By 2030, one in five Americans will be 65 years old. 1 As the US population continues to age, so does the need for treatment options for presbyopia. Many patients look for options other than glasses to correct their intermediate and near vision. They need a choice that fits seamlessly into their daily lives and doesn’t highlight the fact that their eyes are aging.
Multifocal contact lenses are a great solution to presbyopia, and certainly not new. However, some ophthalmologists are still trying to use multifocal contact lenses in their practice. RELATED: Contact lens therapy is critical to removing traces of coronavirus Adapting to this treatment not only ensures patients have access to the latest eye care technologies, but also maximizes the success of the practice from a business perspective.
1: Plant multifocal seeds. Presbyopia is a growing market. More than 120 million Americans have presbyopia, and many of them don’t realize they can wear multifocal contact lenses. 2
Some patients find that progressive lenses, bifocals, or over-the-counter reading glasses are their only options for correcting near vision impairment caused by presbyopia.
Other patients have been told in the past that multifocal contact lenses are not suitable for them due to prescription values or the presence of astigmatism. But the world of multifocal contact lenses has evolved and there are many options for patients of all prescriptions. A recent study found that 31 million people buy OTC reading glasses each year, usually from a supermarket or pharmacy. 3
As primary eye care providers, optometrists (OD) have the ability to inform patients of all available options so they can see better and improve their quality of life.
Start by telling patients that multifocal contact lenses can be a primary form of vision correction or an option for part-time, hobby, or weekend wear. Explain how contacts work, how they work, and how they fit into everyday life. Even if patients ditch multifocal contact lenses this year, they may want to rethink their option in the future. Related: Researchers are testing self-moistening 3D-printed contact lenses
Ophthalmologists often interact with patients outside of the exam room, which can give them the opportunity to educate patients about multifocal contact lenses.
2: Follow the installation instructions. It is important to follow the fitting instructions that come with each contact lens. This is especially true for multifocal contact lenses, as different brands have different optical zones and wearing strategies. Companies are frequently revisiting their contact lens fitting recommendations as more contact lens data becomes available through patient use. Many clinicians create their own customization methods. This may work for a short time but usually results in increased chair time and a low success rate in patients with multifocal contact lenses. It is recommended that you periodically review the manuals for the contact lenses you wear regularly.
I learned this lesson many years ago when I first started wearing Alcon Dailies Total 1 multifocal lenses. I used a fitting method similar to other multifocal contact lenses on the market that links low/medium/high focal length multifocal lenses to the patient’s ability to add ( ADD). My fitting strategy did not meet fitting recommendations, resulting in extended chair time, multiple contact lens visits, and patients with mediocre contact lens vision.
When I went back to the setup guide and followed it, everything changed. For this particular contact lens, add +0.25 to the spherical correction and use the lowest possible ADD value to get the best fit. These simple transitions resulted in better results after the first contact lens trial and resulted in reduced chair time and improved patient satisfaction.
3: Set expectations. Take the time to set realistic and positive expectations. Instead of aiming for perfect 20/20 near and far vision, functional near and far vision would be a more appropriate endpoint. Each patient has different visual needs, and each patient’s functional vision will vary greatly. It is important to inform patients that success lies in their ability to use contact lenses for most of their daily activities. Related: Study Shows Consumers Don’t Seriously Understand Contact Lenses I also advise patients not to compare their vision with multifocal contact lenses to their vision with glasses because it’s an apples-to-oranges comparison. Setting these clear expectations allows the patient to understand that it is okay not to be a perfect 20/20. However, many patients get 20/20 both at a distance and near with modern multifocal contact lenses.
In 2021, McDonald et al. proposed a classification for presbyopia, dividing the condition into mild, moderate, and severe categories. 4 Their approach focuses primarily on classifying presbyopia through near vision correction rather than age. In their system, best-corrected visual acuity ranged from 20/25 to 20/40 for mild presbyopia, from 20/50 to 20/80 for moderate presbyopia, and above 20/80 for severe presbyopia.
This classification of presbyopia is more appropriate and explains why sometimes presbyopia in a 53-year-old patient may be classified as mild, and presbyopia in a 38-year-old patient may be classified as moderate. This presbyopia classification method helps me select the best multifocal contact lens candidates and set realistic expectations for my patients.
4: Get new adjuvant therapy options. Even if the right expectations are set and fitting recommendations are followed, multifocal contact lenses will not be the ideal formula for every patient. One troubleshooting technique that I have found successful is using Vuity (Allergan, 1.25% pilocarpine) and multifocal contact lenses for patients who cannot achieve the desired definition at or near the midpoint. Vuity is the first-in-class FDA-approved drug for the treatment of presbyopia in adults. Related: Addressing Presbyopia Contact Lens Loss Compared to pilocarpine, pilocarpine’s optimized concentration of 1.25% combined with patented pHast technology makes Vuity different and more effective in the clinical management of presbyopia.
Vuiti is a cholinergic muscarinic agonist with a dual mechanism of action. It activates the iris sphincter and ciliary smooth muscle, thereby expanding the depth of field and increasing the range of accommodation. By reducing the pupil, as in pinhole optics, near vision is improved.
Vuity completed 2 parallel Phase 3 clinical trials (Gemini 1 [NCT03804268] and Gemini 2 [NCT03857542]) in participants aged 40 to 55 years with distance-corrected visual acuity between 20/40 and 20/100. Clinical trials have shown that in myopia (low light) there was an improvement of at least 3 lines, while distance vision did not affect more than 1 line (5 letters).
In the photopic state, 9 out of 10 study participants improved near vision better than 20/40 in the photopic state. In bright light, a third of the participants were able to achieve 20/20. Clinical trials have also shown improvement in intermediate vision. The most common side effects with Vuiti were conjunctival hyperemia (5%) and headache (15%). In my experience, patients who experience headaches report that the headaches are mild, transient, and only occur on the first day of using Vuity.
Vuiti is taken once a day and begins to act within 15 minutes after instillation. Most patients report that this lasts 6 to 10 hours. When using Vuity with contact lenses, drops should be instilled into the eyes without contact lenses. After 10 minutes, the contact lens can be inserted into the patient’s eye. Vuiti are prescription eye drops that you can buy at any pharmacy. Although Vuity has not been studied in combination with multifocal contact lenses, I have found that in some cases this combined complementary approach allows patients with multifocal contact lenses to achieve the desired improvement in near vision.
Post time: Sep-11-2022
