Multifocal GP Selection

Fitting Strategy and Design Selection

1. Monovision First
Always check whether monovision is tolerated first. It’s the easiest option to correct using single vision lenses, can complement multifocal designs, and is often the best approach later if/when the patient requires IOLs.

2. Optimising Distance Correction
Aim to slightly over-plus the distance correction—even +0.25D can enhance VDU performance with minimal compromise to distance vision. Instead of briefly demonstrating this in a trial frame, insert it and leave it in for a few minutes. Then ask the patient if their distance vision seems acceptable (e.g., “20/happy”). Set the chart so 6/7.5 is the bottom line. For near tasks, asking the patient to look at their phone is often more practical than a test card with small print like N4.

3. If Monovision Isn’t Tolerated
Choose one of the three designs we offer:

ProCurve Plus
A front-surface multifocal. While multifocals sometimes don’t provide the full effect of the prescribed add, they are ideal for early presbyopes or VDU users who need only a mild accommodative boost. As presbyopia progresses, a blended monovision approach, over-readers, or a switch to Revive/Delta may be needed.

  • Available diameters: 9.8, 10.0, 10.2 mm

Revive Plus
A distance-centre back-surface bifocal offering a full reading power effect. It provides smooth switching between DV and NV, although a small intermediate “no man’s land” may exist. Slightly over-plussing the DV can improve VDU performance. Many patients find managing two clear focal points preferable to the softer multifocal effect—especially those using laptops or tablets rather than traditional VDUs.

  • Standard diameter: 9.5 mm, designed to promote lens translation and enhance the NV effect
  • Note: The back-surface design may cause slight corneal moulding, leading to blurred vision in specs for 1–2 hours after removal.

Delta Plus
A segmented bifocal with a distinct distance and near zone. Reading enhancement is activated when the patient looks down and blinks. Like Revive, it provides a full add effect.

  • Standard diameter: 9.5 mm to encourage lens translation for improved NV function

Fitting Considerations

  • Lens Position: For multifocal or bifocal designs to function optimally, centration is essential. If lenses decenter significantly (high or low riding), monovision is often the more reliable strategy. Adjusting BOZR can help modify lens position or movement.
  • Pupil Size: Less critical in translating GP lenses than in soft multifocals, but small pupils (<3.5 mm) may still limit performance.

Final Design Selection

Choose the most appropriate design based on the patient’s visual needs, lifestyle, and tolerance established during the consultation.