Clinical Scorecard: What Are the Options Now?

At a Glance

Key Highlights

• 42% of the US population is 45 years or older, increasing presbyopia prevalence.
• 16.7% of adults in the US wear contact lenses for vision correction.
• Silicone hydrogel lenses dominate the contact lens market with 64% share.
• Nearly 50% of contact lens wearers have astigmatism >0.75 D.
• Monovision is a viable option for astigmatic presbyopes.

Guideline-Based Recommendations

Diagnosis

• Assess refractive error and categorize astigmatism type (WTR, ATR, oblique).
• Determine corneal vs. refractive astigmatism.

Management

• Use toric lenses for patients with ≥0.75 D of astigmatism.
• Consider monovision for presbyopic patients to avoid reading glasses.

Monitoring & Follow-up

• Evaluate patient adaptation to monovision and adjust prescription as needed.
• Monitor for symptoms such as glare and stereopsis loss.

Risks

• Potential disorientation and longer adaptation time with monovision.
• Increased glare complaints, especially at night.

Patient & Prescribing Data

Adults with presbyopia and astigmatism, particularly those over 45.

Soft toric lenses or toric GP lenses are preferred for patients with significant astigmatism.

Clinical Best Practices

• Consider patient lifestyle and visual demands when prescribing lenses.
• Educate patients on the adaptation process for monovision.
• Regularly reassess visual acuity and comfort with contact lenses.

References

• 2020 United States Census
• National Institutes of Health Survey
• 2024 Contact Lens Spectrum Overview