Prescribing for Presbyopia

It’s All About the Vision

BY CRAIG W. NORMAN, FCLSA

I am unsure what the exact timing of this means, but in the past six weeks as I was writing this article, I’ve been asked in an official manner by six different consulting firms and/or contact lens manufacturers for my opinion as to where the presbyopic soft contact lens market is headed over the next few years.

One main reason I’m asked to be involved is because Contact Lens Spectrum has provided me with a “voice” in this column where I can discuss presbyopic contact lenses. Also, some of this interest is simply due to the time of the year (Q4 2013) and relates to strategic planning for industry. Additionally, the industry is attempting to develop new presbyopic contact lens designs and is going through its due diligence of market analysis.

If you’ve ever been asked to participate in these initiatives, you know they are quite interesting. The interviewer asks a series of pre-planned questions that relate to presbyopia, patient needs, contact lens designs, materials, wearing schedules, compliance, etc.

I always attempt to provide non-biased answers to the interviewer’s questions. But at some point, I’m finally exasperated enough to make what appears to be a flippant response that essentially is, “it’s all about the vision.”

Except that it’s not flippant.

Up on My Soapbox

Here’s what these discussions ultimately entail. At some point, it will be mentioned to me that the company being represented in this interview has a new technology involving, for example, a new aspheric center-near design that has an easy transition from near to distance and back again.

I’ve mentioned this before and will continue to: what we need is the ability to provide great vision. Not modified monovision. Not undercorrection in both eyes to help vision at near or intermediate levels, while giving up distance clarity. Not reading glasses worn over multifocal lenses.

Let me describe a scenario that occurs far too often in fitting presbyopic patients with soft contact lenses. 1) We trial fit a patient and choose the best possible presbyopic lens for him. 2) We dispense the lens. 3) The patient returns for his one-week follow up and hopefully orders three to six months’ worth of lenses. 4) The patient returns for his annual exam and says that he doesn’t wear the lenses as often anymore because the vision is insufficient. 5) Often, we don’t have a good alternative to offer the patient.

Why is this? Well, we know the answer—it’s the vision. Either high-illumination/high-contrast VA or low-illumination/low-contrast VA may be poor. Ghosting symptoms may be prevalent, or the visual compromise from lack of clarity is too much for the patient to want to continue routine wear. Plus, the options presently available from the “Big Four” manufacturers are similar enough that the net results for the patient will be the same.

A Bright Future

But, let me circle back to all of those consulting and manufacturing interviews I mentioned earlier. After speaking with these firms, I’m optimistic about our presbyopic patients’ future in contact lenses.

New technologies are being explored, some with optics much different from those presently in use. Older technologies are being revisited with improved optics and better lens materials. Mass customization may be on the horizon versus the mass marketing that we have now. Decentered optics will become a common option in multiple lens materials.

So maybe in the next 12 to 24 months, it will be all about the (great) vision instead. 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.