Contact Lens Practice Pearls

Preparing Presbyopic Contact Lens Wearers

Contact Lens Practice Pearls

Preparing Presbyopic Contact Lens Wearers

By Thomas G. Quinn, OD, MS, FAAO

Presbyopia is no surprise to us. Unlike other ocular conditions such as glaucoma or dry eye, we know that eventually everyone will experience presbyopia. Don't let it surprise your patients, particularly your contact lens-wearing patients. Be proactive and tell patients who are in their late 30s what is on the horizon. Be gentle and reassuring. Let them know that we have contact lenses that can meet these new demands and allow them to continue to experience the freedom of contact lens wear.

Providing Perspective on Presbyopic Contact Lenses

Success with multifocal contact lenses is greatly dependent on setting appropriate patient expectations. In an effort to let newly presbyopic patients in on the new “rules of the game,” I share these three thoughts with them before they leave the office with their new multifocal contact lenses:

1. Light is your friend. Numerous head-to-head studies have found that multifocal contact lenses are preferred to monovision about 70 percent of the time, but one multifocal contact lens weakness is near vision performance in low light (Situ et al, 2003; Richdale et al, 2006). Don't let this area of challenge discourage you from fitting multifocal lenses. The other benefits are too great. Share this knowledge with patients, then give them the tools to manage this shortcoming.

Encourage those who work at a desk to employ a task light rather than relying on ceiling lights. Let patients know that it may be difficult to read a menu in a dimly lit restaurant. Give them your blessing to pull out a pair of magnifiers, or a pocket or key chain light, under such conditions. Remind them that the goal is to meet most of their needs most of the time with their multifocal contact lenses, but occasionally they will need to employ additional tools.

2. Multifocal lenses are designed to work together. Advise multifocal wearers that they will always see better binocularly. I tell them before they leave the office that one eye may see differently than the other. Rather than repeatedly comparing how each eye is seeing, I encourage them to go about their day with both eyes open. This is particularly important for more advanced presbyopes who may require some binocular imbalance to satisfy visual needs at distance and near.

3. It's a process. Tell all new multifocal contact lens wearers that the proper prescription is dependent on many variables: pupil size, light level, viewing distance, size of objects, etc. Each scenario is unique to each patient. Although we can get very close based on in-office measurements, there is no better way to assess performance than by having patients engage in their usual daily tasks.

I tell my multifocal contact lens patients that sometimes we get things just right at the outset, but sometimes small changes are needed to meet their unique requirements.

Multifocal contact lens fitting is a process, or, if you will, a journey—one well worth taking. CLS

For references, please visit and click on document #189.

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, an advisor to the GP Lens Institute, and an area manager for Vision Source. He has served as an advisor or consultant to Coopervision, B+L, Ciba Vision, and Vistakon and has received research funding from AMO, B+L, Ciba Vision, Coopervision, and Vistakon. You can reach him at