Contact Lenses

The Multifocal CL that Is My First Choice for Presbyopic Patients

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By Kenneth Daniels, OD, FAAO, Dipl. ABO

June 9, 2021

“Susan, I can’t see the menu. Can I borrow your glasses?”

“Sure, I don’t need them. I have multifocal contacts from Dr. Daniels.”

Presbyopia can be frustrating for patients, but at the same time, can be a major practice boost if addressed with the appropriate options. The right multifocal contact lens can change the lives of these patients, giving them a sense of youthful vision. Patients who previously had to wear glasses all the time, or reading glasses over contact lenses, can suddenly see near and far without having to worry if they remembered to put their glasses in their purse or pocket. Here is the contact lens, NaturalVue Multifocal 1 Day Contact Lenses, making it easier for me to deliver high-quality binocular vision for presbyopic patients.

A Completely Different Design than Any Other One-day Multifocal Lens
My practice has been fitting patients with NaturalVue lenses from the time they were introduced to the market several years ago.

NaturalVue is a first-choice multifocal lens for me and my patients because it has a completely different design than any other one-day multifocal lens currently on the market.

NaturalVue’s extended depth of focus (EDOF) design allows for a more balanced level of binocular vision at multiple distances (distant, intermediate and near). The majority of other one-day multifocal designs use a form of blended near centered aspheric optic-concentric design, which forces the practitioner to balance a combination of add powers to minimize the binocular compromise. We did studies several years ago on these designs and found that early presbyopia required a combination of Lo – Lo then graduated to a Lo – Medium as the near-task demand increased or with required add increase subjectively. As time and maturity progress, this requires refitting to combinations Medium – Hi, Lo –HI, etc., based on the visual needs of the patient and the level of subtle binocular blur acceptance.

By contrast, NaturalVue avoids that complexity by using the NaturalVue calculator to determine the initial diagnostic lens. Using this application, and having a standard skew of lenses from +4.00 to -12.25 in 0.25 steps, allows for a much more rapid and less complex lens selection and adjustment when needed.

The fitting is incredibly simple: After completing a well-balanced subjective refraction (including binocular duochrome), enter the data into the Quickstart calculator to get the starting lens powers. Place the lenses on the eye and take a few minutes to discuss and explain to the patient how the lens works while the lenses settle. After the lens settles, evaluate the fit and then evaluate the vision. Note that the key is not to perform an over-refraction, but to listen to the patient and adjust based on the level of acuity at near, intermediate and distance using the suggestions of the calculator. Do not be surprised if you may be slightly biased to the minus side of what you would traditionally consider. This is due to the EDOF design. Also, due to the EDOF optics, you will find that low subjective cylinder is also corrected.

Conversation Leads to Educated & Happy Patients
The art of conversation, demonstration and introduction to the concept of NaturalVue and EDOF technology – virtual pinhole is all that is needed to start on the path to happy multifocal contact lens patients. In the history and in summations, I discuss every refractive option, which allows the patient to state their preference and opens the door to various eyeglass options (including UVA protection) and/or transition to contact lenses (new fit or refit) or even refractive surgery. If you do not give the patient all of their options, they assume there is no contact lens option or that you do not offer it.

Remember, to satisfy the needs of the patient in this complex visual world, a patient may need to utilize various modalities (contact lenses or spectacles). Be sure to explain to the patient: “There are many options, if one fails, we have other options.” This also justifies your fitting and material fees. When you understand the nuances of fitting multifocal lenses, the revenues will quickly follow. This builds over time, as a happy patient is a loyal patient who spreads the word, and the revenue follows.

Many new patients have said to me, “My last doctor never told me there were such things as ‘bifocal or multifocal contacts.'” This is unfortunate because it does a disservice to the patient. Some doctors, who do not educate patients about multifocal contact lens options, may be concerned about the cost of additional chair time. This applies not only to contact lenses, but also to cataract and LASIK co-management.

The great part about NaturalVue is the chair time is minimal. In all cases, after making the appropriate notes on my conversation with the patient, and dispensing the optimized trials, I tell them, “You can call me to say you the love the lenses and order, or if you need a slight adjustment at near or distance, just call or e-mail me and I will provide you with some additional trials to address your needs.” NO additional chair time is required – and no extra visit unless needed.

Create an “Annual Annuity” & Competitive Advantage Over Online CL Sellers
A good contact lens patient presents as an annual annuity via re-purchase. Our goal is to make the patient happy and offer competitive pricing to keep the patient’s order within our office. This is where managed care can be beneficial, using the patient’s benefits in conjunction with rebates. For example, if you charge $110 per box of lenses, this would equal $880 per year, minus vision plan of $150 minus a rebate of $100. The final cost to the patient is $630 or $78.75 per box (35 percent less per box). The patient will find neither that price, nor the service you provide, online.

Share Your Own Experience with Patients
Being a presbyope myself, but still a kid at heart, makes it easier to tell the patient that I am wearing NaturalVue 1 Day Multifocal contact lenses myself. I explain that I wear them in the office, but at home I have computer readers and progressive eyeglasses, which gives me the freedom to choose the best corrective eyewear option for each of my activities. If you, as the practitioner, are not yet blessed to be presbyopic, it goes back to the art of conversation. No need for fancy videos. The patient wants to be presented their options of treatment and have a discussion with their doctor about which modality would best suit them.

NaturalVue is a lens that can deliver superior visual and binocular performance. Patients will quickly “see” exactly what you were talking about and return for care over a lifetime.

Kenneth Daniels, OD, FAAO, Dipl. ABO,  is past president of New Jersey Society of Optometric Physicians (2017-2018), Adjunct Assistant Clinical Professor: PCO and owner of Hopewell-Lambertville Eye Associates. Dr. Daniels is a paid consultant for Visioneering Technologies. To contact him:




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