Contact lens specialists Stephen Cohen, OD and Denise Whittam, OD answer some of the most pressing questions about the trend for people with presbyopia to discontinue contact lenses and offer their advice on how eye care professionals can treat this patient population.
Cohen: About half of all contact lens wearers drop out by age 50.Most people have worn contact lenses for years, but when presbyopia begins to appear and patients notice changes in their readings, there is a huge wear and tear.Age-related ocular surface problems can also lead to school dropouts.Many patients in this age group complain that their eyes feel rough, so they cannot wear lenses all day.Given the current dropout rate, the contact lens market is flat: as many patients drop out of school as there are new wearers.
WHITTAM: It’s frustrating for doctors to hear patients — who have been wearing contact lenses as adults — say they’ve stopped.There are many ways we can help people with presbyopia wear contact lenses.We know that when patients are no longer getting the vision they expect, it’s time to educate them about the latest options for multifocals.
WHITTAM: It’s up to the doctor to ask the right questions and discuss presbyopia.I tell patients that vision changes are a normal part of life, but not the end of contact lens wear.They don’t have to wear reading glasses over single vision lenses or switch to progressive lenses; the new contact lenses provide all the correction they need.I remind them of the many benefits of wearing contact lenses, from a free and youthful appearance to excellent peripheral vision for all-round vision and movement.
It is very popular now to avoid fogging of glasses due to wearing a mask.Many patients who start dropping out do not understand multifocal lenses.Others have tried them in the past or heard negative stories from friends.Maybe the doctor has only tried the audition on one eye, which robs the patient of depth perception and a lot of distance vision.Or maybe they tried monovision and felt sick or couldn’t get used to it.We need to educate patients and assure them that new contact lens technology has solved the problems of the past.
COHEN: A lot of patients think they can’t wear multifocal contact lenses simply because they haven’t been advised by their doctor.The first step is to let them know that we have multifocal contact lenses and they are good candidates.I want patients to try multifocal and see the difference in their vision.
COHEN: I think it’s important to follow new developments and be willing to try new shots.For presbyopia, we have great options such as Air Optix plus HydraGlyde and Aqua (Alcon); Bausch + Lomb Ultra and BioTrue ONEday; and several Johnson & Johnson Vision Acuvue lenses, including Moist Multifocal and Acuvue Oasys Multifocal with a pupil-optimized design.I am most impressed with this lens and look forward to its availability on the 1 day Oasys platform.I start with the lens of choice that meets the needs of most patients.If the patient doesn’t fit that big umbrella, then I’d choose an alternative.To address vision changes and dry eye, the lens should be designed to maintain tear film homeostasis with minimal disruption to the ocular surface.
WHITTAM: I offer 2 different multifocal lenses – a daily lens and a 2-week lens – but these days I tend to go with the pupil-optimized Acuvue Oasys multifocal lenses.It took my patients less than 10 minutes to get used to the lenses, and then I laughed because they saw and felt the same way they did when they first put on contact lenses.The visuals are excellent because they have optimized the lenses for refractive errors and pupil size.The lenses are matched to the pupil and provide the patient with excellent depth of focus at all distances.
WHITTAM: I think doctors are reluctant to put their patients on multifocal lenses because of the flaws in the old technology.Even if we follow the fitting instructions, the lens design requires the patient to give up some distance or near vision, creates halos, and often does not provide the clarity the patient expects.Now we don’t need to compromise because the new lens has perfected it.
I install multifocal lenses the same time as I do spherical lenses, even with pupil-optimized lenses.I got good refraction in ambient lighting and a sensory dominant eye assessment, then I entered the numbers into the Fitting Calculator app on my phone and it told me the correct lens.It’s no harder to put on than other contact lenses.
COHEN: I start with the current diopter because even a little change can affect the success rate of contact lenses.For multifocals, I just stick to the fitting guidelines, which are the product of solid research.A lot of trial and error gave us what we needed to get the fit right and handle troubleshooting quickly.
WHITTAM: While there are many contact lens wearers over the age of 40, very few wear multifocal contact lenses.If we don’t address the dropout problem associated with presbyopia, we will lose a lot of contact lens patients.
In addition to retaining contact lens wearers, we can also develop our contact lens practice by fitting opticians who have never worn glasses or contact lenses.They are not used to vision problems and they hate wearing reading glasses.I encourage them to try trial lenses that correct their vision in an inconspicuous way.
Cohen: I think converting potential dropouts into contact lens wearers can facilitate the practice on many levels — not just the income from a box of contact lenses.Contact lens wearers return on average every 15 months, compared to 30 months for spectacle wearers.
Every patient who forgoes contact lenses also skips half of their office visits.When we address their issues, they tell friends about new contacts they feel good about throughout the day.We are creating passion, loyalty and testimonials for our practice.
Post time: May-09-2022
