Product profile

Do zonal multifocals still add up?

By Nick Atkins, FBDO (Hons) CL, FBCLA

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During my optical career, I’ve been very fortunate to work with some innovative and some would say ‘game-changing’ products. When I was at Bausch + Lomb back in the 1990s, we launched the world’s first multipurpose contact lens solution – ReNu – and just before the millennium, the UK’s first silicone hydrogel lens – PureVision. These were exciting times, and it is great that Positive Impact (PI) has provided me with a way to still be involved in launching innovative and, sometimes, revolutionary products.

I’m aware that the phrase game-changing is often used very loosely and sometimes inappropriately; but I believe I have the credentials to be able to recognise truly game-changing products – and we are fortunate to have one in the PI portfolio – NaturalVue Enhanced 1 Day Multifocal (NaturalVue).

In 2019, Visioneering Technologies (VTI) redefined the art and science of vision correction with the launch of a unique extended depth of focus (EDOF) contact lens into the UK market. I genuinely believe that NaturalVue will prove to be the most significant innovation in the optical design of multifocal contact lenses in the last 20 years.

Being the first EDOF daily disposable contact lens with a CE indication for both the treatment of presbyopia and myopia progression control, this unique design will help practitioners address two major areas of unmet need today. Practitioners have known for some time that these two segments are significant business opportunities. It is fair to say that, for presbyopia, traditional multifocal contact lens options take more chair time to fit, as well as to refit when the near add power changes, only to regularly fall short on performance.

SIGNIFICANT MARKET OPPORTUNITY Over the years, contact lens options for presbyopic patients have created challenges for both practitioners and patients. Many emerging presbyopes have grown up wearing contact lenses and they do not want to give them up. Most traditional soft lens designs result in visual compromise for the patient at one distance or another.

In fact, practitioners report up to 85 per cent of patients experience compromised vision at near, intermediate or distance1 (Figure 1). The impact is patient dissatisfaction and drop-out.

The unique, patented EDOF design of NaturalVue provides excellent vision at every distance for presbyopes, that is comparable to spectacles2. Having a totally new multifocal contact lens design provides practitioners with a new tool to address this huge market opportunity.

KEY FEATURES AND BENEFITS The key features and benefits of NaturalVue Multifocal contact lenses include:  A patented EDOF design, which creates a wider range of focus  It is fitted like a single vision (SV) spherical lens  It has a centre distance (CD) design with a universal Add

PATENTED EDOF DESIGN Developed, refined, and tested over nearly a decade, Neurofocus Optics technology applies the principles of pinhole optics and the adaptive power of the human brain to the design of contact lenses. It was designed by Dr Richard A. Griffin, an optometrist, optical engineer and aerospace engineer. From Dr Griffin’s design, VTI holds 14 issued patents worldwide with a further eight pending.

The unique amount of plus power in the design is significant enough to produce peripheral blur. This generates a virtual pinhole aperture to create an EDOF. By introducing a virtual pinhole, Neurofocus Optics technology delivers clear vision at near, intermediate and distance, along with excellent depth perception, enhancing presbyopic patient satisfaction (Figure 2). In clinical trials, patients achieved average visual acuity within two letters of best corrected spectacle vision (BCSV) and stereo acuity nearly equivalent to spectacles (NaturalVue 37” vs. BCSV 33” of arc)2 .

FITTED LIKE A SV SPHERICAL LENS NaturalVue works on the principle that when you get the distance vision clear, the near vision will simply follow. The key to delivering the best vision is to move the focal point along the visual axis closer to the fovea. Once focused on the fovea, the EDOF becomes available to deliver the extended range of vision.

Understandably, though counterintuitive

Figure 2

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Distance Vision Near Vision Intermediate Vision Distance Vision Near Vision Intermediate Vision

Figure 1: Compromises in vision with zonal multifocals2

The Neurofocus Optics® Difference

Results in excellent vision at every

distance.1

Distance Intermediate Near

Figure 2: The Neurofocus Optics Difference: results in excellent vision at every distance2

1. VTI data on file 2015. n=59. Data assessed after 1 week of wear. 2 MKT-NVM-SP1 r3 X

Presbyope First Fit Promotion

NaturalVue Enhanced 1 Day Multifocal contact lenses with Neurofocus Optics® offer excellent vision at all distances, without relying on glasses.1

Fit like a single-vision distance lens

1

1 Universal EDOF design (for an e ective ADD up to +3.00D) Preferred 4:1 over other multifocal contact lenses1 92% repurchase rate1

Buy a 30 or 90 pack & Get a second for FREE

Prebyopes represent the largest and most immediate opportunity to bene t from the unique NaturalVue EDOF design.

Until the end of the year we are offering NEG members an excellent opportunity to double your product margin.

When you order a new presbyopic patient their rst supply (30 or 90 pack) we will only charge you for one pack, not two.

PLUS buy on your NEG account and your NEG member discount and management fee payment applies.

To order call or email customer services on:

Telephone: 01424 834665 | Email: naturalvue@positiveimpact.co.uk | Web: www.vtivision.uk

Terms and conditions: Promotion available to: 1. Accredited NaturalVue tters only; 2. New patient ts only; 3. Named patients only Normal credit terms apply. Promotion ends Sunday 31st December. No other discounts apply. Positive Impact reserves the right to refuse to accept individual orders.

for experienced zonal multifocal fitters, you need to ‘push’ minus powers to ensure the focal point isn’t in front of the fovea as this will blur images at all distances. When fitted following the fitting guide, an 88 per cent first fit success rate is achievable2 . CD DESIGN WITH UNIVERSAL ADD Experience tells us that using a CD design ensures the best distance vision. The challenge with zonal designs is delivering similarly good near vision in this format. By creating a virtual pinhole to generate EDOF, NaturalVue has no Add power in the conventional sense. EDOF allows multiple focal points along the visual axis to be clear.

With Neurofocus Optics and EDOF technology, a range of clear vision can be delivered simultaneously (Figure 3) enabling nearly twice the range of clear vision (up to 76cm) compared to best corrected spectacle vision2. In practice, this means that patients with adds up to +3.00D can be fitted with the single NaturalVue lens design (Figure 4). INTERACTIVE TRAINING AND ACCREDITATION SESSIONS Fitting NaturalVue is very straightforward once you know how. And there lies the nub: the caveat is that you must forget everything you ever knew about how to fit a zonal multifocal. It is for this reason that PI insists that every contact lens practitioner wishing to introduce NaturalVue to their practice and patients undergoes a one-hour, online, peer-to-peer training session to become accredited to fit lenses.

The sessions are relaxed, small group online meetings, ensuring active participation and encouraging questions to ensure understanding. To book a place visit the NaturalVue page on the PI website. ZONAL MULTIFOCALS NO LONGER ADD UP Traditional zonal multifocals create two images for the brain to interpret. Those images are ever-present and so when one is in focus, the other is blurred, to a greater or lesser extent. This blurred image is believed to create the image ‘ghosting’ patients report. This is particularly bothersome on print whilst reading and creates haloes on lights during night driving.

It is widely accepted that it typically takes two to three visits to fit a zonal multifocal contact lens; in fact, many manufacturers’ own fitting information confirms this. This is arguably okay if this time is appropriately charged for and it ends up with a successful patient; but what about when one or neither scenario is met?

A clinical study coordinated by VTI has shown that when the fitting guide is followed to the letter, a successful NaturalVue fit can be achieved in an average of 1.1 visits3 . Thus, if we say zonal multifocals average 2.5 visits versus 1.5 for NaturalVue (being generous to zonal multifocals), that’s at least one whole appointment saved. Not only that, but in addition to saving the cost of that appointment, another NaturalVue patient could be successfully fitted in the time freed up, generating additional revenue and more profit. ONCE IT’S FITTED – IT’S FITTED But the commercial benefits don’t end there. In fact, it’s only the tip of the iceberg from a chair-time saving perspective over the lifetime of the patient. This is because once NaturalVue is fitted, it’s effectively fitted for life. By that I mean that the only reason to change the specification of NaturalVue is if the distance power changes. How so?

Well, the single EDOF design manages to cover a continous range of Add powers right up to +3.00D. This means that if you were to fit an emerging or pre-presbyope successfully with NaturalVue and their distance prescription didn’t change for the

next 30 years, then the patient would simply continue to wear the same specification lenses for that time. The practice simply continues to collect the direct debit for lens supply and an annual check-up. No wonder we call it game-changing. In fact, it seems almost too good to be true doesn’t it? Perhaps this, and being creatures of habit, explains why many practitioners Neurofocus Optics® Technology creates an Figure 3: Neurofocus Optics technology creates an continue to fit the tried and tested lenses Extended Depth of Focus extended depth of focus they feel comfortable with; often doing so by limiting the type of patients they fit, whether by age, prescription or other factors. The innovative design of NaturalVue is proving to deliver excellent results with patients over a wide range of ages and prescriptions. Studies show that 92 per cent of daily activities can be completed without using reading glasses when wearing NaturalVue2 . Studies show NaturalVue contact lenses deliver strong patient satisfaction and retention with:  Patients preferring NaturalVue 4:1 over other multifocal contact lenses2  A 92 per cent repurchase rate4 compared to 57 per cent published annual retention rate for some other multifocal designs5 CONCLUSION Wasn’t it Einstein who referred to our mental state if we continue to do the same things, yet expect different results? For me, continuing to plough the zonal multifocal furrow is a similar analogy. So, if you haven’t tried NaturalVue yet, what are you waiting for? Not only are your presbyopic patients compromised by zonal multifocals, but your practice profitability is too. Changing to NaturalVue Enhanced 1 Day Multifocal is the classic win-win.

Nick Atkins is managing director of Positive Impact and a past president of the British Contact Lens Association.

REFERENCES

1. VTI Data on file, 2013. As reported by eyecare practitioners. 2. VTI Data of file, 2015. N=59. Data assessed after one week wear. Subjective visual ratings based on a scale of 1 -100, 0 = extremely poor/cannot perform, 100 = extremely good/no problems. All values statistically significant, p ≤0.05. 3. VTI Data of file, 2015. N=59. Data assessed after one-week wear. When following the fitting guidelines. 4. VTI Data on file, 2016 after 12-months. 5. Sully A, Young G, Hunt C. Factors in the success of new contact lens wearers. Contact Lens & Anterior Eye 2017 40:15-24. ■