Presbyopic patients are a strong source of potential revenue in any eyecare practice. Presbyopes are often the ones who make the financial decisions for their household and even make their family’s choice of eyecare provider. But how many of those patients wear contact lenses in your practice? Contact lens wearers are often more loyal and may make more referrals to their specific eyecare provider, especially if there is anything unique about their vision needs.

Presbyopes can be difficult to fit. Adding any significant amount of astigmatism creates a greater and more unique challenge; there are even fewer contact lens wearers in this category. These patients can be challenging, but they also create a big opportunity when they can be successfully fit.

Managing a Case

A 48-year-old male engineer who is a new patient presented complaining about a loss of crispness with his current spherical multifocal lenses. He is considering just going back to spectacles. His prescription is OD –0.50 –1.00 x 174 and OS –0.75 –1.00 x 018, with a +1.75D add. He is a critically observant patient who is not being satisfied with his current contact lenses due to the uncorrected cylinder. This loss of sharpness is amplified with the spherical multifocal designs.

How do you manage this patient?

1. Get all of the baseline information up front. Assess his motivation to wear contact lenses and discuss all of the fees for your time and expertise up front. Assess his visual needs, including both occupational and recreational visual demands. Ask him to prioritize his visual demands. Let the patient know that correcting both presbyopia and astigmatism with contact lenses is not as precise as with multifocal spectacles, but contact lenses will allow him to perform a majority of his visual tasks without glasses. Auxiliary eyewear may be necessary for certain tasks, but the contact lens prescription can be customized for tasks that are consistently required and critical for his everyday needs.
2. Have lots of tools in your bag. There are quite a few options for presbyopic patients who have astigmatism, with many new options expected in the future. Multifocal GP lenses and multifocal hybrid lenses are both excellent options for patients whose corneal cylinder matches up closely with their refractive cylinder.

Monovision with soft toric lenses can provide decent vision, but it may struggle to meet the variety of visual demands that patients often encounter throughout the day. Soft toric multifocal lenses also present a nice opportunity, especially for those patients who are already accustomed to wearing soft lenses.

There are even soft multifocal toric options that are available for monthly replacement. There was only one lens design available in this category for many years, but Bausch + Lomb recently launched its Bausch + Lomb Ultra Multifocal for Astigmatism, which can be dispensed from a fitting set and provides another opportunity for these uniquely challenging patients.

My patient was already accustomed to wearing soft contact lenses and preferred that option if they could satisfy his visual demands. I was able to successfully fit him with soft toric multifocal lenses that provided good vision for a majority of his visual needs.

Room to Grow

Astigmatic presbyopes may have higher expectations, but they may also provide a strong untapped opportunity in your practice. Don’t let them drop out of contact lens wear. With many options to consider, proactively look to grow this market within your practice. CLS