What is your experience with presbyopia?
I first started fitting multifocal contact lenses in my pre-registration year. My mum is an optometrist and we now run a practice together. Back then she was my supervisor and, as I had a keen interest in contact lenses, she kindly allowed me to take over all her contact lens clients.
The nature of being an independent practice in the north-east of England means that approximately half of my contact lens wearers are presbyopic and enjoy wearing multifocal contact lenses. Multifocal contact lenses are great to fit because it’s a whole new category of people, some of whom always wanted lenses but believed they couldn’t have them, others who want to disguise their age (don’t we all).
Contact lenses give presbyopes another visual option, whether choosing to wear lenses for sport, socially or for general day-to-day activities, it can give them a choice and some freedom from glasses.
What are the key areas that must be considered when managing a patient’s presbyopia?
To be successful you must uncover what they require from their contact lenses and then manage expectations appropriately. What are their day-to-day activities? What other interests do they have? What environments are they in? What are their tears like?
We know with maturity comes a general reduction in tear volume and tear quality and poorly performing tears can result in poor comfort and poor vision. Therefore, the tear film must also be considered when choosing a contact lens material.
Modern multifocal contact lenses are easier to fit than ever before. Following the fitting guides that are available enables the correct lens power to be identified more quickly, reducing chair time for the practitioner and enhancing the positive experience for the patient. No two people are the same, no lens will interact the same way on every eye, and that’s what I love about contact lenses; it’s about getting to know people and their eyes and it’s always interesting.
"To be successful you must uncover what they require from their contact lenses and manage expectations appropriately"
What are the most common reasons for drop out and how can it be avoided?
Poor vision and poor comfort, which often have the same underlying cause, are the biggest reasons I hear for why people have previously dropped out of lens wear when I see them in my contact lens clinics.
Patients don’t understand that there are alternative contact lens materials and designs, and that their contact lenses may need adjusting over time to best meet their needs. Therefore, if they start to struggle, they don’t want to tell us – fearing we may tell them they have to stop wearing lenses, and then they enter a spiral of reducing wearing time, which can ultimately lead to complete drop out.
Unless we are careful to ask detailed questions at the aftercare we may fail to uncover that someone is becoming unhappy in their lenses. Communication is absolutely key to ensuring we keep our patients happy.
How do you go about helping a patient who has concerns about presbyopia and managing it with contact lenses?
Presbyopia is an everyday occurrence for us as practitioners, but for that patient going through it, it can be life changing. Going from just being able to open their eyes and see to needing to use an optical appliance, be it spectacles or contact lenses, is a complete change to their lifestyle and can be quite an emotional time.
From being able to apply eye makeup again, to reading texts in private without a giant font size, days or evenings out without the dread of forgetting reading glasses, golf, running or horse riding, multifocal contact lenses allow the balance of vision from far to near to be restored without being limited to following your nose as with multifocal spectacle lenses.
Listening to concerns, providing support and reassurance and demonstrating how they can be helped by contact lenses is one of the most satisfying things to do. I find one of the largest groups for new contact lens wearers is emerging presbyopes who aren’t ready to need reading glasses just yet.
"Presbyopia is an everyday occurrence for us as practitioners but for that patient going through it, it can be life changing"
What does the future hold for managing presbyopia and what are the next steps that need to be taken to better manage it?
People are going to become more aware of multifocal contact lenses and already I’ve noticed more people proactively booking in asking to be fitted.
Innovation and technology development is constant and it will be exciting to see what evolves next. While multifocal contact lenses have certainly come a long way, with designs now available that take into account pupil size changes, which occur not only with age but also refractive error, it would be great to have this new technology in more lens modalities and materials. I’m also hoping for a greater choice in disposable multifocal toric contact lenses. I keep lists of people who I would really like an alternative lens option for and my list of multifocal toric candidates is growing ever longer.
What does it mean to win the AOP Awards Contact Lens Practitioner of the Year accolade?
I am very honoured and proud to be Contact Lens Practitioner of the Year 2018. I am so grateful and thankful to those who voted for me to win. I hope I can represent everyone who loves fitting contact lenses. I’ve been very lucky in the first 10 years of my career to have so many opportunities with contact lens fitting and long may this continue.