prescribing for presbyopia

Can Presbyopic Contact Lenses Compete With Spectacles?

BY CRAIG W. NORMAN, FCLSA

During a recent lecture I gave, an attendee made the comment that fitting contact lenses for presbyopia is too time consuming, needs too many measurements to be successful, and that patient success is too low. Furthermore, she mentioned that in her opinion, it's much easier to fit spectacle lenses on presbyopes than it is to fit contact lenses.

It made me wonder — is this true or merely perception? I discussed this point with colleagues, and one mentioned that to be successful, we should first look at the proper fitting steps for presbyopic patients.

Presbyopia Fitting Step by Step

Let's review these basic steps:

1. Ask or review lifestyle questions to better customize the lens to the patient.
2. Take accurate ocular measurements to improve success rates.
3. Take these measurements with patients in a comfortable position similar to their daily task environment.
4. Use state-of-the-art instrumentation to make these measurements.
5. Measure each eye independently.
6. Choose the proper design based on patient needs and ocular measurements.
7. Review fitting guidelines for any presbyopic lens you fit and closely follow those guidelines.
8. During dispensing, closely review the proper wear and care of the patient's new purchase.

These guidelines are not for contact lenses, but in fact are the steps for proper fitting and dispensing of progressive addition spectacle lenses (PALs). But, each one applies to contact lenses as well. So what does this mean?

Are Contact Lenses Really so Different From Spectacles?

Obviously, PALs are successful. They have had ongoing technological advances, improved designs, and increased awareness among practitioners and patients alike. More so, techniques for improving their success have been refined, as listed above.

Can we say the same for contact lenses? Most definitely!

Manufacturers have been continually developing new presbyopic contact lenses with better materials and designs; in fact, two new bifocal soft lenses are launching this year. The same is true for GP lenses, with new front-surface design aspheric multifocals and thinner, lighter translating bifocals now available. Plus, the numerous consumer advertising campaigns about presbyopia have made patients quite aware of this alternative.

All in Good Time

But, is fitting contact lenses for presbyopia too time consuming?

I believe this is not the case, provided that you perform the initial interview of each patient's visual wants, needs, and lifestyle in detail and that you analyze all of the pertinent ocular measurements, just as you would when prescribing PALs for presbyopic patients. These two steps will directly point to whether patients are good candidates or not, what type of lens you should choose, and which design is best.

Then, simply follow the manufacturers' fitting suggestions, and you should achieve success rates approaching that with spectacle lenses for presbyopia. 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.