Early or Emerging Presbyopes
CRAIG W. NORMAN, FCLSA
Pre-presbyopia is the earliest stage at which
patients begin to describe symptoms of (or when clinical findings demonstrate a
decline in) accommodative amplitude. At this life stage, readinging
small print requires extra effort and the patient history suggests that a reading
addition would prove helpful. Unfortunately, when we give patients the option of
optical correction for near work, they usually decline it. I call this the "initial
denial stage," where patients refuse to believe that they may need bifocals to improve
their reading vision.
What should we do for patients who are currently wearing contact
lenses when they first describe presbyopic symptoms?
Will Reading Glasses Work?
Obviously, for some patients a low-power spectacle reading prescription
works just fine depending on their vocation, avocation and willingness to wear an
auxiliary correction. The key for some patients is to have more than one pair of
reading glasses "strategically placed" where they use them most often. Generally
speaking though, most lens wearers would prefer not to wear reading glasses if possible.
Undercorrect Distance Vision
Another strategy is to slightly undercorrect the contact lens
distance power in both eyes. This is especially effective for mid- to higher-range
myopic patients where full contact lens distance correction may stimulate accommodative
effort and result in increased presbyopic symptoms. If acceptable to the patient,
this is a very effective short-term solution, given that you create only subtle
decreases in distance acuity. Beware, though, of patient symptoms regarding vision
while driving, especially at night.
Monovision, in which you (generally) correct the dominant eye
for distance viewing and the fellow eye for near, can also prove effective for emerging
or early presbyopes. Decreases in contrast sensitivity and stereopsis tend to be
minimal at this stage because the undercorrection of the reading eye is usually
only 0.50D to 1.00D. Even so, patients may describe some difficulty driving, especially
at night, or for other vision-sensitive tasks.
Offer Multifocal CLs Early
For the past few years, we've become more aggressive in offering
multifocal soft or GP lenses to early presbyopes. These lenses can provide excellent
vision for this demographic at the three key levels of distance, near and intermediate.
The Bausch & Lomb Multifocal Low Add design is a center-near
aspheric lens that may work well in these cases. CooperVision also offers the Frequency
55 Multifocal, Proclear Multifocal or Ultravue Multifocal, all available in either
a distance "D" or near "N" design. Generally, using the D design with a +1.00D add
power in both eyes corrects emerging presbyopes quite well. CIBA Vision's Focus
Progressives lens is also effective for this patient type.
Aspheric lenses are also an excellent option for current GP wearers
who are demonstrating signs of early presbyopia. It's important to note that you
should use only low add correction in these cases. Parameters for many of these
designs are available on the www.GPLI.org Web site.
Consider correcting contact lens wearers with multifocal soft
and GP designs when they first describe presbyopic symptoms. You might find this
strategy very effective in helping patients deal with their initial denial stage
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 an advisor to the
GP Lens Institute. He is also a consultant to B&L.
Contact Lens Spectrum, Issue: January 2006