Setting realistic expectations

What are the most common concerns patients ask about presbyopia and how do you explain the changes that occur?

Simon Donne (SD, pictured below): The most common concern is that they feel there is something seriously wrong with them, especially if they have gone through their whole life without needing glasses. They are also worried that it is going to get worse and that wearing glasses or contact lenses will make it get worse more quickly.

I have to be empathetic and reassure them that this is completely normal. I explain that it happens over time and that using spectacles or contact lenses will certainly not make things worse. I explain that it is a gradual loss of elasticity of the lens inside the eye, which allows you to focus when you’re reading.

I also then reassure the patient that there are many options to manage all their visual needs, including solutions which can keep them spectacle free. I think this is particularly important for patients who have spent their whole life not wearing glasses; they don’t want to suddenly start wearing glasses as they will feel like they have aged a decade overnight.

What are the key steps that you take to ensure success with contact lenses when correcting presbyopia?

SD: Communication is key. All correction options must be communicated to the patient clearly, in language that they understand. I ensure that the language I use when discussing multifocal contact lenses with the patient is very positive, but I also set realistic expectations because their experience will ultimately be different to that in varifocal spectacles or reading glasses.

When I am fitting patients with multifocal contact lenses, it is very important to follow the fit guide. I wouldn’t fit varifocal spectacles by just guessing the most appropriate add, heights and pupillary distance and then wonder why the patient is dissatisfied with the outcome, and this is exactly the same with multifocal contact lenses.

What factors must be considered to ensure patients are satisfied?

SD: The design of multifocal contact lenses just keeps getting better. With the 1-Day Acuvue Moist Multifocal contact lens, I get as good of a success rate as I do with varifocal spectacles. With this lens, I am now just as happy fitting a -9.00 with a high add, as a patient who is a +6.00, because they just work.

I think that we definitely need to consider the material of contact lenses because as we get older our tear film ages and dries out. Therefore, we need a material that works with the tear film and enhances it rather than works against it.

I think fitting a lens that takes everything into consideration is important, as far as prescription and age goes. In other words, when the add increases as the patient gets older, I don’t want them to drop out of contact lenses because they can’t see. Now, this is much less of an issue.

These days, people are busy, irrespective of their age, and contact lenses must fit into these busy lifestyles. Patients don’t want to be hindered by having to fiddle about with reading glasses every time they need to pay for something with their credit card. I typically find that patients want the ease of a daily disposable contact lens, as even the three or four minutes in the morning and evening to clean and store lenses just doesn’t fit in with their lifestyles.

What’s brilliant about fitting patients with multifocal lenses is that these patients are already coming to see you; you don’t have to draw more patients into the practice

What business opportunities are there for treating presbyopic patients, and what is the best way to ensure sales growth?

SD: What’s brilliant about fitting patients with multifocal lenses, is that these patients are already coming to see you; you don’t have to draw more patient into the practice. Yet positive word of mouth when you have made a patient really happy can also help drive more patients to your practice.

Multifocal lenses are now so good that we should be offering them to every patient whose prescription allows. They offer an additional sales opportunity because these patients are often part time wearers, so still want varifocal spectacles and will often then also want to purchase plano sunspecs. By signing the patient up to a direct debit scheme, this ensures you get regular income every month.

What are your three top tips for treating presbyopic patients with contact lenses? 

SD: 1. Make sure that all patients are aware that multifocal lenses exist and ensure that all of your staff are highly trained and can talk about the contact lens options as confidently as they can talk about the spectacle options 

2. Always follow the fit guide to ensure maximum success when fitting multifocal contact lenses

3. Use positive language when discussing multifocal contact lenses; remember the benefits they offer over varifocal spectacles.

I find contact lenses are completely liberating in a way spectacle lenses can’t be; they offer so much freedom

How has presbyopia affected your day-to-day life?

Michael Stevens (MS): It’s a real hinderance having to move from distance to near vision and having to change the position of my laptop or book so that I can see properly when wearing my varifocal spectacles.

When were contact lenses introduced as a treatment option for you and did you have concerns?

MS: I’ve worn contact lenses since my optometrist introduced me to contact lenses that corrected my presbyopia, which was as soon as I noticed that my near vision wasn’t what it once was. I was concerned that the contact lenses may be difficult to get used to because I had heard that varifocal spectacles could be tricky to adapt to, but I had no problems at all.

How did your optometrist explain what presbyopia is and how did they help you manage it?

MS: He explained that it a loss of elasticity of the lens inside my eye which would make it difficult for me to see up close. He said that it naturally occurs over time, which really reassured me. He was able to correct my vision with multifocal contact lenses and varifocal spectacles, so I could have a choice about what I wanted to wear.

How have the contact lenses helped you in day-to-day life?

MS: I find contact lenses are completely liberating in a way spectacle lenses can’t be; they offer so much freedom. My lifestyle means that contact lenses are a much better option for me. For example, when I am playing an instrument with my contact lenses in, I am able to see the music, conductor and the audience without having to move my head like I would with my varifocal spectacles. With contact lenses, I can see in a totally natural way, wherever I am looking.