“The BCLA CLEAR Presbyopia initiative will provide an invaluable resource”

BCLA chief executive officer, Luke Stevens-Burt, and Lynn White, project executive, discuss the latest CLEAR reports on presbyopia

A middle aged couple sit together on the sofa sharing an iPad and smiling at the screen. They hold it at arms length and one wears glasses.
Pexels/ Marcus Aurelius

The British Contact Lens Association (BCLA) has released a new global consensus report on presbyopia, aiming to provide evidence-based guidance on presbyopia and its management.

The initiative will see the publication of seven papers in the Contact Lens and the Anterior Eye journal, featuring work from 84 experts from 18 countries.

OT heard from BCLA chief executive officer, Luke Stevens-Burt, and project executive, Lynn White,  on the aims of the initiative, key findings, and next steps.

What has it meant to you to put together the BCLA CLEAR Presbyopia papers?

It has been a privilege to contribute to another important project delivered by the BCLA and it is incredibly satisfying to be part of a global group of authors that have made this happen. It has been a very useful and productive exercise to investigate what we really know, and more importantly what we do not know, about presbyopia. For example, there is not even consensus about its mechanism, which is something that, as professionals, we perhaps take for granted. This is the first time a comprehensive review of the academic understanding of presbyopia and its management has been undertaken and it is a huge achievement.

The papers are a review of the academic literature and focus on the condition of presbyopia itself – epidemiology, mechanism, evaluation and diagnosis of presbyopia – and then cover management techniques including spectacle, contact lens, surgical and pharmacological options. The intention is to indicate where our collective knowledge base and practice is supported by scientific evidence.

Why was presbyopia chosen as the focus for this report?

Globally, the prevalence of presbyopia was estimated in 2015 at 24.9%, affecting 1.8 billion people. It is projected to stabilise to 24.1% by 2030, but affect more people (2.1 billion) due to an increasingly ageing population.

Following the success of the BCLA CLEAR Contact Lens series of papers, the BCLA felt that the time was now right to address this important topic with an academic review of epidemiology, mechanism and management techniques, especially as effective management of the condition is often termed the ‘Holy Grail’ for eye care professionals and industry alike.

This is the first time a comprehensive review of the academic understanding of presbyopia and its management has been undertaken and it is a huge achievement

Luke Stevens-Burt, BCLA chief executive officer, and Lynn White, project executive for BCLA CLEAR Presbyopia

Did anything surprise you from the topics covered in the report?

The main surprise for all the contributors to the papers was that many aspects of presbyopia that we thought of as standard knowledge or practice have very little basis in evidence. Even the mechanism of presbyopia is not yet fully understood. Much of what we take for granted is not supported by academic research and this actually opens up the field for more research, which then can lead to better clinical practice.

Has the report identified further areas for investigation or innovation? 

Near vision is important to all of us given our increasing interaction with digital devices. Given that there is a lack of evidence-based research in many areas of presbyopia and its management, there is scope for exciting new developments in management techniques. Contact lens and spectacle optics are continually being improved and there is much potential for improvement in intraocular lenses (IOLs), scleral, corneal and pharmacological techniques

In light of the report, what place do you think presbyopia holds in the contact lens market currently? What focus do you think this should have amongst practices? 

Currently, as evidenced by the subject matter covered in conference programmes such as BCLA Focus, practitioner interest lies with myopia control, dry eye treatment and specialist contact lenses. As a globally ageing population, where people are increasingly maintaining an active lifestyle, contact lenses are an excellent choice for management and they are not offered as an option as much as they could be.

Many patients drop out of contact lens wear when they approach presbyopia but there is no reason why patients should not have the option of both spectacles and contact lenses, as there are a multitude of multifocal contact lens designs now available.

In addition, contact lenses can be used as a diagnostic tool by practitioners to test a patient’s suitability for IOL or surgical options, such as monovision. There is scope for practitioners to widen their knowledge base and skills on presbyopia, and the BCLA is discussing introducing courses for individual practitioners and practices.

What do you hope eye care professionals will take away from this report? 

We feel the BCLA CLEAR Presbyopia initiative will provide an invaluable resource to the global community of eye care professionals, academics and industry colleagues, on all aspects of presbyopia. From the point of view of individual eye care professionals, it is hoped that the report will encourage them to think more broadly how to assist their patients in dealing with presbyopia. The intention is that BCLA CLEAR Presbyopia will be the resource to which the community will refer for evidence-based consensus and a springboard for further research and innovation.


Inside the creation and dissemination of the research

What did the project involve?

Thus far the project has taken around two years – including the invitation for authors in summer 2022. Expertise was drawn not just from academia, but from clinical practice, industry and ophthalmology and potential co-authors were taken from many submissions globally. From these experts, panels were convened to focus on specific topics within presbyopic research and management.

Headed by a lead author, the panels reviewed the academic literature to determine the current knowledge and opinion for their topic, which they then distilled into an academic paper. This process was overseen by a group of executive editors who reviewed the output of each panel. The papers are a unique overview of the state of global presbyopic research and management.

What will the next phase of the project involve?

Over the next 12–18 months we will develop different resources that will synthesise the research into accessible and comprehensive formats. This ranges from summaries of the findings to recorded videos, patient information, and possibly a certificate. We have convened a phase two project group that will lead this work and, where required, small working groups will be recruited to carry out work on specific resources. We aim to release the first two or three in the second half of 2024.

How will this help to bring the research to life in practice?  

This research is incredibly important to shaping presbyopic care globally, but it will be a struggle to achieve the full potential impact if eye care professionals (ECPs) don’t have access to it. In their current format they are scientific papers, which some ECPs may find challenging to understand, and almost certainly most ECPs don’t have time to read entirely and fully digest.

The purpose of phase two is to extract the key bits of information and make them accessible to ECPs so that they can use the findings to make an immediate and positive change to the presbyopic care they deliver.

These resources will be in a range of formats and purposes – including for patients – and in some cases will be translated. Through this we aim for ECPs to deliver better care, and patients to be better informed and receive more successful care, globally.