Prescribing for Presbyopia

We Need More Daily Disposables for Presbyopes

BY CRAIG W. NORMAN, FCLSA

The problem of ocular dryness is being discussed from many different perspectives in this Annual Dry Eye Issue. In my experience, some patients describe more end-of-day lens awareness (dryness or discomfort) while others complain of greater awareness after wearing their lenses for days or weeks prior to replacement. What strategies will benefit presbyopic patients who experience these symptoms?

Managing Lens Dryness

Luckily, the Tear Film & Ocular Surface Society (TFOS) is addressing this question for all lens wearers with the formation of the TFOS International Workshop on Contact Lens Discomfort that will be meeting again later this year in Italy. One mission of this group is to “develop a contemporary understanding of the definition, classification, epidemiology and neurobiology of contact lens discomfort.” Hopefully, over time, this organization will develop some definitive answers to this nagging problem.

For now, how can we best manage presbyopic patients who present with these symptoms?

In general, the obvious first steps are to ensure that patients aren’t suffering from asthenopic symptoms associated with uncorrected spherical error or astigmatism, or from lens care incompatibility. Also recommend ocular lubricants when dryness occurs.

Once this is accomplished, my view is very simple: we need to place as many presbyopes as possible into daily disposable lenses. I believe this modality should be the number-one choice whenever possible for all soft lens wearers, but especially for the 45+ age group of soft lens wearers. Each day the lenses are fresh and clean, with no deposits that can increase lens awareness and no concern about lens care solutions causing any level of ocular sensitivity.

Here’s our dilemma: we have very limited options available in the United States. As of this writing, only two daily disposable multifocal lens options are available to us—Focus Dailies Progressives (Alcon) and Proclear 1 Day Multifocal (CooperVision).

A Hurdle to Overcome

The four major soft lens manufacturers are undertaking a lot of research and development of new lens materials, resulting in some true advancements in hydrogel, silicone hydrogel, and even combinations of both materials.

We’re also increasingly hearing reports that the real issue of lens awareness and contact lens dryness is associated with “coefficient of friction and lubricity.” While these are not necessarily new factors in the dynamics of contact lens wear, they are finally reaching a high level of scientific interest. I agree with this line of investigation and applaud the manufacturers in their efforts.

But in the meantime, we need help today with our lens-wearing presbyopes who experience lens dryness. Because the optics of most of these multifocal lenses have remained relatively unchanged over the past decade, I ask that lens manufacturers not wait for new materials but simply provide us with more daily disposable options—now.

Let’s try to decrease the dropout rate of soft lens wearers by having more lens options available for the one demographic category that we know needs daily disposables—our presbyopes. CLS

Craig Norman is Director of Research, Michigan College of Optometry at Ferris State University. He is a fellow of the Contact Lens Society of America and is an advisor to the GP Lens Institute. You can reach him at CraigNorman@ferris.edu.