Presbyopes are coming into the office and complaining about their vision. They don’t want to be told that they are getting older and that they need to pick up a pair of reading glasses. I can say these things because I am officially in this group. It is hard to admit that, but I am 45 and out of the denial group.

Multifocal contact lenses are vastly underused in my peer group (I’m associating with the presbyopes now). There are many reasons for that. Presbyopic patients can be tough, and it takes time to make them happy. They have a higher incidence of dry eyes, and they are more frustrated about their current vision changes. This leads to higher expectations for both glasses and contact lenses, which can lead to frustration by both eyecare practitioners and patients if those expectations are not met.

It has been shown that presbyopic patients prefer contact lenses when comfort and good vision can be achieved (Rueff and Bailey, 2017). However, many presbyopic contact lens wearers drop out primarily due to discomfort and poor vision (Sulley et al, 2017).

In fact, many of these patients don’t come in asking for contact lenses; but, they would love to have that recommendation from their eyecare practitioner. Make the offer. Find a way to discuss multifocal contact lenses with all of your presbyopic patients, but consider taking the following steps prior to a fitting to improve success with them.

1) Set Proper Expectations

It is important to let patients know that their focusing symptoms are normal and that there is no perfect fix for this condition. Multifocal contact lenses can improve depth of focus, but they are not fixing or treating the changes in their intraocular lenses. Let patients know that they may see some minor ghosting, which will improve as their brain adapts.

2) Listen to Your Patients’ Visual Needs

Look at their occupation and discuss their visual needs prior to grabbing those initial diagnostic lenses. It is important to know whether patients spend part of their job driving around at night or whether they spend most of their day on the computer looking at small spreadsheets. Those visual needs will help determine the contact lens or modality with which to start.

3) Describe the Fitting Process

Let patients know that it may take a little fine-tuning to get their multifocal contact lenses working the way they want. The lenses are customized for their visual needs, and small changes can make a big difference in success.

4) Use the Fitting Guides

Some eyecare practitioners have been in practice for a while and feel like they don’t want to pull out a fitting guide. If that is the case, look at it secretly then. Many, many patient encounters have gone into developing those fitting guides. They do help, and they will maximize your success.

In Summary

Multifocal contact lenses can be a huge practice builder. Presbyopes prefer contact lenses when success can be achieved. But, it does initially take time and energy from both patients and practitioners. Subsequent years are often easier adjustments, but take the time upfront and set a strong foundation for a future of contact lens wear for your presbyopic patients. CLS

For references, please visit and click on document #277.