all new Insights technology, the wearer can now co-design their progressive lens with SeeMax Ultimate. Every SeeMax Ultimate is tailored to your patient’s needs, preferences and viewing habits. A simple to use app makes the process of creating their own progressive a more powerful and personal experience. SeeMax Ultimate is now available in 1.5, 1.6, 1.67 clear, polarised and Transitions GEN 8 Style Iconic and Style colours, and 1.74 clear and Transitions GEN 8 Iconic. Contact: Nikon Account Manager Opticare Alpha and Beta OpticareOpticare's Alpha and Beta are new generation freeform digital premium multifocal lenses that are German-designed but locally-made. Alpha has a maximum cylinder of 1.86D and is equally balanced for distance, intermediate, and near. For patients requiring a prescription lens for general use, recommend Alpha. It is also best for myopes. Meanwhile, Beta has a maximum cylinder of 1.69D and is mainly designed for intermediate and near, although it is still excellent for distance. For patients needing a prescription lens for computer and near, recommend Beta. It is best for hyperopes. Contact: Opticare (AUS) 1800 251 852 Intuitiv Intuitiv Intuitiv progressive lenses by OSA are a step forward for the visual freedom of progressive lens wearers. Intuitiv’s ergonomic technology understands your patient’s vision by not only taking into account the preferential path used by hyperopes, emmetropes and myopes as they scan down the lens, but also the different physical and visual postures of right and left-handers. Intuitiv positions mid and near zones according to your patient’s handedness. Using five times more calculation points across the lens surface than previous progressives, plus new aspherisation techniques to further reduce aberrations, this exceptional design allows for wider, more stable intermediate vision, an improvement patients will notice. Contact: OSA Account Manager Varilux X Varilux X Today’s presbyopes are active, connected, and constantly multitasking. Essilor’s Varilux X series is unique in extending vision for all their tasks within arm’s reach. Varilux X series matches every wearer’s visual needs within this 70cm / arm’s length zone, regardless of their posture and visual behaviour. Wearers see multiple objects clearly along a single direction of gaze without having to move their head. Nine out of ten say they no longer need to move their head to see sharply.* Varilux Xtrack Fit or Xclusiv require Near Vision Behaviour to analyse multiple factors – downgaze, lateral offset, reading distance and visual behaviour – for a complete view of the wearer’s near vision posture. This ‘volume of vision’ model personalises the lens design for the individual wearer. Contact: Essilor Account Manager Reference * Single-centre study – Eurosyn – France (n=42); % of wearers who need a little or no head movement to see clear. Hoyalux iD Myself Hoyalux Hoyalux iD Myself delivers a progressive lens design beyond what has been possible before. Two new patented technologies – Adapt Ease and 3D Binocular Vision – aim to address the key problem areas consumers continue to have with progressive lenses today. Adapt Ease technology improves the near and intermediate visual width and gaze transition without influencing distance vision. Deformation areas, that are an increasing adaptation challenge, are mainly located next to the reading area and peripheral parts of the lens. These areas are cause for significant discomfort and make day-to-day life more difficult. By adding controlled, very low astigmatism and controlling the axis of this within the near peripheral zones, Hoya achieves a significant improvement in the width of visual fields of the near and intermediate without influencing the far vision area. 3D Binocular Vision technology is a leap forward in providing stable image perception, enabling control of unwanted prismatic effect on the periphery of the lens. This allows progressive lens wearers to benefit from significantly reduced distortion and swaying effects along all dimensions. Contact: Hoya Account Manager B.I.G. Exact B.I.G. ExactB.I.G. Exact is the first high-precision lens made from an exact biometric eye model, based on individual measurements with the DNEye Scanner. Because every eye is different, Rodenstock has moved away from using a ‘standard eye model’ to calculate their lenses. The DNEye Scanner measures over 7,000 data points and more than 80 eye parameters. Combined with the standard prescription B.I.G. Exact values, this biometric data can be used in the manufacturing process to make the lens more accurately match each patient’s eyes.This provides people with the sharpest vision possible at any angle and in every direction of gaze, both in the lens’ peripheral zones and at distances from mid, near and far. The benefits include quick adaptation due to sharper vision and increased visual comfort, and improved contrast. Improved contrast leads to better vision in low light levels, especially when driving at dusk. Contact: Rodenstock Account Manager Zeiss SmartLife Progressives Zeiss SmartLife Zeiss SmartLife Progressive lenses, part of the Zeiss SmartLlife lens portfolio, deliver effortless and comfortable vision at all distances and directions so your patients can take on everything their eyes face today, no matter their age.Zeiss SmartLife Progressive lenses are designed to meet the vision needs of people with a connected and on-the-move lifestyle. The optical performance in the lens periphery is designed for frequent changes of head and eye position, driven by how people interact with their handheld devices. This new design fingerprint provides a smoother transition into the lens periphery, with less perceived blur, enabling peripheral vision in natural dynamic interaction. Eight out of 10 consumers adapted to their new lenses within one day.* Contact: Zeiss Account Manager *External consumer acceptance test on the Zeiss SmartLife Lens Portfolio, n=82 study participants. Aston Optometry School, Aston University, UK, 2019. Shamir Autograph Intelligence The updated Shamir Autograph Intelligence is the artificial intelligence lens that evolves with your patients. This award-winning lens design has been improved to deliver the best visual experience, optimally matched to your patient’s visual age. What’s new? • Shamir IntelliCorridor technology improves intermediate vision by increasing softness, visual field, and visual acuity – providing the right power profile for each visual age, and • The updated Autograph Intelligence improves digital vision across all visual ages, by providing softer lenses for early presbyopes and more addition for advanced presbyopes. Autograph Intelligence delivers the ultimate visual experience across every visual field and for every visual age. Visit: www.shamir.com/au Unity Via Progressives From those who require the very best to those who are happy with a few less bells and whistles, the Unity Via Progressive Lens portfolio features three easy-to-fit and dispense lens designs that use intelligent technology to meet the unique visual and lifestyle needs of any progressive patient. Contact: VSP Optics (AUS) 1800 251 025 Premium Contact Lenses Alcon Total1 Total1 multifocal contact lenses feel like nothing^ and enable your patients to see clearly at multiple distances, from near through far. The lens provides exceptional comfort for 16 hours thanks to its unique Water Gradient material and Smartears technology. With almost 100% water at the outer surface of the lens,* the Total1 lens creates a cushion of moisture on the eye, making it so comfortable that your patients may forget they’re wearing them.^ It also features Precision Profile optical design to balance the effects of presbyopia for clear vision up close, far away and everything in between. Contact: Alcon Vision Account Manager NaturalVue Multifocal 1 Day The NaturalVue Multifocal 1 Day is a centre distance design with patented extended depth of focus (EDOF) optics. The EDOF design works naturally with the brain to produce a continuous range of clear vision and stereopsis comparable to spectacle wear with an effective add up to +3.00Ds. Available in 0.25D steps from +4.00 to -12.25Ds, the design has a rapid, continuous and uninterrupted progression in plus power from the centre of the lens through the optic zone. This creates a virtual aperture1with relative plus in the periphery, and is clinically proven to slow the progression of myopia. 2Contact: Contact Lens Centre Australia (AUS) 1800 125 023 References 1. VTI Data on file, 2015. N=59. Data assessed after one week of wear. Preference based on those who expressed a preference among brands tested. 2. Cooper J, Oʼconnor B, Watanabe R, et al. Case Series Analysis of Myopic Progression Control with a Unique Extended Depth of Focus Multifocal Contact Lens. Eye & Contact Lens: Science & Clinical Practice. 2017;44(5): e16-e24. ^Based on % wearers agreeing with the statement, “while wearing my lenses, I sometimes forget I have them on”. *Based on laboratory measurements of unworn lenses Patients should be advised to always read the label and follow directions for use. iMyDay Multifocal MyDay CooperVision’s MyDay multifocal contact lens has demonstrated first-fit success in 83% of patients, with 98% successfully fit with two pairs or fewer.1,2* Contact: CooperVision Account Manager *Warning: UV-absorbing contact lenses are not substitutes for protective UV-absorbing eyewear, such as UVabsorbing goggles or sunglasses, because they do not completely cover the eye and surrounding area. Patients should continue to use UV-absorbing eyewear as directed. *When using the fitting guide. References 1. CVI data on file, 2021. Prospective, subject-masked, randomised, bilateral, two-week dispensing study at five US sites with MyDay daily disposable multifocal; n=58 habitual multifocal contact lens wearers. 2. CVI data on file, 2020. Prospective, double-masked, bilateral, one-week UK dispensing study with MyDay daily disposable multifocal; n=104 habitual multifocal contact lens wearers. SEED 1dayPure EDOF SEED SEED 1dayPure EDOF is a one-day multifocal soft contact lens with extended depth of focus (EDOF) optics, patented by BHVI and designed for presbyopia management. The low add profile of the 1dayPure EDOF lens may be particularly useful for pre-presbyopic patients who suffer from accommodative stress due to excessive use of computers and digital devices. It can potentially help the wearer by reducing the eye’s accommodative efforts without noticeable visual loss. By providing a wider depth of focus, the perceived image quality is improved across a range of distances, from far to near. Contact: Capricornia Contact Lens (AUS) 07 3208 8500 Ultra for Presbyopia Ultra Bausch & Lomb’s Ultra for Presbyopia monthly silicone hydrogel lens uses Advanced MoistureSeal Technology1to provide a lens with unsurpassed oxygen transmissibility 2and a Dk/t of 1632. The technology also optimises wettability and creates a high water content of 46%. 2Bausch & Lomb Ultra for Presbyopia offers a 3-Zone progressive design which provides a seamless transition between three zones 3to allow easy adaptation between key distances. Designed for a successful first time fit, 4the Ultra for Presbyopia offers two add powers 5for ease and simplicity of fit. Contact: Bausch & Lomb Account Manager References 1. Hoteling, A et al. Characterization of bulk PVP content of samfilcon A silicone hydrogel lenses. ARVO Poster 2014 4648 – A0273 2. Hoteling A et al. Optimizing Physical Properties of a Silicone Hydrogel Material with 2-phase polymerization processing. ARVO Poster 2014 4648-A0273. 3. B+L data on file (2015) Power Profiles for B+L and Competitor MF lenses. Nimo data 22 July. 4. B+L data on file. 2015. Dispensing cross over study with samfilcon A MF low and high add (test) and PV2 FP low & high (control) lenses. 5. B+L data on file. 2015. Lens Design Report – Ultra MF and PV2 FP. Optical Design Comparison.Acuvue Oasys Multifocal Acuvue Acuvue Oasys Multifocal has a unique optical design that is optimised by incorporating the natural pupil variation that occurs across the refractive error range and in patients as they age.1The Acuvue Oasys brand family of contact lenses has never been beaten in comfort.* In terms of the overall fit success of Acuvue Oasys Multifocal, you can expect 97.3% of patients successfully fit using four lenses or less.2Contact: Johnson & Johnson Vision Care Account Manager mi* ClinicalTrials.gov is a website maintained by the NIH. The 31 clinical studies evaluated subjective comfort as a primary or secondary endpoint for Acuvue Oasys brand two-weekly family and for Acuvue Oasys 1-Day with HydraLuxe Technology brand family contact lenses. Review conducted 29 April, 2022. Reference 1. JJV data on file 2022. CSM-Acuvue Pupil Optimized Design Technology: JJVC contact lenses, design features, and associated benefits.

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