Five steps to talking to patients about presbyopia

How practitioners introduce and explain presbyopia, discuss its impact on daily life and recommend appropriate vision correction options, including contact lenses, is central to helping patients understand the condition and make informed decisions. This is particularly important for locum optometrists, who are unlikely to have met the patient before and may not see them again.

“Communication and how the practitioner effectively builds a relationship with the patient is of primary importance,” optometrist and professional affairs consultant at Johnson & Johnson, Neelam Patel, told OT.

Here, Patel shares five steps for effectively talking to patients about presbyopia.

1 Building rapport and listening

“Communication and building a relationship with the patient are incredibly important. The stronger the relationship you build, the more likely the patient is to trust you as a practitioner and feel confident in your recommendations.

“The quickest way to build rapport is by listening. Ask patients about their changing visual needs, the tasks they carry out each day and whether there are any activities they find particularly challenging or frustrating. Ultimately, I want to understand which visual tasks matter most to them, what they struggle with, and the emotional impact those difficulties have on their daily lives.

“By taking the time to listen and understand their lifestyle and visual needs, we can refer back to those specific challenges when making a recommendation and explain how a particular solution could help. This shows patients that you’ve listened to them and genuinely understand their concerns, making it easier for them to see how your recommendation is relevant to their individual circumstances.”

2 Use analogies to support patient understanding

“Remember that although we see presbyopia every day in practice, it may be the first time a patient has heard the term, and for many people that can feel worrying.

“First and foremost, I explain that presbyopia is a completely natural part of the ageing process. I reassure patients that it’s a normal change, experienced by everyone, and that there are plenty of effective ways to manage it.

“When explaining what presbyopia is and how it affects vision, I use simple language and analogies. Patients can only retain so much information during an appointment, so making explanations simple helps.

“Importantly, I link my explanation back to an experience the patient has shared with me about their vision.

“For example, I’ll say: ‘Inside your eye is a lens that changes shape to help you focus, especially on things that are close-up. Over time, that lens gradually becomes thicker and less flexible, rather like the layers building up on an onion. As a result, it can’t change shape as easily and focusing on near tasks can become more difficult. That’s why you’ve noticed yourself holding your phone further away or needing a brighter light to read.’

“Using analogies in the testing room has transformed the way I communicate with patients about conditions. When I first qualified, I recall my explanations being very scientific. Overtime I’ve realised that analogies can simplify even the most complex conditions. They help patients understand what’s happening without feeling overwhelmed by technical information.”

Using analogies in the testing room has transformed the way I communicate with patients about conditions

3 Support informed decision making with real-world examples

“When recommending contact lenses and asking a patient to try them in the testing room, I try not to rely solely on the Snellen chart or a reading card. Instead, I encourage them to experience the lenses in real-world situations.

“I may ask patients to take out their phone and read their WhatsApp messages or an email, or walk outside the practice and look around. Seeing how the lenses perform during everyday tasks has a greater impact than reading letters on a chart. This approach allows the patient to start seeing where and how the contact lenses are going to work in their real life.

“Many patients don’t experience the full benefits of contact lenses immediately – it’s around the third day of wear that the brain begins to adapt and patients often become much more aware of the visual advantages. I speak to patients about this and as a result, during a trial, I encourage them to wear the lenses on consecutive days so they can experience those benefits for themselves. This also helps manage their expectations.”

4 Managing patient expectations

“When multifocal contact lenses first became available, they weren’t as successful as they are today – technology has advanced immensely – so I wasn’t always confident fitting them. As a result, I used to downplay expectations and describe them as a compromise.

“Today, improvements in lens design mean we can achieve much better-balanced vision, meaning multifocal contact lenses are a great vision correction option for presbyopic patients with astigmatism too.

“I’m honest with patients because honesty builds trust and rapport, but I also focus on the positives when making recommendations and discussing contact lenses. If patients understand how the lenses could improve their daily lives, they’re much more likely to approach a trial with a positive mindset.

“I also explain the difference between varifocal spectacles and multifocal contact lenses. For example, I say: ‘While varifocal spectacles work with a linear progression through different viewing zones, multifocal contact lenses work differently, like autofocus on a camera’

“Explaining these differences helps patients understand that there isn’t a single perfect solution. Instead, I talk about having an “optical wardrobe.” Most people own more than one pair of shoes because different shoes suit different occasions, and the same applies to vision correction.

“I reassure patients that the fitting process doesn’t end when they leave the practice. When they come back, we can make adjustments if needed to optimise their vision and comfort.”

I talk about having an ‘optical wardrobe.’ Most people own more than one pair of shoes because different shoes suit different occasions, and the same applies to vision correction

5 Introducing the patient to ACUVUE® Oasys Max 1-Day Multifocal for Astigmatism

“When introducing a new contact lens, I don’t use lots of technical language. Instead, I explain that until recently, if you had both astigmatism and presbyopia, we didn’t have a daily disposable contact lens that corrected both together. I then explain that this new lens brings both corrections together in one daily disposable lens.

“Some patients entering presbyopia will already be in vision correction and in the past may have tried contact lenses. For these patients, it’s important to discuss how technology has changed, and emphasise their changing requirements.

“One exciting fitting development with the new contact lens is the ACUVUE® Simplifit calculator, which streamlines the fitting process. The practitioner enters the patient’s spectacle prescription, the sensory dominant eye and the functional reading addition. The calculator then recommends the initial lens selection.

“Patients can be fitted with the available multifocal trial lenses and the astigmatism can be demonstrated using a flipper, allowing them to experience how the final correction is likely to feel.

“This creates a much better patient experience because they don’t leave disappointed that a trial lens isn’t immediately available.

“For locums, I’d also recommend ordering the recommended lenses along with both the distance enhancement and near enhancement options. Therefore, even if another practitioner carries out the follow-up, everything is already available, reducing delays and improving continuity.”