Prescribing for Presbyopia

Are Old Options New Ones?

BY CRAIG W. NORMAN, FCLSA

I would like to preface what you’re about to read by acknowledging that I strongly believe in the role that GP lenses play in contact lens practice, and especially in managing presbyopia. (This should not be a surprise to any reader who has perused this column through the years that I’ve been fortunate to contribute to Contact Lens Spectrum.)

A year ago, I wrote a column about participating as a lecturer/instructor in the Contact Lens Manufacturers Association’s (CLMA) Gas Permeable Lens Institute (GPLI) Cornea and Contact Lens Resident Symposium. This conference is such a powerful event that I felt it warrants being discussed again.

Twenty-seven recently graduated optometrists from across North America who have committed to another year of contact lens-focused education gathered together for an intense weekend of GP, custom soft, and hybrid lens fitting lectures. They were provided with updates on lens designs, materials, and fitting concepts. Additionally, they each had 14 direct patient interactions in which they were either fitting new patients or following up with habitual wearers.

A New Contact Lens Landscape

For me, the meeting reaffirmed an opinion that I have been contemplating for a while. Clearly, there are now four distinct contact lens categories: 1) GP lenses, 2) scleral lenses, 3) soft lenses, and 4) hybrids—even for presbyopia.

This does not appear to ring true for the new generation of optometrists who are extremely “scleral-centric” when it comes to rigid lenses. They are either not interested in, or have not been exposed enough to, traditional (corneal) GP lenses to realize that there is a clinical place for them. And that thinking will continue ... until they are exposed to them.

New Again

When you have the opportunity to either examine presbyopic patients who are successful in corneal GP lenses or to trial fit presbyopes with GP lenses and hear them describe how great their vision is, you can become a believer in this lens category.

At this GPLI meeting, each group of residents had the chance to fit a presbyopic patient with their choice of up to six corneal GP multifocals/bifocals, with hybrids also an option (I will discuss hybrid fitting in a future column). The lenses that were “trialed” had been previously ordered by simply supplying the manufacturers with keratometric measurements and spectacle prescription with add power.

The results were astounding. The residents with whom I interacted were truly impressed with the positive responses that presbyopes had to their trial lenses. Another key takeaway was that numerous corneal GP options can work for these patients including bifocal, multifocal, and progressive designs.

Revisiting my scleral-centric comment from above, every group of residents with whom I interacted while teaching about both GP corneal and scleral lenses asked if scleral lenses were available for presbyopes. My answer is “yes, they are.” But, when prescribing sclerals for presbyopia, you face the same visual challenges and optical issues that need to be addressed with presbyopic soft lenses: center-near designs, no translation during the blink cycle, and pupil dependency in different positions of gaze.

So, let’s not push aside corneal GPs for presbyopia just yet. Corneal GPs are a viable option and need to be included among the recommendations that we give patients today. 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.