prescribing for presbyopia
Play Matchmaker for Your Patients and Their CLs
BY CRAIG W. NORMAN, FCLSA
At the recent British Contact Lens Association (BCLA) meeting, Eef Van Der Worp, Ph.D, from the Netherlands, offered some interesting thoughts on how he approaches the presbyopic patient. His step-by-step plan makes a lot of sense. You'll notice that his prescribing patterns slant toward GPs. In Holland, approximately 35 percent of contact lens wearers wear GP lenses.
Step one: Determine whether monovision or bifocal/multifocals are best for the specific patient.
In Dr. Van Der Worp's mind, while monovision might be of consideration for patients in the early stages of presbyopia, bifocals or multifocals will usually perform better overall.
Don't hesitate to discuss multifocals with all patients over 40. In fact, we can make the case that early presbyopes definitely benefit from being fit with one of the low-add lens designs. Don't wait until the patient's presbyopia symptoms become problematic.
Step two: Determine whether soft lenses or GPs are best.
While previous soft lens wearers should first consider remaining in soft contact lenses, GPs remain an excellent option for this group. Soft lenses tend to be a better choice for the patient who is either emmetropic or needs little distance correction. This is primarily because the lack of movement of soft contact lenses may give a little more consistency for distance vision. But, as you'll see in Dr. Van Der Worp's chart (Figure 1), he breaks down which lens types he believes will function better depending on the patient's visual, physiological, comfort and cost needs.
Step three: Choose the lens style (either simultaneous or translating vision).
Dr. Van Der Worp believes that, in general, simultaneous lenses are great for starters -- for both presbyopes and practitioners. Simultaneous lenses are straightforward to fit and result in good success rates. While he said that translating GP designs provide the best vision, the fitting process may be slightly more difficult, but not enough to discount using them when indicated.
Step four: Choose the right manufacturer. Most designs are proprietary to a specific laboratory so you can order the lens only from that manufacturer. But if a style is available from numerous manufacturers, ensure that the lenses are of the highest quality.
Make sure that the manufacturer can provide adequate consultation. This is often the most critical part of the fitting process.
A Telling Question
Dr. Van Der Worp's closing remarks at the BCLA seemed the most pertinent to me. He asks each patient, "What vision level is most important (far, intermediate or near)? Two distances out of three are usually easy to correct. We'll try to correct the third level also, but unless you're an early presbyope it may not be achievable."
Most patients who can discern which visual levels are most important to their visual needs can be successful.
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Figure 1. A chart of which lens types function better for certain patients.
Craig Norman is director of the Contact Lens Section at the South Bend Clinic in South Bend, Indiana. He is a fellow of the Contact Lens Society of America and is also an advisor to the GP Lens Institute.