Understanding Tool Logic & Output

• "Calculated CL Targets" Section:

  This shows the theoretical CL powers after VC and rounding, *before* checking specific lens availability.

  • Raw VC Power: Unrounded result from the VC formula.
  • Final Rounded Target Power: Raw power rounded using the sphere/cyl rules. This is the "ideal" target.

  Use this as a reference to understand the calculation steps.

• "Target Sphere" in Lens Results:

  Usually refers to the Final Rounded Target CL Sphere, unless notes indicate SE compensation or substitution (see Tab 1 & 3), or a fitting guide adjustment (e.g., Clariti MF).

• Correction Type / Dominant Eye Options:

  These only activate if Near Add > 0.00D, as they relate to presbyopia correction (Monovision or Multifocal). Dominance is needed for Monovision and some MF designs (e.g., CV Biofinity D/N).

• Correction Type - Monovision Explained:
  • Goal: One eye (dominant) corrected for distance, the other (non-dominant) for near.
  • Calculation:
    1. Full Near Add is added to the *spectacle* sphere of the non-dominant eye.
    2. Vertex correction is performed separately on the dominant eye's distance Rx and the non-dominant eye's adjusted (distance + add) Rx.
    3. Looks for standard *Spherical* or *Toric* lenses matching these two different targets.
  • Result Display: Standard Sph/Toric lenses shown. Non-dominant Rx is higher (more plus/less minus). Notes indicate "[Monovision Near/Distance Eye]".
• Correction Type - Multifocal Explained:
  • Goal: Simultaneous distance and near vision in both eyes via lenses with different power zones.
  • Calculation: Uses *generalized* principles based on spectacle Add to select an initial CL Add power (Low/Med/High or +1.00, etc.) and sometimes a design (e.g., D/N) based on database rules (see lens data). Some guides (like Clariti MF) also require initial sphere adjustments based on Add/Dominance/Rx. The tool attempts to apply these adjustments to the *Final Rounded Target CL Sphere* before displaying the starting Rx.
  • Result Display: Shows Multifocal or Multifocal Toric lenses with a recommended Add/Design and potentially an adjusted sphere.
  • Crucial Note: Multifocal fitting varies significantly by brand. Always consult the specific manufacturer's fitting guide. This tool offers only a *potential* starting point, including attempted fitting guide adjustments.

Interpreting Lens Matches

• When is Toric Suggested?

  If the *Final Rounded Target CL Cylinder* is -0.75D or stronger (more minus).

• Compromise Fit - SE Compensation (Toric):

  Scenario: Target Cyl > Lens Max Available Cyl (e.g., Target -3.00D, Max Lens -2.25D).

  Tool Action:

  1. Selects Max Lens Cyl (-2.25D).
  2. Calculates sphere adjustment: Adj = (Target Cyl - Lens Cyl) / 2
= (-3.00 - (-2.25)) / 2 = -0.375D.
  3. Adds adjustment to *original target sphere* and rounds the result.

  Result: Notes highlight this ("Sphere adjusted... SE Compensation"). Yellow border.

• Compromise Fit - SE Substitution (Spherical MF for MF Toric Need):

  Scenario: MF Toric needed, but tool shows a Spherical MF lens.

  Tool Action: Sphere shown is the **SE** of the *final rounded target CL sphere & cylinder*. Add is selected per guide.

  Result: Notes highlight this ("Using SE Sphere... Astigmatism not corrected"). Significant compromise. Yellow border.

• Ideal Fit - True Multifocal Toric:

  Scenario: MF Toric needed, matching MF Toric lens found.

  Tool Action: Uses *Final Rounded Target CL Sphere, Cylinder, Axis* directly. Selects Add/Design per guide.

  Result: Corrects astigmatism & presbyopia. **Standard (Green) or Compromise (Yellow)** border/text depending on compensation/adjustments. (Ideal styling removed for BFTM specifically).

• Fit Adjustment - Fitting Guide Sphere Modification (e.g., Clariti MF):

  Scenario: Specific multifocal lens (like Clariti MF) fitting guide dictates an initial sphere adjustment based on Add, Dominance, and Rx type.

  Tool Action: Applies the guide's recommended sphere adjustment (e.g., +0.25D or +0.50D) to the *Final Rounded Target CL Sphere*. The Add (e.g., Low/High) is selected based on the Spectacle Add.

  Result: Notes indicate this ("Guide Adjustment: Sphere adjusted..."). Standard (Green) or Compromise (Yellow) border depending on whether this adjustment *creates* a compromise state.

• Compromise Fit - Distance-Only Toric (for MF Toric Need):

  Scenario: MF Toric needed, but only a standard Toric lens match found.

  Tool Action: Shows standard Toric fit correcting distance sphere/cyl/axis.

  Result: Notes indicate Add is not addressed ("Covers Distance Rx only..."). Yellow border.

• Result Grouping & Ranking:

  Results grouped by Brand, then sorted within the brand:

  1. Special Priority (Ranking): Biofinity Toric Multifocal (if MF Toric needed) will still rank highly due to Lens Type Preference, but uses standard styling.
  2. Best Fit Type (Pair): Ideal Match (Green/Blue, non-BFTM MFT) > Compromise (Yellow) > Standard Match (Green). Considers the *less optimal* eye fit.
  3. Lens Type Preference (Multifocal Mode): Prefers lens matching need (MF Toric > MF > Toric > Sphere), if fit types are equal.
  4. Material: Silicone Hydrogel > Hydrogel.
  5. Alphabetical: Family Name, then Full Lens Name.
• XR (Extended Range) Lenses:

  Only suggested if target power is *outside* the standard lens range (e.g., Biofinity XR vs Biofinity). Often have 0.50D steps. Verify availability and steps with official guide.

• Input Formatting:

  Sphere/Cyl/Add inputs snap to nearest valid 0.25D step from datalist on change/blur (helps format correctly: +/- sign, 0.00).

Applying This in Practice

• Tool Limitations: This tool provides a *calculated starting point* only. It CANNOT replace your clinical judgment or a proper fitting process.
• Essential Clinical Steps (Always Perform):
  • Comprehensive Eye Exam (Refraction, Health Check)
  • Keratometry (Corneal Curvature)
  • Biomicroscopy (Slit Lamp Exam)
  • Tear Film Evaluation
  • **Trial Lens Evaluation:** Assess fit (movement, centration, coverage), vision (over-refraction), and comfort *on the eye*. The first lens is just a starting point!
• Verify Parameters: Lens availability (powers, BC, Dia) changes. Always consult current manufacturer fitting guides or product information.
• Use Fitting Guides: Essential for Toric & Multifocal fitting details, optimization, and troubleshooting.

Illustrative Multifocal Refinement Principles

(General concepts - Consult specific guides for accuracy!)

• General: Assess binocularly after settling (~10-15 mins).
  • Distance Blur: Try +0.25D sphere binocularly (or dominant eye).
  • Near Blur: Try +0.25D sphere non-dominant eye.
  • Modify sphere *before* changing Add/Design. Avoid minus sphere initially.
• CV MyDay: Dom eye fixed Low Add. Refine non-dom sphere/add PRN. Then adjust dom sphere.
• CV Biofinity D/N: Follow D/N rule. Refine sphere first before changing Add/design. (Applies to MF & MF Toric).
• Alcon Center-Near (DT1 MF, Total30 MF, Air Optix MF): Refine sphere +/-0.25D (max plus) before changing Add level.
• J&J Center-Near/Pupil Optimized: Refine sphere first before considering Add change.
• B+L Progressive: Refine sphere first, consider Add change later.
• CV Clariti MF (and Umere MF): Refine sphere first (±0.25D steps). For distance issues, adjust **Dominant** eye. For near issues, adjust **Non-Dominant** eye. **Do not change Add power** during initial refinement.