Presbyopia in practice

The scenario

“I have recently read insight reporting that around 40% of patients are unaware of multifocal contact lenses. As a manager of a practice with a demographic heavily weighted to over 45-years-old, I’d like to ensure that clinicians and non-clinicians across my team are comfortable and able to raise the presbyopia conversation with relevant patients. Can you share any tips?”

Grace, practice manager

The advice

Josie Evans, optometrist and Johnson & Johnson MedTech faculty member

The terms we use

Generally, when raising and talking to patients about all types of contact lenses, one of the main things that’s really important is a shift in the use of terms across the whole practice team.

When a patient arrives for an appointment, for example, the member of staff greeting them could ask whether they’re there for an eye examination or a contact lens consultation. Similarly, in the consulting room, when a patient requires a change of prescription, I would say, ‘Let’s consider your vision correction options,’ as the broadness of this term encompasses both spectacles and contact lenses. The patient may not opt for contact lenses there and then, but this helps plant the seed that they could be suitable, and they may ask questions in the future.

The front of house team is key when raising awareness of vision correction options with patients, including options at different life stages. Most of the team in my practice wear glasses or contact lenses – it’s usually one of the main reasons they’re aware of coming into optics as a profession – making them the perfect people to fit with new contact lenses when they become available on the market. This ensures they have that first-hand experience of just how many contact lenses are available and the types of patients they are most suitable for at different life stages.

Ensuring that all of the practice team is informed and knowledgeable supports both in-practice and phone conversations, where they can mention they have tried a particular contact lens and share their experiences.

For example, if a team member has a passing comment from a patient, either on the phone or in person, with the patient saying, ‘I’m struggling with my reading vision and would like to make an appointment,’ they are educated and informed enough to firstly reassure the patient in that moment, but can also share their experiences when relevant.

The front of house team is key when raising awareness of vision correction options with patients, including options at different life stages

Long term education

Patients can be made aware of contact lenses and the contact lens options that are available to them throughout the patient journey in a range of ways. This can be through electronic communications from the practice such as appointment reminders, with a relevant line at the end that mentions contact lenses, or through visual displays in practice.

In my practice, we have found a lot of benefit from videos in the reception area. We have a 20-minute video that is made up of several small sections on a range of topics such as dry eye, myopia management, and multifocal contact lenses. This video aims to educate patients about their vision, it also explains when and why they might need multifocal lenses, and how they work.

Following-up this education in the consulting room, if a patient is pre-presbyopic – in their late 30s, early 40s for example – I will ask how their vision is, and even if they say that their reading vision is fine, I tend to say, ‘that’s brilliant and I’m glad these are working well for you right now, but if over the next five to 10 years you find that you’re holding things further away in order to see them a bit more clearly, or you’re struggling in lower lighting levels, that’s very normal. Just let me know and we can look at solutions designed for that – this process happens for everybody.’

By having this conversation with pre-presbyopic patients, they will be better prepared for the vision changes they may experience before it happens. Vision changes won’t be a shock to them, and they will know to come back into practice and talk about the vision correction options available to them.

Often patients who have just become presbyopic will also have a whole cohort of friends going through the same changes at the same time. If they have that regular contact with their practice and their optometrist, and they have that insight, they can share it with others as well. Spreading the right words is really positive.

When it comes to patients who are happy with their vision correction, it can be tricky to speak to them about other options, but what I tend to say is, ‘While I’m really pleased that these lenses are working well, contact lenses continually evolve and there could be something better suited to you.’ I will then discuss the benefits of other lenses on the market and suggest that they let us know if they would like to try something new at any point.

In our practice, we are keen on ordering trials of new contact lenses for patients, which they can try free of charge in their own environment if they wish to. This also helps build trust with patients, as they know that you are not just trying to sell them something, but always trying to ensure that they are in the best lenses possible for their vision requirements. This trust will then support conversations, such as those around presbyopia, when they are needed.

By having this conversation with pre-presbyopic patients, they will be better prepared for the vision changes they may experience before it happens

The handover

The connection between front of house and the consulting room is really important.

We are keen in our practice to make notes on a patient’s record of every conversation so we get to know the patient and their requirements as best we can. In addition, our front of house team will make notes on the appointment booking itself so the practitioner who sees the patient knows why they may have made the appointment and anything they have expressed an interest in or a concern about. This means that we are more informed and prepared for the patient. Staff can also leave tasks on the notes, which allows us to, for example, order in and have the right contact lenses available for a trial for the patient. This is particularly helpful for when you might be talking to the patient about changing lenses to better meet their needs, including for presbyopia.


As told to Emily McCormick.