prescribing for presbyopia

Avoid These Patients to Increase Success

BY CRAIG W. NORMAN, FCLSA

We often focus on which patients are best for bifocal and multifocal contact lenses. What about those we should avoid? It's human nature for us to believe that we can fit all patients with some presbyopic contact lens. But can we?

Instead, we can increase our success rates while suffering less frustrations from patient encounters throughout the day by simply advising certain patients up front of their inability to adequately wear contact lenses.

Unrealistic Expectations

In my experience, unrealistic expectations are the number-one reason for patient dissatisfaction with soft or GP contact lenses for presbyopia. Inquire up front exactly how prospective wearers plan to wear their lenses — all day, partial day, once a week, etc. Noting the patient's wearing schedule in advance will help point you in the right direction for lens selection.

Notation of visual expectations is also critical. Ask patients to choose which two distances are most critical for vision correction: driving distance, computer level and reading level. Beware if patients choose all three distances — especially if these patients are more mature presbyopes for whom modified monovision or an additional correction with spectacles may be indicated. If wearers expect to have full vision at all of these areas, they may be disappointed.

Previously Unsuccessful with Numerous Other Designs

Be wary of patients who have tried other bifocal lens options without any wearing success. A detailed history in these cases is crucial to determine why the previous lenses didn't work.

Is it because the lens type — soft contact lens versus GP contact lens — was incorrect? Was the specific design not suited for the patient's ocular structure, pupil size and dynamics and tear quality?

Also dig in to how patients were wearing their lenses by determining what their daily tasks are combined with their working environment. Desk work and computer tasks in a dry office setting are a recipe for decreased wearing time and greater lens awareness. Poor lighting is another. We evaluate visual response with multifocal contact lenses in lighting conditions that are often much different than those of other wearers.

The "Impatient" Patient

A quick fit may not be possible, so consider avoiding patients who are unwilling to return for "fine-tuning" of the fit.

I know it's preached how critical reduced chair time is for the efficiency of the eyecare practice — and it is. But with contact lens management of presbyopic patients, additional visits may be necessary to complete the selection of the most appropriate lens type and design parameters. Wearers must know and agree to this in advance.

Diagnostic lens fittings are helpful, but they can't simulate the all-day wearing experience in the over-40 demographic. Having patients return to report on their experiences often results in small tweaks to the lens that improve the wearability of bifocal/multifocal lenses — ultimately making patients successful long-term. CLS

Craig Norman is director of the Contact Lens Section at the South Bend Clinic in South Bend, Indiana. He is a fellow of the Contact Lens Society of America and is an advisor to the GP Lens Institute. He is also a consultant to B&L.