BY JOSEPH T. BARR, O.D., M.S., EDITOR
AUG. 1996

High myopia and presbyopia are powerful motivators for contact lens wear. Before you shake your head in utter disbelief and turn the page, I'd like to tell you about two recent cases and a graduation convocation lecture.

While trying to read his notes from the podium, Jack Bennett, O.D., Dean of the Indiana University School of Optometry, told the 1996 graduates of The Ohio State University College of Optometry how he had inadvertently lied to his patients.

"For years, I told them that they would adapt to their bifocals," he recalled. "What I learned later is that you don't adapt to them. You just learn to live with them."

We think our bifocal spectacle-wearers are happy, but really they're just coping without what they once had and what they really want again -- accommodation.

Case one is a highly myopic presbyope whose O.D. had told her that contact lenses wouldn't work with her astigmatism and presbyopia. As she tells it, "Every time I'd ask about contact lenses, he'd roll his eyes and change the subject." A highly skilled Cornea and Contact Lens Diplomate of the American Academy of Optometry fitted her with bifocal contact lenses -- RGPs no less -- and she is quite a success.

Case two is a highly myopic researcher who is finally fed up with his -6.00 bifocal spectacles. He is quite motivated to wear his new soft bifocals despite some handling and variable vision problems. It seems his son's recent success with contact lenses prompted him to try them.

Remember how much larger the image is for the contact lens-wearing high myope (actually significantly less minified). Sure, a contact lens causes myopes to have to accommodate more, but if they can't accommodate any more, give them the correction they want, the cosmesis they want and less minification than they have with their eyeglasses.

Although there may be a compromise with monovision or bifocal contact lenses, there's also a significant compromise for bifocal spectacle-wearers as Dean Bennett described. Either way, there's no way you can give back their accommodation which is what they really want.

Because success rates are low for bifocal contact lenses, you may think that you should resist them for the non-contact lens wearing, highly myopic presbyope, but don't prejudge your patients. And remember, the early presbyopic hyperopes do even better because you're improving both their distance vision and their near vision. Discuss all your patients' options with a positive attitude, and then give them a chance to try contact lenses if they're motivated to do so.

We don't typically plan an issue of Contact Lens Spectrum to have feature articles on similar topics, and I don't typically talk to you on this page about what's in the rest of the issue. But, this month our readers hit the jackpot with some very fine information on presbyopia and contact lens wear. CLS