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Satisfying Presbyopic Contact Lens Wearers
BY JANE J. BEEMAN, COA, NCLC-AC, FCLSA, PRSA

The onset of presbyopia brings a shudder to even the most experienced contact lens fitter. A perfectly happy contact lens wearer can suddenly and seemingly overnight become one of your most unhappy and time-consuming patients. That's why satisfying the presbyopic contact lens wearer takes as much psychology as clinical skill.

Start with an Explanation

Take the time to explain to new presbyopic contact lens wearers the underlying reason for their condition. Few patients understand the physical movement of lens and globe that happens so effortlessly during childhood and early adult life. They do, however, understand that all tissues and muscles relax with age and use, so explain that the change of their eye's crystalline lens and surrounding tissues results in a loss of accommodation, or what we call presbyopia.

Inform patients that presbyopia occurs slowly over the adult years. Explain that they may have seen early signs in their 30s, such as loss of focus at near (which they solved by moving reading materials further away) or slow return to focus at distance after long periods of close work.

Express Your Expectations

Tell your patients they are not alone. Most of the population will develop presbyopia regardless of previous refractive needs. Confront the limitations that presbyopia will bring to patients' field of vision. Don't promise the same depth and field of focus that they had when they were 18 years old. Clearly discuss your expectations for the final outcome and help them chose the best correction option after explaining all that's available. Only patients can decide if the expectations you outline are reasonable for their lifestyle and visual needs.

Consider Gas Permeable Options

High-fashion frames with invisible multifocal spectacle lenses, multifocal soft or GP contact lenses, reduced-power contact lenses (monovision) or fashionable reading glasses are all options for the vigorous, youthful presbyopic adults of today. But the sheer variety and customization of designs makes GPs the ultimate tool in a contact lens fitter's toolbox.

For the habitual GP wearer, the transition to a bifocal design is usually the least traumatic. Aspheric designs can quickly transform a GP patient's lenses into correction for early presbyopia. Translating designs may offer a refitting challenge because there are anatomical and design needs required for proper lens movement with each blink. However, when correctly fit, the optical clarity of separate retinal images is superb.

Don't Forget New Soft Designs

New technology has also brought to market the best soft hydrogel multifocal contact lens products ever. Many new disposable and planned replacement soft multifocal lenses boast comfortable fit, convenience and good optics.

Understanding each design and getting experience fitting each product is critical to improving your success rate. Each design has its own strengths, and finding a design to fit a particular patient's needs is the first step to a successful fitting.

For instance, a design that features a large area of distance optics and a limited near zone may not best serve an accountant. Or he may need three lenses ­ two with larger reading areas for working hours and one with a larger distance zone for non-work wear.

If you've tried fitting bifocal contact lenses in the past with little success, try them again. They're worth a second look.

The past director of professional services for Bausch & Lomb, Jane is now in clinical practice in Rochester, NY, and is a frequent guest speaker at leading academic and professional programs around the world.