By setting reasonable expectations and meeting the patient’s visual needs, you can keep patients in lenses into their 40s and beyond.
When a contact lens patient age 40 or older presents for an annual exam complaining of problems with near vision, dryness or discomfort, do you recommend glasses with progressive addition lenses instead? Do you tell the patient to buy over-the-counter readers? If so, you are missing an opportunity to improve the patient’s visual comfort and satisfaction with contact lenses.
Ideally, a discussion about presbyopia should begin before the patient notices difficulties at near. As he or she approaches age 40, you should begin to mention that there are contact lens options to help near vision when it starts to become more difficult. This plants the idea that it is possible to continue to wear contact lenses into middle age and beyond.
MULTIFOCAL VS. MONOVISION
Now that the patient has begun to experience problems with near vision, the strategy you try first will depend on several factors. Distance prescription, occupation and personality all play a role. For example, does the patient need perfect distance vision, such as a truck driver might? Is there a greater requirement for comfortable near vision for working at a computer all day? Is the patient easygoing or demanding?
Once you discuss the patient’s visual needs and set expectations, do you do a trial fit of monovision or multifocal contact lenses? One advantage of multifocal lenses: They keep patients in a more natural binocular state. They also allow for clear vision at a gradual range of distances. When you explain multifocals and monovision, most patients will opt to try multifocals first.
Not every patient will be a great candidate for multifocals, however. Patients who require perfection at distance and near are obviously a challenge. Monovision often works better with the exacting nature of these patients’ visual needs. A significant amount of astigmatism also is a problem, as soft multifocal toric lenses are not always successful.
Another challenging group to fit with multifocals are emmetropic patients. While multifocals are available in emmetropic prescriptions, these patients often will not tolerate the blur at distance required to make them work.
ADDRESS DRY EYES
While providing patients with acceptably clear vision may seem like the biggest challenge in fitting presbyopes, studies show that more than half of them discontinue contact lens wear due to dryness and discomfort.
Treatment of underlying ocular disease is essential as you begin this process. By treating dry eye aggressively, patients will be comfortable in their lenses for more hours of the day. Fully evaluate the root cause of patients’ dry eye, and treat them with lid hygiene, warm compresses, fish oil supplements and prescription drops, as appropriate. Also, if you proactively recommend appropriate artificial tears to use with their contact lenses, you can increase patients’ comfort during the trial period.
Aging eyes are especially prone to dryness, so fitting patients in comfortable, breathable lenses is important. With advances in silicone hydrogel materials, there’s no reason not to put the patient in a lens that delivers plenty of oxygen to the cornea. A range of silicone hydrogel multifocal contacts are available, so you have healthy lens options to offer all your presbyopic patients.
THE DAILY DISPOSABLE OPTION
Some patients may not get enough near correction in any lens to wear contact lenses for a long workday at a computer. While many presbyopic patients are willing to wear glasses with progressive lenses for a nine-to-five job, they long for the ease of contacts in their off hours. Daily disposables are a perfect part-time solution. The ease of care makes them ideal for a hiking trip or an evening out.
If you ask former contact lens wearers whether they ever would like to wear contacts again, the answer will often be yes. Part-time wearers are often easier to fit because they have lowered near visual demands. They don’t need perfect near vision, and they’re often happy with just enough add power to glance at their phone or a map. By providing these patients with a few boxes of daily disposables along with their glasses, you’ll increase patient satisfaction and grow your practice.
Presbyopic contact lens dropouts represent a missed opportunity to provide patient satisfaction and grow your practice. With new contact lens technology, there are a wide variety of options that can keep patients out of full-time spectacle wear. The key to a straightforward fit with less chair time is managing the patient’s expectations. Fully discuss the tradeoff with each method before the trial lens fit, and contact lens patients will enjoy wearing lenses for many years.
Jenny Kiernan, OD, a graduate of the University of Missouri-St. Louis College of Optometry, specializes in fitting contact lenses at Eye Consultants of Colorado in Conifer, CO.