I got an unwelcome present for my 44th birthday: presbyopia. Yes, the classic arms-too-short scenario started to happen often enough that I could no longer avoid it. Having worn contacts since age 20, I was reluctant to give them up. Glasses are too visually distracting, especially while driving—the loss of peripheral vision has always been a deal-breaker to me. And as someone who tends to watch TV with an iPad on my lap, I especially found it fatiguing to shift focus so often between the two screens (my eyes couldn’t keep up with my ADHD). Lastly, in my line of work, I do a whole lot of near-vision tasks.
So, I had three specific real-world visual scenarios in mind when I went to my optometrist. Your patients’ issues may differ from mine, but the transition into presbyopia is not a pleasant experience. For many people, it’s their first age-related change of any kind—and, for that reason, patients are highly motivated to make it go away.
As contact lens specialists discuss this month (see “The Multifocal Contact Lens Market: It’s Yours to Lose.”), the opportunity to better serve this patient group is often literally right in front of you. Unfortunately, the view from the other side of the slit lamp is that we emerging presbyopes are more enthusiastic about this than you are.
Although multifocal lens designs have improved considerably, eye care professionals still consider them the redheaded stepchild of the family far too often. When presbyopic contact lens correction is brought up, it’s usually monovision that gets the attention, because it’s considered easier for the practitioner and cheaper for the patient. That deference to our wallets is certainly appreciated, but I speak for many of my brethren when I say I’d be glad to pay more for a better product, particularly given that monovision is a stop-gap measure. Once the presbyopia advances, patients have to abandon it—and contact lens wear too. By then, the transition to multifocals will be too hard. But those who start adapting to multifocals early on can gradually progress with them as their presbyopia does.
Look at the graph of contact lens wear among different age cohorts in "The Multifocal Contact Lens Market: It's Yours to Lose." It traces a (somewhat misshapen) bell curve with a peak in the early-30s group, followed by an inexorable decline to zero as age progresses. For whom does this bell toll? For thine contact lens practice, if you let these trends continue without intervention.
Everyone knows the aging of the population is transforming the demographics of optometric practices. Expect the proportion of your traditional contact lens-aged patient base to shrink as a consequence.
Industry research shows that 16% of contact lens wearers drop out every year—and this has held steady for the last 20 years, despite improvements in technology along the way. The number one reason is discomfort, an obstacle strongly correlated with poor compliance. So the first order of business is to be more forceful in your policing of lens wear-and-care habits. But getting more attuned to the visual demands of presbyopes runs a close second in terms of priorities.
The 16% of patients who drop out every year have been replaced by, coincidentally, the same amount of new lens wearers each year. But this parity between those entering and those exiting won’t last forever. You’ll end up working harder to replace a growing number of patients with a shrinking base of new recruits. Meanwhile, a huge group of patients will be deprived of a correction they’d clearly desire.
What to do
First, master the techniques. Fitting multifocal contact lenses is a bread-and-butter optometry service that needs to be a part of your everyday repertoire. If not you—who? Opticians can’t, and ophthalmologists don’t want to bother.
Second, get over any hang-ups about price-sensitive patients. We emerging presbyopes don’t mind paying for value. Identify the specific visual tasks that concern your patient the most, and direct the conversation to how you can help.
Lastly, be enthusiastic! If you discuss presbyopia in the grave tones of a cancer diagnosis, patients will get apprehensive and bail. Tell patients all about the compromises, of course. But then flaunt your unique abilities to help us put off, a wee bit longer, our need to acknowledge the aging process. Trust me, we’ll be glad to play along.