Having better conversations about presbyopia in practice

However, over the years, McDearmid has learned that how she and her team communicate with patients about presbyopia is just as important as the solutions they recommend.

“I used to think that I should wait until a patient complained of the symptoms before mentioning presbyopia. Now, I do the opposite,” she told OT.

Here, McDearmid shares the four steps that she follows in practice to ensure both her and her team communicate effectively with this growing patient demographic.

1 Step 1: Start the conversation before there’s a problem

“For me, the conversation starts early, often with patients in their late 30s and certainly by the early 40s. I don’t wait until a patient is struggling to read their phone at arm’s length to raise the topic of presbyopia. This isn’t because I want to emphasise ageing, but because I want to normalise it. Presbyopia isn’t a failure, it isn’t a disease, it’s a birthday-related change, and if we introduce it that way, everything changes.

“Whether they are already a contact lens wearer or not, this conversation is about gently preparing them for what’s to come. In the testing room, I explain that at some point they may notice their arms ‘aren’t long enough’ or that they’re leaning back from the screen. I normalise it as a birthday-related change that happens to us all.

“This early education is important as it prevents panic later and reduces the risk of contact lens dropout. I’ve seen too many patients assume, ‘My lenses don’t work anymore,’ when in fact presbyopia is simply emerging.

“For patients who I meet who may never have needed correction previously, I’m also particularly mindful. The first visual change can feel alarming, which is when reassurance matters the most. In this situation I explain what’s happening physiologically – that the lens inside the eye becomes less flexible – and that it’s normal and manageable.

“My goal at this stage isn’t necessarily to sell a solution, but to build awareness.”

It’s tempting to look at a date of birth and jump straight to ‘You need multifocals.’ But I try to resist

2 Step 2: Listen before you leap to the answer

“When a patient in their mid-40s sits in my chair, I often have a good idea what’s happening before we start. It’s tempting to look at a date of birth and jump straight to ‘You need multifocals.’ But I try to resist this and instead, I might ask, for example: ‘What’s bothering you the most?’, ‘When do you notice it?,’ ‘What does a typical day look like visually?’ or ‘What would an ideal outcome look like for you?’.

“Sometimes they describe the classic symptoms such as difficulty reading, increasing phone font size, headaches or fatigue. However, other times what they share is more subtle, such as end-of-day strain, avoiding small print, or frustration in low light. With experience I have learnt that listening properly often reveals more than refraction alone ever could.

“Presbyopia isn’t just about near vision, it’s about lifestyle, identity and confidence. For someone who has never worn glasses, being told they ‘need readers’ can feel like a milestone they weren’t ready for.

“However, by fully understanding a patient’s challenges, I can tailor my recommendation, whether that’s spectacles, multifocal contact lenses, or a combination, in a way that feels personal.”

If the patient asks questions and wants more detail, I’ll explain… But my favourite thing is to simply get the patient to try them

3 Step 3: Make the benefits clear (not the technology complicated)

“I used to over-explain multifocal contact lenses to patients. I used to think that a detailed technical explanation showed my expertise. However, from personal experience, I have learned that you can share too much information with the patient and at times it can be intimidating.

“Now in practice, I focus on the benefits of the contact lens I’m recommending first. Instead of leading with design features, I might say: ‘This will let you check your phone without taking your lenses out,’ or ‘You’ll keep your natural look without relying on reading glasses.’

“If the patient asks questions and wants more detail, I’ll explain how modern multifocal contact lens designs work using analogies. But my favourite thing is to simply get the patient to try them.

“Trials are great for this and unlike spectacles, contact lenses can be tried immediately. When patients see the benefits themselves, the barriers melt away.

“It’s also worth noting that new-generation multifocal designs have dramatically improved performance at distance, intermediate and near for patients. When my patients trial new contact lenses with updated technology, they’re often surprised at how natural it feels.”

I think the language we use hugely matters. I never say a patient has ‘failed’ a trial

4 Step 4: Remove fear and reinforce confidence

“Patients often have lots of misconceptions about presbyopia. They might ask: ‘Am I too old to start contact lenses?,’ ‘Will glasses make my eyes worse?,’ ‘I tried multifocals years ago and they didn’t work.’

“If this comes up, I reassure patients that starting contact lenses later in life is absolutely possible. And I remind them that contact lens technology has evolved significantly.

“I think the language we use hugely matters. I never say a patient has ‘failed’ a trial. If something isn’t perfect, I frame it as gathering data and collecting helpful information that will guide us to refine the fit.

“Most importantly, I take responsibility for the process and reassure them, ‘If this doesn’t feel right, that’s on me – we’ll adjust it’.”