For a patient wearing multifocal soft lenses, what is the best method to perform over-refraction?

Over-refraction for patients wearing multifocal soft lenses typically involves determining the best visual correction that complements the existing lens prescription to achieve optimal visual acuity at various distances. Among the various methods listed, using a pinhole is particularly effective in this context.

The pinhole technique eliminates peripheral rays of light that can cause blur, thereby allowing the examiner to focus only on the central rays. When a patient looks through a pinhole, only light coming straight from the lens is allowed to enter the eye, helping to assess the true refractive state of the eye without the influence of blur from the multifocal design. This is especially important with multifocals, as patients often experience varying clarity based on their gaze direction and the lens's design.

While other methods can also be utilized in over-refraction, they do not specifically address the challenges presented by multifocal lenses as effectively as the pinhole. Autorefractors can provide a swift assessment but may not properly account for the multifocal nature of the lenses since they primarily assess the eye in a stationary position. A phoroptor might offer precision in determining refractive errors, but it might not be as helpful in the dynamic situations commonly experienced with multifocal wearers. Hand-held lenses can be useful