Fitting Procedures
The back surface of the AccuFocal and AccuFocal Plus flatten very rapidly from apex to edge. This flattening rate (eccentricity) produces the progressive add effect. It also substantially alters the sagittal depth/lens fitting relationship. In order to offset this rapid flattening, the apical radius must be fit substantially steeper than the flattest corneal meridian. A properly fit lens MUST center well and have good pupillary coverage. A spherical over refraction should be performed with only trial lenses. Push maximum plus for 20/20 binocular distance vision acuity.

Base Curve Selection
The initial base curve of the AccuFocal should be fit 2.50 steeper than the flattest "K". AccuFocal Plus should be fit 3.00 steeper than the flattest "K".

Diameter Selection
The diameter should be 8.8 mm to 9.4 mm with the average 9.2 mm. If the cornea is on the steep side fit a smaller lens. It is on the flat side fit a larger lens.

Power Determinations

1. AccuFocal should be fit on patient's who have add powers up to and including + 1.50.
2. AccuFocal Plus should be fit on patient's who have add powers + 1.75 or greater.
3. An over-refraction in spheres only must be performed separately for distance and near.
4. The distance over-refraction is done first and the result should be the most plus power that provides 20/25 vision monocularly.
5. Place the over-refraction in a trial frame and have the patient read binocularly.
6. If near acuity is J-1 or J-2, order the lenses. If near acuity is less than J-2 you will have to do a near/far power balance.

Near/Far Power Balance¹
If near vision is not acceptable, begin adding plus BINOCULARLY in + 0.25 steps in a trial frame. As you add plus keep rechecking both near and distance acuity. NOTE: You are trying to achieve good visual acuity for distance and near simultaneously. Therefore, it is important to add only + 0.25 sphere at a time to the distance Rx so that a correct power balance is achieved. Maximum plus at distance is the key, especially for those older patients requiring adds of +2.50 or greater. Sometimes, a modified monovision may be employed with this lens on higher add patients. Like a spherical mono fit, distance visual acuity will be blurred for distance in the near eye. However, the reduced acuity will be much less severe.

Conclusions
It is important to trial fit the AccuFocal lens to obtain the proper power balance for distance and near. Beware of patients with high adds. Usually add powers greater than + 2.50 will obtain good visual acuity for near and distance simultaneously. A proper fit lens will have good papillary coverage and center well. Maximum plus must be pushed when over refracting for distance. When performing the power adjustment make sure to use trial lenses only and to recheck distance acuity frequently.

Important Criteria

1. Fit lenses on patients with + 2.50 adds or less who do not have lenticular astigmatism or high corneal astigmatisms.
2. The base curve should be fit at least + 2.50 steeper than the flattest K.
3. The lens must center well.
4. Over refraction should be done with trial lenses only.
5. Maximum plus must be prescribed for distance.
6. When performing the distant/near power balance, keep rechecking distance acuity. Do not fit the lens if you cannot obtain good visual acuity for near and distance simultaneously.