Demystifying comfort concerns for the presbyopic

The scenario

As a locum mainly working in High Street practices that have high contact lens concentration across patients, I’ve noticed drop out occurring in the 40-plus age demographic as they enter presbyopia. Some patients have told me they find wearing their contact lenses less comfortable, and don’t realise that changing their lenses could help this – they have been in their lenses for a number of years without issues. Can you share advice on how I can have an effective comfort conversation with these patients earlier on, as well as how to educate those who may need to switch lenses?

Mo, locum optometrist

The advice

Clair Bulpin, optometrist and Johnson & Johnson Vision team faculty member

Comfort conversations with all contact lens wearers need to happen constantly. A happy contact lens wearer may be happy because they simply do not know that there are alternative options available. These conversations become even more important in respect to the presbyopic demographic.

As practitioners, we understand the presbyopic changes that are on the horizon refractively, but also physiologically and anatomically. Whether this is in relation to its arrival or progression, presbyopia brings change.

As clinicians we know this, but the patient often does not. It is not practical to expect a single contact lens type to survive the patient’s entire lifetime in contact lenses. Now I love a high heel, but the heel I wear has reduced these days compared to what it used to be – they are certainly less pointy toed, and the stiletto no longer provides quite the stability I require, meaning I gravitate towards a more robust chunkier heel. I’ve adapted to my changing lifestyle and changing comfort needs. The changes in these shoes are visible to the naked eye, I can physically see as well as feel the benefit of these differences. However, one contact lens looks pretty much like the next to the untrained eye, which means the patient cannot ‘see’ the difference. Therefore, we have to discuss and explain the options fully with our patients as well as allowing them to ‘feel’ the benefit for themselves.

A happy contact lens wearer may be happy because they simply do not know that there are alternative options available

Planning for change

It is our duty as eye care professionals to forward plan for change. A routine contact lens appointment on a seemingly happy patient is often a straightforward meeting which ends with signing off the same specifications so the patient can continue to get their contact lenses.

Explaining to a patient at each encounter that understanding their needs and changes in their lifestyle and environment may mean you can suggest a better, alternative contact lens option for them is critical.

Resetting the ‘starting point’ is a great way to introduce other options. I will quite often comment that whilst the contact lenses they are in is a great product, if I was starting from scratch today, I would recommend an alternative, and then I’ll explain why. The patient has nothing to lose from trying this new contact lens, and even if they elect to stay where they are, at least they know they have choice. In a presbyopic contact lens wearer, the changes in tear film physiology or general health may necessitate a more frequent conversation around change.

Comfort conversations with all contact lens wearers need to be happening constantly... These conversations become even more important in respect to the presbyopic demographic

Comfort concerns

It is useful to note that a perceived reduction in comfort can sometimes be a refraction problem in disguise. Many patients in the early stages of refractive change will describe discomfort in their contact lenses when there is actually an underlying visual concern.

The myope, who now has to deal with the increased accommodative demand in their contact lenses over spectacles, is a classic example. Having lived a life loving contact lenses, they may find now that the flexibility of being able to drop their spectacles down their nose, or even remove them to help with near, outweighs the benefit of their beloved contact lenses.

But why does the comfort change? For the same reason that I can no longer spend the day in sky-high heels – our bodies change physically with time.

I like to discuss how a patient’s eye is maturing rather than aging, but we can sugar coat it how we like, things still change. The tear film becomes less stable with age, meaning that the same contact lens material may cease to be as comfortable over time. This is not an issue with the product or the patient, more that they are no longer the best match.

More importantly, none of these changes will happen overnight. It’ll be a gradual change that may initially just be subtle change in wearing habits. Really understanding what is ‘new’ or ‘different’ at each visit can be key to catching these patients early.

Contact lenses may all look very similar, but they are certainly not all created equal. We know they work differently, and for sure will feel different, but the patient cannot ‘see’ these elements, so the features and benefits of the chosen contact lenses need to be fully explained.

An honest conversation at every interaction provides the forum to discuss options

Education, education

In respect to educating those who may need to switch their contact lenses, they simply have to understand that their current set up is not the only option. Contact lens drop out is a real concern over all demographics, with discomfort often being cited as the number one reason to discontinue lens wear. There are tangible reasons as to why this may disproportionately affect the presbyopic patient more, due to the tear film and physiology changes that occur.

Sadly, many contact lens wearers simply disappear; often they don’t seek advice ahead of ceasing their contact lens wear. The motivated contact lens lover may make an appearance to ask our advice, but often we never truly get to know who has fallen out of love with their contact lenses.

An honest conversation at every interaction provides the forum to discuss options. Provide tangible comparisons to other areas of their life. Skin changes over time, the same products that were used 20 years ago may no longer fit our requirements over time. Discussing advancing technologies can be tied into an analogy, whether it’s in relation to an upgrade on a mobile phone or a television.

New things hit the market all of the time. Air fryers? We survived without them for years, but that doesn’t mean it isn’t a useful addition to the kitchen.

Choice is important so the patient remains in control. Our job is to ensure that where there are options, we ensure they have that choice. and that the conversation occurs at every interaction with the patient.