The changing landscape around presbyopia

The need to speak to presbyopic patients early was identified as a key way to keep contact lens wearers engaged as their vision needs change, in a recent webinar hosted by Johnson & Johnson Vision.

The changing landscape for patients with presbyopia webinar explored the need for, and benefits, of multifocal contact lenses. Through the session Johnson & Johnson Vision introduced its two-week reusable Acuvue Oasys Multifocal contact lens, launched this July, with a panel of practitioners sharing their experience and advice.

Launching the session, Dr Kurt Moody, director of professional education in North America for Johnson & Johnson Vision Care, shared data which revealed that 92% of contact lens wearers aged over 40 expect to continue wearing contact lenses.

The data suggests 33% of current contact lens wearers are presbyopic or will soon be, but suggested that 62% of those aged over 45 will discontinue contact lens use as they develop presbyopia, either because of vision, comfort, or both.

Exploring the need for multifocal contact lenses, a panel of optometrists shared the role these products play in their practice.

From the UK, Shelly Bansal, practice director and contact lens specialist, explained that in the practice 24% of sales over the last year have been related to multifocal contact lenses.

Webinar co-host, David Ruston for Johnson & Johnson Vision, compared this with the statistic that, in the UK, only 7% of contact lens wearers are using multifocal contact lenses.

Dr Patricia Poma-Nowinski, optometrist and senior partner in an optometric practice in the US, also shared that, for those who qualify, around 50% of her patient population is in multifocal contact lenses, adding: “I believe that everyone over 40 should be presented with the option.”

The panellists highlighted the importance of starting the conversation around presbyopia early.

Joking about being an ‘educator,’ Poma-Nowinski said: “I think starting the conversation earlier is important so that patients know you have their backs and that there is an option for them.”

Bansal also supported this approach, sharing that presbyopia can come as “too much of a surprise to our patients” if it is not talked about.

Dr Fabrizio Zeri, a lecturer and researcher at the University of Milan, agreed, adding that when first told about multifocal contact lenses, some patients don’t believe the technology can be applied to a contact lens.

Discussing the benefits of multifocal contact lenses for the patient group, the practitioners highlighted vision and convenience as key. They also recognised that the products can help to keep patients wearing contact lenses while catering for their unique needs.

Identifying potential reasons for dropout, Poma-Nowinski highlighted the importance of the tear film, pointing out “we’re coming out of a year in which everyone is starting at computer screens and phones and not blinking right,” adding that meibomian gland dysfunction “is becoming king unfortunately.”

She particularly emphasised the importance of a stabilised tear film addressing those who are perimenopausal or menopausal.

The company introduced its Acuvue Oasys Multifocal lens with Pupil Optimised Design this June, also featuring a hybrid back curve technology and a proprietary embedded wetting agent.

Commenting on the plans for further modalities, Moody shared that there will be a one-day Acuvue Oasys Multifocal, “and it’s going to be sooner than later.”

He also shared that the company has plans for a toric version of the multifocal, with research and development ongoing in this space.

The webinar hosts discussed the technologies behind the contact lens design, while panellists discussed how they have been fitting it in practice.

After starting to fit the lenses in May, Bansal shared that patients have responded positively to the lens in terms of comfort, vision and handling, and particularly valued the inversion marking of the lens. Poma-Nowinski felt that getting the refraction ‘spot on’ was important to success in fitting, along with following the fit guide, while Bansal also highlighted the online calculator as a useful tool.

Sharing insight from his research into the centration of multifocal contact lenses, Zeri suggested using a topographer to assess the position of the lens when fitting.

The webinar participants also discussed the material of the lens and the importance of this for presbyopic patients in particular, with Zeri sharing: “If you can get a better wettability, you can improve wearability.”

While clinicians tend to look to measures to determine success in a contact lens fitting, Zeri suggested patient satisfaction and subjective performance should also be a key indicator, considering how the lens performs in practical settings, like smartphone use or working in front of a computer.

He highlighted research in which he found that one of the best predictors of success of multifocal contact lenses is not the “objective performance of the lens but the subjective performance of the lens.”