Prescribing for Presbyopia

Our Resolutions for the Year 2016

BY CRAIG W. NORMAN, FCLSA

As we ring in the New Year, it’s the perfect time to make plans for the year ahead. In both my January 2008 and January 2011 Prescribing for Presbyopia columns, I wrote about what resolutions I would make to improve my presbyopic contact lens practice for the upcoming year.

My Previous Resolutions

Combined, my previous resolutions were: 1) ensure that I’m using the latest products; 2) evaluate and update my inventory and fitting sets; 3) review my fee structure for presbyopic fitting services and lens materials; 4) review how our practice communicates the benefits of contact lenses to our presbyopic patients; 5) mention contact lenses to all appropriate presbyopic patients; 6) routinely analyze the center segment-to-pupil position in soft presbyopic lenses; 7) use more custom-made soft lenses for my presbyopic patients; and 8) consider bifocal/multifocal designs for medically necessary contact lens fits.

What’s amazing to me is that each of these points is still appropriate for any of us interested in improving the success rates of presbyopic contact lens wearers.

Let’s focus on a few of these.

Daily Disposable Options 2016 might well be the year of daily disposable multifocal lenses, with several on the market and more on the horizon. These designs fit in perfectly with presbyopes’ lifestyle, providing the flexibility of wearing contact lenses on their own personal schedule. Expect toric multifocal daily disposables to also soon become more readily available.

Scleral Lens Options On the opposite end of the contact lens product spectrum are multifocal and bifocal scleral designs. The options are too many to list here (but you can see them in more detail in Dr. Melissa Barnett’s article “Multifocal Scleral Lenses” in the December 2015 issue). These designs provide greater correction options for medically indicated scleral lens wearers of presbyopic age. Furthermore, many expect that scleral lens use for normal refractive errors will increase, which opens up these designs for those patients as well.

Other Developments Expect new hybrid, soft, custom soft, and GP presbyopic designs to also enter the market this year.

New Resolutions

Following are some new resolutions to consider:

1) Listen more closely for dry eye symptoms. Clinically, dry eye symptoms are closely related to increased lens awareness, decreased wearing time, and dropouts. Address the dry eye first. Educate patients and recommend the therapies that can provide longer, more comfortable wear. Most patients are amenable to using lubricating drops, especially if they are aware of their need before being fit with contact lenses.

2) Ask patients about their visual tasks. Which two of these three distance levels are of most importance—smartphone, desktop, or driving? Then, specifically design the presbyopic correction to ensure that these two are maximized, which is typically easy to accomplish with today’s lenses. In my experience, this “pick two” philosophy improves outcomes.

3) Do not make financial decisions for patients. Practitioners too often mention how “expensive” products are rather than discussing how “beneficial” they may be. Let’s face it, it’s more costly to correct presbyopia than single vision—but this is true across the board, whether with spectacles, contact lenses, or surgery. Instead, provide the recommendation regarding what’s “best” for patients and let them decide whether it’s affordable or not.

Happy New Year! May all of your resolutions come true. 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.