The under-representation of contact lens wearers in the presbyopic population has been long-standing and much discussed. Despite the attention, it remains a significant area of missed opportunity. From my perspective, the number one reason for the low number of presbyopic contact lens wearers—especially considering the large potential that exists—is the failure of practitioners to actively recommend them to patients.

With the earliest versions of soft multifocal contact lenses, this might have been understandable. They had relatively low success rates and often required special efforts or adjustments to be acceptable. There are still some active practitioners (not a great number) who remember fitting them, and that number is lessening each year. Back then, when lecturing, it was not uncommon to field such questions as “When will a good bifocal come out?” and there was an attitude of “I’ll wait until they perfect it before I recommend it to patients.” While not many things are “perfect” in life, current soft multifocal contact lens options are very good. There are multiple designs in excellent materials available in every wearing modality.

It’s Not the Lenses

The failure today lies not with the products, but with providers who have not embraced them and have failed to learn how to utilize them to the best benefit of the large presbyopia segment of the population. The learning curve to fit current soft multifocals is relatively short—just follow the fitting guides to achieve good success.

There continue to be large numbers of presbyopic patients who would welcome the opportunity to get away from their glasses, even for just some of the time. If given a chance to experience multifocal contact lenses—or better yet, having their practitioner actively recommend them as a good alternative to glasses—many more patients could benefit from their comfort and convenience.

A New Option to Consider

Speaking of products in the category, another new addition has been added to our presbyopia fitting toolkit: the Dailies Total1 Multifocal from Alcon. This new daily disposable lens is in the same silicone hydrogel, water gradient technology material as the Dailies Total1 sphere; the 156 Dk/t may benefit some older eyes, even on a daily wear basis. More likely, the comfort that this material affords to some patients who have contact lens-related dry eye symptoms will be the key attribute of this new lens, as will the convenience of daily disposability.

The Dailies Total 1 Multifocal incorporates the exact same optical design as the company’s other multifocal offerings. It is a center-near aspheric lens with low, medium, and high add power options. Initially, the lens has been introduced with sphere powers of +3.00D to –6.00D, but this will eventually expand to include a range from +6.00D to –10.00D with the three add options for each lens power.

Don’t Be the Weakest Link

With yet another presbyopic contact lens option, the ability to successfully fit presbyopes with contact lenses has never been better. Practitioner confidence, enthusiasm, and interest remains the most significant barrier to many more patients being able to enjoy the lifestyle and vision enhancements that contact lens wear can provide. So take the pledge to no longer be “The Weakest Link.” CLS

Dr. Pence serves as associate dean, Clinical and Patient Services, Indiana University School of Optometry in Bloomington, Ind. He is a Fellow of the American Academy of Optometry. He is also a consultant or advisor to Alcon, has received educational funding from Alcon, Johnson & Johnson Vision Care, and B+L and has received travel funding from CooperVision. You can reach him at