Prescribing for Presbyopia

Presbyopes: Worth the Trouble

Prescribing for Presbyopia

Presbyopes: Worth the Trouble

By Jason R. Miller, OD, MBA, FAAO

As we continue to improve our contact lens fitting techniques, we are in a unique position to make a big difference with our presbyopic patient population. There are huge growth opportunities as 74 million baby boomers were born between 1946 and 1964 (National Center for Health Statistics). Soft contact lenses really grew up and became popular when this now-emerging presbyopic population was hitting their teens. These patients don't want to stop wearing contact lenses. In addition, this demographic has tremendous spending power and will make educated decisions on where to spend their money (Studebaker, 2009).

These emerging presbyopes want clear vision with their contact lenses, that is why they're in your chair. If you take this opportunity and successfully transform them into multifocal wearers, they will not only never leave you, but will tell their friends how you helped them. Presbyopes may make you work for their support, but they are worth the effort.

Don't Forget to Stretch

Even though presbyopes lose the flexibility of their crystalline lens, it is important to maintain your flexibility during the course of a multifocal lens fitting. There is not one multifocal design that is perfect for everyone. Be comfortable with the various designs and why some may provide better distance clarity, while others may maximize their near visual acuity.

I've heard some colleagues say that multifocal contact lenses are a pain, the patients are demanding, and it is a frustrating fitting process. I would agree with some of that to some degree. I would also say there are two ways to look at this situation:

Unwanted Stress Tell presbyopes that they're not good candidates for contact lenses and dismiss them.

A Business Opportunity Tell them the advantages and disadvantages of multifocal lenses and let them know when they're good candidates for that technology.

Don't get upset if you have to see them a few extra times. If you charge appropriately for a multifocal contact lens fitting, your time will be compensated and you could develop a lifelong patient.

Focus on the Fitting Process

Remember, this is a process and not a one-time event. The most important thing to remember during the fitting process is to, “Listen to their needs!” There is no cookbook with these lenses and sometimes things don't always make sense. Focus on the patients' wants and needs.

For example, ask patients, “How do you feel like you're seeing? Are you comfortable reading your cell phone and driving comfortably?” Don't even look at the chart to see their individual functional visual acuities. Make adjustments based on what they want.

You are customizing the multifocal lenses to the patients' daily visual tasks. If you correctly identified a patient's dominant eye, now is where you make visual adjustments. I would recommend changing only one variable at a time. If they want more distance, give them a little more distance or a little less add in the dominant eye. If they want more near, give them a little more near or a bigger add in their nondominant eye. Have the patients back in a week and see how they are doing.

Was the Stage Set Correctly?

Don't forget to identify patients' occupations, hobbies, and daily visual requirements. This also aids in properly identifying their visual needs and discussing proper expectations ahead of time.

By successfully transforming this patient population into multifocal contact lens wearers, you will inevitably gain the respect of these presbyopic patients and develop ambassadors for your practice. CLS

For references, please visit and click on document #186.

Dr. Miller is in a partnership private practice in Powell, Ohio, and is an adjunct faculty member for The Ohio State University College of Optometry. He has received honoraria for writing, speaking, acting in an advisory capacity, or research from Alcon, Argent Media, Aton Pharma, CooperVision, and Hoya. You can reach him at