PRESCRIBING FOR PRESBYOPIA
DOUGLAS P. BENOIT, OD
As we head into the New Year, many of us think about making resolutions. Some are general, such as being a better person. Others are more specific, such as getting more exercise. One that we all could embrace as practitioners is being better at patient education. With our busy practices, it is easy to let this facet slip through the cracks.
We also may stay in our comfort zone rather than talk to patients about new developments. We should resolve to discuss all available contact lens options, including multifocal designs, with every appropriate patient.
For presbyopic patients, any consideration of contact lens correction must include patient education on what multifocal contact lenses can and cannot do. If patients expect their vision to be perfect at all distances (“like it was before I needed bifocals”), they will be disappointed. If they accept that there will be trade-offs, the chance of success is much greater. Remember, presbyopia is a compromise. Progressive addition spectacle lenses are not perfect, but they allow people to function pretty well in most situations. The same is true of presbyopic contact lenses.
Choosing the Best Modality
Other considerations that may influence your decision to move forward include the modality that is best for each patient. Will they be a full- or a part-time wearer? Part-time wear may make adaptation more difficult, especially if a GP lens is needed. How critical is vision at various distances? Would they be happy with glasses for work and contact lenses for casual activities? Lastly, are they willing to pay the higher professional fees associated with these more complex designs?
After such a discussion, if patients do not think that they can be happy with contact lenses, move on to another form of vision correction. Do not waste your time or theirs when the likelihood of failure is high.
On the other hand, if patients understand the limitations and find them acceptable, proceed with the evaluation. First, review the process. Discuss the evaluation phase, in which the proper lens design and powers are determined. Emphasize that they will need to return for follow-up visits to ensure that the powers are appropriate and that the lenses are not causing any harm. Changes may need to be made before the prescription is finalized.
Managing Follow Up
After patients have been prescribed the best lenses for them, stress again that most of their expectations have been met. Also, point out the importance of compliance with the care regimen and/or replacement cycle. Pre-appoint patients for progress evaluations at one week, one month, three months, and yearly. Emphasize again that these visits are necessary to ensure that proper ocular health is maintained. Also, if a power change is needed, it can be addressed earlier. Finally, at each follow-up visit, re-educate patients about what these lenses are doing for them.
Multifocal lenses can be a great option for your presbyopic patients. Proper education on realistic expectations is important for success and needs to be re-emphasized at all visits. If patients feel that the vision is still inadequate, make adjustments to get them back to their visual happy place. The more presbyopic lenses you fit, the more fun you will have. Happy New Year! CLS
Dr. Benoit is the senior optometrist with Concord Eye Center, a multi-subspecialty ophthalmology group in Concord, NH. He is a Diplomate of the American Academy of Optometry’s Section on Cornea, Contact Lenses and Refractive Technologies, currently the Special Advisor for the Section. Dr. Benoit is a Distinguished Practitioner and Fellow in the National Academies of Practice-Optometry Section and is a Diplomate of the American Board of Optometry. He is also on the Advisory Board of the GPLI and is the 2016 GPLI Practitioner of the Year. Dr. Benoit is a consultant to, and clinical investigator for, Alcon and Visioneering Technologies.