40 is the New 20/20 — Presbyopia Equals Opportunity

Many presbyopic contact lens wearers drop out due to inadequate vision. Today's new silicone hydrogel multifocal designs make it easy for them to continue wearing the modality they love.


40 is the New 20/20 — Presbyopia Equals Opportunity

Many presbyopic contact lens wearers drop out due to inadequate vision. Today's new silicone hydrogel multifocal designs make it easy for them to continue wearing the modality they love.

By Dwight H. Akerman, OD, FAAO

It's a well known fact that the population in the United States is aging, but when it comes to expanding the contact lens market to include more presbyopes, one particularly meaningful feature of this trend stands out: Our population is MIDDLE aging.

More than 169 million people in the United States (55% of the total U.S. population) wear vision correction. Of this group, more than 63 million people (53%) up to age 64 are presbyopic.1 The multifocal contact lens market is underdeveloped versus spectacles — 92% of presbyopes wear spectacles as their primary mode of correction while only 8% wear contact lenses.

In short, there are hundreds, if not thousands, of presbyopes in your practice, and more are coming. These patients represent a tremendous opportunity for practice growth because wearing spectacles full time simply isn't an option for them.

The latest-technology silicone hydrogel multifocal contact lenses, available only recently, enable ECPs to not only keep emerging presbyopes in contact lenses, but also to satisfy the requirements of new presbyopic contact lens wearers. New silicone hydrogel multifocal lenses fulfill our ultimate goals of providing comfortable, crisp, binocular vision at near, intermediate and distance across a wide range of prescriptions, while also satisfying comfort and physiological requirements.


Practitioners have a plethora of vision-correction choices for patients with presbyopia. New-generation multifocal contact lenses are a great option for many patients — especially emerging presbyopes who already wear contact lenses.

Patients who have been successfully wearing contact lenses for many years often are not anxious to stop wearing contact lenses and begin wearing spectacles full time. They enjoy the freedom of contact lenses and want to continue wearing them even though they now require a presbyopic correction. However, many contact lens wearers stop wearing their lenses when they become presbyopic due to comfort, convenience and vision issues. New-generation silicone hydrogel multifocal contact lenses have largely addressed these issues and may allow patients to wear contact lenses well into their 60s and 70s.

Silicone hydrogel multifocal contact lenses are also a better choice than monovision or monovision plus eyeglasses. Some ECPs may take the easy approach to emerging presbyopia in contact lens wearers by fitting these patients with monovision. Monovision may work adequately for a few years, but as the disparity between the eyes increases, most patients won't be satisfied with their binocular vision. They often add readers over their contact lenses, defeating the purpose of wearing contact lenses in the first place. Monovision may be the easiest change, but it�s not the best solution.

Unlike monovision, new-generation silicone hydrogel multifocal contact lenses provide crisp, clear, binocular vision at all distances. As vision changes over time, practitioners can change the prescription without the inherent problems associated with monovision. Even better, new-generation silicone hydrogel multifocal lenses don't require the lengthy chair time that turned many practitioners away from firstgeneration HEMA multifocal lenses. Thus, monovision should no longer be a first-line option for presbyopic contact lens patients. The goal of most ECPs is simple — clear binocular vision — and new-generation silicone hydrogel multifocals provide the ultimate solution.


When we look at contact lens wearers, the numbers are fairly stable among patients aged 25 to 40.2 But around age 40, the numbers begin to steadily and dramatically decline (Figure 1). This decline in contact lens wear virtually mirrors the simultaneous increase in patients' need for vision correction. More and more people need vision correction, but fewer are wearing contact lenses.

Figure 1. Contact lens usage drops off dramatically after age 40, while the need for vision correction steadily increases.

What's behind this age-related pattern in contact lens use? Two reasons seem likely. First, people who are age 50 or older are less likely to have worn contact lenses because they began needing vision correction at a time when contact lens technologies weren't advanced or widespread. The second reason, in a word, is dropouts.

"Over-40" contact lens dropouts are unique. Sure, comfort is the most common reason patients of all ages stop wearing contact lenses, but an interesting split exists. Before age 40, comfort is the number one reason for a whopping 41% of dropouts. Only about 15% cite vision problems.2

Patients age 40 and older who drop out of various contact lens options, including monovision, spherical lenses and older multifocal lenses, cite comfort as their primary reason 26% of the time, while 24% cite vision as their primary reason (Figure 2).

Figure 2. Before age 40, patients stop wearing contact lenses mostly because of comfort issues. After age 40, dropouts are often the result of comfort AND vision issues.

New-generation silicone hydrogel multifocal contact lenses address patients' vision issues, giving them crisp, clear, binocular vision at all distances. There are no monovisionrelated problems and no need to wear reading glasses over contact lenses to see clearly.

New-generation silicone hydrogel multifocals address comfort-related dropouts, as well. Unlike multifocal lenses made from old-technology HEMA materials, today's multifocals are made from silicone hydrogel, so they offer greater comfort, wettability and oxygen transmission.

When we look at comfort-related dropout numbers, consider these statistics. Among U.S. patients with singlevision lenses, 61% wear silicone hydrogel, compared with 39% who wear non-silicone hydrogel lenses.2 The numbers are dramatically different among multifocal contact lens wearers, just 30% of whom wear silicone hydrogel lenses, while 70% remain in older-generation non-silicone hydrogel lenses. These data suggest a major opportunity to upgrade patients to a better wearing experience.2

For aging patients, silicone hydrogel materials are a major step forward. As people age, dry eye symptoms may begin or worsen, particularly among women, who make up a large share of the contact lens market. Thus, many presbyopic women are challenging contact lens candidates. They need a lens that doesn't exacerbate dry eye, and new silicone hydrogel designs fill that need.

Monthly replacement schedules can improve compliance and potentially reduce dropouts, as well. Consider that 72% of patients who wear monthly replacement lenses are compliant with the manufacturer's recommended replacement schedule, compared with just 48% of 2-week replacement wearers.3 By providing patients a replacement schedule that encourages better compliance, ECPs are also supporting a better wearing experience for their patients.



1. Annual Estimates of the Resident Population by Sex and Five-Year Age Groups for the United States: April 1, 2000 to July 1, 2008 (NC-EST2008-01) (Accessed 11/4/09
2. CIBA Vision, data on file.
3. Dumbleton K, Woods C, Jones L, Fonn D, Sarwer DB. Patient and practitioner compliance with silicone hydrogel and daily disposable lens replacement in the United States. Eye Contact Lens. 2009;35:164-171.