Lens Choices

When was the last time you saw an ad or marketing materials for bifocals or trifocals? If you have to think about it for more than a moment, you’ll realize how long it’s been since these lenses have dominated the dispensary.

Eclipsed by the more technologically advanced progressive lenses, which offer greater visual and cosmetic benefits to many wearers and generate bigger profits for manufacturers, wholesalers, eyecare professionals and retailers, conventional, segmented multifocals are experiencing a slow, steady decline in popularity. That decline has been hastened by lens manufacturers that have eliminated less-profitable, commodity multifocals while pursuing a policy of benign neglect when it comes to marketing their remaining multifocal product lines. Some lens manufacturers have even gone on the attack, disparaging segmented multifocals as “200 year-old-technology.”

The shrinking market for these lenses is also contributing to the decline. The older generation of bifocal and trifocal wearers is gradually dying out and most emerging presbyopes are either buying readers or progressives.

Although progressive lens sales bring in bigger bucks, unit sales of segmented multifocals remain solid. Millions of pairs of conventional multifocals are still sold every year to loyal customers who wouldn’t be caught wearing any other lens. According to Jobson Optical Research, the total lens market for the 12 months ending in March 2003 was 72.7 million. Of that, 50.0 percent (37.0 million units) was single vision, 26.0 percent (18.9 million units) was bifocals/trifocals and 23.1 percent (16.8 million units) was progressives.

Who’s buying all those segmented multifocals? “Most common bifocals and trifocals are presently dispensed for people in four different categories,” says John Miller, vice president of sales and marketing for X-Cel Optical, one of the few companies that actively promotes bifocals and trifocals. According to Miller, the four categories consist of people who never have worn a progressive lens and don’t care to try one; people who have tried unsuccessfully to wear progressive lenses and cannot adapt successfully; people who need “task specific” multifocals for occupation or recreational activities; people who need the lenses for specific clinical vision problems.

Most dispensers regularly encounter patients from the first two categories.
“We’re a cataract center and a lot of our patients are bifocal wearers,” says Page Savin, optical manager at Clayton Eye Center, a full-service eyecare facility in Morrow, Ga. “Because some patients feel completely happy with those lenses, the doctors don’t feel a need to switch them to progressives. For a patient who is cataract-age and accustomed to wearing a lined multifocal, they don’t want to start learning to use a lens again. But if a patient tries a progressive and it doesn’t work for them, we’ll put them back in a lined multifocal for no extra charge.”

When dispensing bifocals, the opticians at Clayton Eye Center favor flat-top 28s and 35s, Savin reports. She also notes a recent increase in sales of 8x35 trifocals, “because they offer a wider reading area.”

One bifocal Clayton opticians do not recommend is the full-seg “Executive” style popularized years ago by American Optical. “If they’re wearing an Executive, we try to get them out of it because the design of lens makes it thicker and heavier,” says Savin.

Many patients at Bundy Opticians in San Mateo, Calif. are also longtime bifocal wearers. “We’ve been in business for 45 years,” says owner Gerry Bundy. “We have a lot of old timers who don’t want to make a change.” Bundy will typically discuss lens options with these patients, including progressives, but many often remain with bifocals.

“I talk with them and see if they’re the type of individual who can make the change,” he says. “If you get someone outside their comfort zone, they may not want to change.”

Focusing on Options
Bundy points out that even patients who stick with their familiar bifocal or trifocal can still benefit from premium lens treatments that enhance the performance and appearance of the lens. He packages bifocals together with options such as UV coating or scratch-resistant coating or photochromics. Bundy also does a good business in polarized lenses because his older patients tend to be glare-sensitive. “Easily 90 percent of our prescription sunglasses are polarized, because we take the time to explain the difference with and without polarization using brochures and demonstration units.

“Many of them also ask about night driving, which leads us down the path to AR coating,” adds Bundy. “In most cases, the patient is very pleasantly surprised by the effect.”

Clayton Eye Center’s Savin says her staff also stresses the benefits of AR, although for a different reason. “We’ll focus on options such AR, because of the patient’s sensitivity to glare before and after cataract surgery,” says Savin. “Also, because we’re in the south, we make sure all of our patients are educated about photochromics and UV.”

Addressing Task-Specific Needs
Lloyd Malsin, optician and owner of Clairmont-Nichols, an upscale optical shop on Manhattan’s East Side, dispenses a lot of progressive lenses. Yet he often recommends bifocals to patients. “If progressives were 100 percent satisfactory, everyone would be wearing them,” he observes. “That’s why the lens companies offer non-adapt policies.”

There are many reasons to use a conventional bifocal, according to Malsin, who dispenses at least three or four pair a day, amounting to about 10 percent of his total multifocal sales. “It might be an advantage to someone who has antimetropia, when one eye sees far, and the other near. A bifocal might minimize the jump. It can also help someone who has anisometropia, when there is a difference in image size between two eyes.”

Malsin also recommends bifocals for patients who have specific visual tasks required for their job or recreational activities. “For a radiologist who has tremendous peripheral intermediate needs and who has a reading need as well, we feel that a flat-top 35 or 45 might be the best choice,” he says.
Like many dispensers, Malsin often fits golfers with bifocals. “If they have purely distance needs with an occasional view to a scorecard, that person is probably best fit with a conventional bifocal low and out of the way.”

Fly fishing is another activity that can be enhanced with bifocals. “A progressive is a wonderful lens, but it often gets in the way of a fly fisherman’s field of vision,” says Bundy. “If you can put a bifocal in the lower part of their field, it helps them when they’re tying a fly. For the most part they’re interested in distance, so you want to give them a larger distance field of vision. A lot of time they’re looking down, not at the horizon, so the bifocal gives them a clear field of vision below eye level.”

Bundy says many people can also benefit from bifocals while engaged in everyday activities. “We find these lenses are helpful for people who are multitasking. For example, they might be casually reading or watching TV and want to get in a more relaxed position. It’s hard to watch and sit erectly while wearing a progressive. So we offer them both reading glasses and bifocals for their intermediate needs. You can’t watch TV with reading glasses and with a progressive you have to turn your head. For those instances, why not consider a standard bifocal?”

Unfortunately, the range of bifocal and trifocal options is shrinking, as fewer conventional multifocals are produced each year and very few new segmented multifocals are being introduced. “It’s criminal that big companies are eliminating options for bifocals,” says John Launder, a dispenser at the ophthalmology practice of Bruce Kirschner, MD, in Burlingame, Calif. “It’s been getting more difficult to get any flattops. Recently, I couldn’t get a 1.67 bifocal. I can’t get a flat-top polycarbonate Transitions lens. Even the labs are resistant. The situation is making people who wear these lenses have to switch to progressives. That becomes a frustrating situation for the patient and the optician.”

Despite manufacturers’ cutbacks and the shrinking market, bifocals and trifocals are likely to be around in one form or another for a long time to come, at least as niche products. As long as these lenses serve special vision needs, dispensers may continue to rely on them for another 200 years.

Dispensing Occupational Multifocals
Occupational multifocals are specialized lenses whose design attributes optimize visual tasks for presbyopic patents. Certain prescription ranges may be problematic and dispensers are advised that a bit of research may be required in tracking down these designs. Larger lens manufacturers are beginning to discontinue some designs. Some labs no longer inventory them, but the labs that still inventory these products often have fitting guidelines and other technical support available.

The most important issues dispensers must consider when selling these lenses are selecting a frame that features enough room for the segments to be utilized, having patients measure their work distances and correcting their vision for these distances, since they often differ than typical reading distances.

While these unique lenses will never garner immense sales, as the population ages and workers stay in their jobs longer, demand for the lenses will continue.

Double Segment Bifocals
Available in executive bifocal, flat-top and round segment designs and commonly called double-Ds or “DD Segs,” these lenses are basically double bifocals. In other words, there’s the usual bifocal segment in the lower portion of the lens and an additional bifocal segment in the upper portion of the lens. Segment size and placement vary depending on manufacturer.
Patients: For jobs that require patients to see near objects above their heads, such as pilots, machinists and plumbers.

These are the trifocal versions of the double segment designs and can be simply described as a trifocal with a bifocal segment on top.
Patients: Occupations are similar to those requiring a double segment bifocal, although patients requiring a quadrafocal either are more advanced presybopes or they require an intermediate zone.

Occupational Trifocals
Occupational trifocals come in a variety of designs. The basic concept is an intermediate segment that is larger than traditional trifocals. Flat-top designs, which have the largest intermediate segment in this category, include 10mm x 35mm, 12mm x 35mm and 14mm x 35mm. Occupational trifocals are also available in executive, curve top and “CRT” designs. Some add powers for the intermediate zones in occupational trifocals are higher than the traditional 50 percent, which can be extremely beneficial to advanced presbyopes. Check with manufacturers for segment size, placement and intermediate add-power.
Patients: Anyone who uses the intermediate, usually a more advanced presbyope. Occupations include computer users, draftsman, accountants and pianists.

Ribbon and Bar Segments
The bifocal segments are minimized in these lenses, placed on the lens so there’s a distant zone both above and below the segment. Ribbon and Bar refer to the shape of the segment. Depending on patient needs, the lenses can be edged in such a way to manipulate segment location, i.e., they can be more toward the periphery or the center, depending on patient preference.
Patients: In general, anybody who has minimal requirements for a near zone or requires a distance zone below the bifocal segment. For example, railroad switchmen need a near zone, but also need a distance zone below the near segment so they don’t lose their footing on ladders. Mail carriers, house painters and meter readers are other examples of patients. —Timothy Herrick