It’s as if the nerd just became the popular kid.

“Presbyopia? Oh yeah, I knew him when he wore a pocket protector.” (Not that there is anything wrong with a pocket protector, I was seen with one from time to time in high school). This condition, which has plagued mankind for centuries, is getting a face-lift, and that cannot be ignored.

Today, we can look at our practices and determine how to use innovations to help our patients. Like all new innovations, they need to be purposeful and front of mind, otherwise they will be forgotten and ignored.

By now, the innovations in the pharmaceutical world around presbyopia drops should stand out like a sore thumb. I predict that, in the next four years, we will have five products on the market, not just one. Most will have a pupil constriction effect on the eye, but each will have a novel mechanism of action.

These innovations will become a major part of exam conversations with patients. Direct-to-consumer advertising, mainstream media, social media promotions, and word-of-mouth will drive patients into the office to request more information about these drops.

Ignoring the presbyopia trajectory will not make it go away.

When it comes to contact lens-wearing patients, these drops may push back contact lens multifocal fitting a few years. When the 38- to 42-year-old patient comes in with eye strain, but with an accommodative posture that hardly warrants full-time multifocal lenses, the solution may be to use one of the presbyopia eye drops once or twice daily to reduce the strain on the accommodative system with intense near tasks. These patients will continue to do fine in distance prescriptions during the weekend and for daytime midrange vision.

While managing presbyopia with contact lenses, try to keep patients in their current add power and have them and add the drops when performing intensive near tasks for extended periods of time. Keeping the patient in a lower add power preserves distance vision while giving the option of an eye drop for more intensive tasks.

Other nonpresbyopic patients may also benefit.

When patients encounter substantial glare or halos at night, some practitioners have treated them with off-label brimonidine to reduce their pupil size. While the effects are patient- and aberration-dependent, this has been a lifesaver for some patients who want to drive at night. Some advantages of the use of pupil-constrictive presbyopia drops are obvious. And, while they would be off-label for this use, shrinking the pupil will create a better depth of focus, reduce halos and glare (for some), and help these patients gain a little better near vision as well.

While the clinical benefits of presbyopia drops are not all known yet, they certainly can be used for the contact lens-wearing patient’s benefit. Their application and our understanding will continue to expand as clinicians explore their mechanisms of action, both on- and off-label. CLS