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contact lens practice pearls
Countering the Challenges Of Presbyopia
BY THOMAS G. QUINN, OD, MS, FAAO
It�s not easy turning 40. Hormonal changes can trigger changes in tears,
resulting in ocular discomfort, which is the leading cause of contact lens
dropout.1 Changes in accommodation can result in near blur for
patients who are wearing singlevision distance lenses, leading to frustration
and inconvenience, the second leading cause of dropout.2 What can we
do to prevent patients from abandoning their contact lenses?
As presbyopia progresses and patients experience greater difficulty reading,
they often reach their breaking point at a time other than when they�re due for
their annual visit. Unaware of the existence of multifocal contact lenses and
frustrated with their vision, they end up picking through a selection of
magnifiers at the corner drugstore so they can continue to wear their contact
lenses. Magnifiers may clear their vision, but the inconvenience of fooling with
them often leads patients to conclude, �I may as well just wear my glasses. It�s
less hassle.� By the time they reach our practices, they may already have
settled into this new lifestyle choice. Here�s how to help your presbyopic
patients stay in their contact lenses.
When examining asymptomatic 38- or 39-year-old contact lens wearers, take time
to educate them about the impending change in their focusing ability. This is an
ideal time to bring it up because it�s not yet a problem, making the news more
palatable. You might say something like, �You�re doing well with your current
lenses, but in the next few years you will begin to notice changes in your near
vision. This is a normal time-related change. I want you to know that when that
time comes, we have contact lens designs that will allow you to continue to
enjoy clear vision at all distances.�
Tell the incipient presbyope, �I�m recommending you return again in one year.
However, if you notice your near vision becoming a problem before then, let me
know and I�ll see you sooner.� This opens the door for patients to call you
rather than head to the drugstore.
Probing Questions To Uncover Dryness
The risk of poor comfort with contact lens wear is often at its highest in
middle age, particularly for women undergoing hormonal changes. One way to avoid
contact lens dropout from dryness-induced discomfort is to explore this issue
every time patients are in your chair, whatever their age. Ask how their lenses
feel, particularly at the end of the day. Ask if they experience any dryness.
Many patients are not aware of these changes until asked about them directly.
Once you�ve identified a comfort problem, jump into action. Don�t wait until the
problem gets worse. You might be too late. Upgrade patients to the innovative
new moisture-retaining contact lens materials available today. Change their care
system to hydrogen peroxide or avoid chemicals altogether and recommend daily
In some cases, you may need to recommend strategies to enhance the ocular
Consider some or all of those listed in Table 1.
The Great Pretenders
Keep in mind that dryness can be induced by other factors (Table 2). A common
scenario that develops in middle age is lens surface contamination. Eyes become
drier as we age, and skin can become drier as well. Patients may start using
lotions and oils that find their way onto the contact lens surface.
Contact Lenses for Life
Contact lens wearers enjoy visual freedom that can�t be experienced with
spectacles. Keep your emerging presbyopes in their contact lenses through
education and proactive intervention. You will help take some of the sting out
of turning 40.
1. Young G, Veys J, Pritchard N, Coleman S. A multi-centre study of lapsed
contact lens wearers. Ophthalmic Physiol Opt. 2002;22:516-527.
2. Vistakon Attitude and Usage Study of Vision Corrected Consumers, 2002.
Dr. Quinn is in group practice in Athens, Ohio. He is a diplomate of the Cornea
and Contact Lens Section of the American Academy of Optometry and an advisor to
the GP Lens Institute.
Contact Lens Spectrum, Issue: May 2007