Prescribing for Presbyopia

Managing Your Patients’ Expectations

BY CRAIG W. NORMAN, FCLSA

Merriam-Webster’s definition of “expectation” is 1) a belief that something will happen or is likely to happen, and 2) a feeling or belief about how successful, good, etc., someone or something will be. Clinically, the management of patient expectations is one of the key elements of the patient encounter. It might be counseling regarding how a therapy or medication can be expected to work, how one’s vision changes during aging, or how a spectacle or contact lens product will function. For our older patients, this is especially important, as typically the visual system is not performing as efficiently during our presbyopic years as it did earlier in life.

Practitioner Goals

This month I’d like to follow up on an article published in the November 2014 issue of Contact Lens Spectrum by Dr. Amy Dinardo and Trevor Fosso from the Michigan College of Optometry titled “Multifocal Contact Lens Success: Fact or Fiction?” The article reviews a pilot study that looked at the commonalities of 20 presbyopic patients who viewed themselves as successful contact lens wearers; it analyzed wearing schedules, vision demands and acuity, contrast sensitivity function, types of refractive errors, lens types, quality of life, and personality traits.

The method for subject recruitment in their study is noteworthy. Prospective enrollees were simply asked the question “Are your contact lenses meeting your expectations?” If yes, they were invited to participate in the study. If no, they were scheduled to return to the Michigan College of Optometry for further evaluation of their lenses in an attempt to make improvements.

So why is this important? Mostly, it’s that if you were to ask eyecare practitioners what their expectations are for their multifocal/bifocal contact lens wearers, the responses might include that such patients demand great visual acuity at all distances, don’t want to wear an additional correction such as reading glasses, want to wear their contact lenses all day long on a daily basis, and want lenses that are completely comfortable all day long.

Well, the Dinardo/Fosso study found this to not be true for many of the test subjects.

What Patients Really Expect

For instance, 25% of these successful patients were wearing reading glasses over their contact lenses either occasionally or frequently—and didn’t mind. This reinforces the notion that mentioning the potential use of readers with multifocal contact lenses proactively sets up this expectation for patients and, if they’re not needed, it’s a bonus.

Additionally, some patients simply do not want to wear their lenses full-time, but still consider themselves successful, happy multifocal lens wearers. It was not uncommon to find patients who reverted to glasses often during the week for certain activities. Today, the numerous single-use daily disposable multifocal lenses available are a great option for this type of patient.

One of the more fascinating findings was regarding patients who had mild-to-moderate dry eye, yet were quite happy with their lens wear. The study demonstrated that 80% of these successful wearers routinely used rewetting or lubricating drops. Yet, they still rated their lens comfort high (4.5 out of a five-point scale).

The moral of the story? Try to learn as much as possible about how your presbyopes plan to wear their lenses, then detail what they can expect. You may be surprised that patients can be much more satisfied than what our professional expectations indicate. 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.