Presbyopes continue to make up a significantly high percentage of the average eyecare practice. Yet, while the 2015 census data claim that 40% of the U.S. population is 45 or older (U.S. Census Bureau, 2016), multifocal or bifocal contact lenses have not achieved anywhere near as high a level of practitioner usage and patient acceptance. For instance, four separate sources estimated that only 8% to 18% of contact lenses were prescribed in this category in 2016 (Nichols, 2017).

At the recent American Academy of Optometry Meeting, a colleague asked whether I’d heard any news regarding lenses for presbyopia during the presentations I had attended. Realizing that I hadn’t heard anything new from the podium, I reviewed the program grid; of the 18 courses in the contact lens track, not one had the terms presbyopia, bifocal, or multifocal in the title. Meanwhile, “scleral” was in 11 of the 18. Surely, there must be significantly more patients who need/desire presbyopic contact lenses than sclerals.

What’s Going on?

Here’s one observer’s opinion:

1) Surgical procedures have finally become a competitive threat to presbyopic contact lenses. Approximately 17 million laser-assisted in situ keratomileusis (LASIK) procedures have been performed in the past 17 years in the United States (www.statista.com ). Undoubtedly, millions of those patients were either treated with monovision or are now becoming presbyopic and using over-the-counter readers or prescription eyeglasses. For sure, only a small portion wear contact lenses.

But forget LASIK. Pseudophakic IOLs are becoming more popular every year. On the emerging front are corneal inlays, although presently they are primarily designed for emmetropes and provide a monovision effect. The biggest challenge yet may be scleral implants and true accommodating IOLs, which are on the horizon.

2) Myopia control. At the aforementioned AAO meeting and at the recent Optometric Management Symposium, there was more buzz regarding the use of soft multifocals for myopia control than for presbyopia. This should not be taken negatively, but I hope that the manufacturing and research community doesn’t put all of its efforts into children at the expense of innovations in true presbyopic designs.

3) We need new lens designs. Manufacturers have made terrific strides in producing more comfortable soft lens materials. Plus, a soon-to-launch new surface treatment for custom soft, GP, and hybrid lenses may allow even greater numbers of patients to wear contact lenses. Also, the influx of multifocal daily disposable options is improving comfort and wearing time, while decreasing solution sensitivities.

But, comfort is only part of the equation. Will extended depth of focus, center-distance, universal add power designs be the answer? Will decentered optics that claim to fix the “line of sight” issue become widely available? Will they perform as promised? Time (and patient response) will determine the efficacy of these design philosophies. What is interesting is that they are different—hopefully different enough to help solve the presbyopia puzzle.

What Do We Make of This?

Presbyopia by definition relates to the ability to focus. My only hope is that we don’t lose our focus when it comes to using contact lenses to care for our presbyopes. CLS

For references, please visit www.clspectrum.com/references and click on document #254.

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. He receives honoraria from Bausch + Lomb and Truform Optics. You can reach him at CraigNorman@ferris.edu.