A 58-year-old patient came into the Kading office yesterday, noting that she loves her contact lenses but is having to wear her readers a little more often. She commented that this doesn’t happen every day, but on the days when it does happen, she must wear her readers for two to four hours. Her distance visual acuity was 20/20 OD and 20/25⁺ OS with her daily disposable multifocal lenses, which have a low add in her right eye and a high add in her left eye.

Historically, most practitioners would consider this patient’s solution to be one of the following:

1. Give her a high add in her right eye.
2. Give her more plus power in one of her eyes.

Regardless of the solution selected for this patient, she will have a slight decrease in distance vision to gain a slight near improvement for a few hours a week. If only we had a presbyopia solution that a patient could use for a few hours a day to help solve these types of problems. Enter presbyopia drops.

The age of presbyopia drops is upon us. Within the next five years, we predict that three to six presbyopia drops will come onto the market. While the mechanism of action may be different for each of the supposed drops, many of them work by constricting the pupil. It is imperative that we clinicians use the tools at our disposal, present them to our patients, and work to find the most ideal solution for each patient.

My patient shared that she loves her multifocals. They give her incredible freedom, but she has this one sticky point that bothers her on occasion. It is not a constant problem, but an occasional one.

Historically, we have used, and will continue to use, multiple powered contact lenses for our patients. They simply choose their better near or better distance lens for the tasks of the day. While this is one solution afforded to our daily disposable patients, it has its limitations in that it is often an all-day decision.

The Verdict

Presbyopia drops may afford patients shorter duration or occasional usage to simplify their contact lens wear. We have been using them for emmetropes, part-time contact lens wearers, spectacle wearers, distance and multifocal wearers, and our specialty patients. In each case, the conversation with the patient requires additional education and—from a practice management perspective—that needs to be taken into consideration.

Presbyopia is not new, and it is normal. And now, presbyopia drops are a new normal in eye care. Like Benjamin Franklin’s bifocals, this solution could certainly change the face of presbyopia treatments. While not a singular solution, it will be a part of millions of patients’ weekly regimen. If you are not using it routinely in your office, we invite you to try this new option for treating presbyopia. CLS