Article

PRESCRIBING FOR PRESBYOPIA

TARGETED PRESCRIBING

“I love my new contact lenses!” My patient’s exuberance enveloped me like a warm embrace. It was particularly sweet because this normally understated 60-year-old female, who is a retired school administrator, had tried contact lenses in the past but had dropped out.

A few weeks prior to the visit described above, she presented for a comprehensive eye examination. She reported having attempted multifocal soft contact lens wear about 10 years earlier. At the time, her job demanded that she spend an average of six to eight hours per day on the computer. As she put it: “It was simply more comfortable to view the screen when I wore my glasses. So, I just started wearing my glasses all the time.”

Then she added a comment that piqued my interest: “I really miss the contact lenses for golf.” She went on to say that she didn’t mind wearing her glasses for other tasks, but the weight and awkward head positioning demanded by the progressive lenses made them annoying while on the golf course.

Change Offers Opportunity

Some might view this particular patient as a poor candidate for contact lens wear, considering her history of prior failure. But much had changed with her visual demands since she had last tried contact lenses. She no longer was glued to a computer all day, and her new schedule allowed her to play more golf. She now had a targeted need: visual freedom while golfing.

We often view patients as either spectacle wearers or contact lens wearers. Instead, consider viewing patients as busy, multifaceted individuals who engage in a wide variety of tasks, some of which may be better served by spectacle wear and some by contact lens wear. Target your prescribing to whichever approach performs best for a given activity.

Daily Disposables for Occasional Wear

Wearing contact lenses for certain tasks and not for others inherently leads to part-time, or occasional, wear. In such instances, daily disposable lenses offer many advantages. Contact lens cases develop microbial loads in a relatively short period of time (Lakkis et al, 2009). In fact, having re-wearable two-week or monthly replacement lenses sitting idly in cases for extended periods of time may increase the risk of ocular infection. This is obviously not a problem with daily disposable lenses.

Worried about cost? There is evidence to suggest that daily disposable lenses may actually be more cost effective compared to reusable lenses when worn fewer than five days per week (Efron et al, 2010).

Teeing Off with Contact Lenses

My patient was fit with daily disposable multifocal lenses following the manufacturer’s guidelines. She returned a few days later reporting that her vision was pretty good at near but not as good as she’d like at distance. She reported often losing sight of the golf ball after teeing off. I jokingly told her that we had two options: “Either we change your contact lenses to improve distance vision, or you need to quit hitting the ball so far.” Not surprisingly, she elected to pursue the first option.

Understand the Priorities

When prescribing multifocal contact lenses, determine a patient’s highest visual priority. In this case, her priority was distance vision. When troubleshooting, this awareness drives better decision-making.

After first confirming that the distance power was correct in each eye, I lowered the add power in the dominant eye. Although her near vision dropped off slightly, she didn’t care. This adjustment did the trick for what she wanted. She remarked, “I can hit that ball a country mile and still see it!”

Some presbyopes have limited interest in full-time contact lens wear but may benefit greatly from occasional wear for specific activities. Targeted prescribing can improve your patients’ quality of life and may have them greeting you with exuberant appreciation! CLS

For references, please visit www.clspectrum.com/references and click on document #286.