Reflex Toric Multifocal is best fitted by providing us with your patient’s K’s and spec Rx including add.  You should expect to receive a lens with an add power +0.50 greater than the spec add.

When evaluating the lens you should look for good movement and centration. Any rotation should be measured and note if the rotation is stable. Use the LARS rule to recalculate for stable rotation. If the rotation is unstable consider reordering with a steeper base curve.  Reorder lenses to achieve stable rotation before assessing vision.

On initial assessment of vision try to encourage the patient to look at real-life objects rather than test charts, for example, get them to look out of the window for distance and look at their watch or phone for near vision.  If possible don’t over refract at this stage as the patient is still in the very early stages of adaptation.

After a week of wear reassess the lenses and if needed over refract using handheld lenses instead of a trial frame or phoropter.  Over refraction is best carried out binocularly and if needed consider a modified monovision approach prioritising distance vision in the dominant eye and near vision in the non-dominant eye.

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