Special Edition 2011
Prescribing for Presbyopia

Considerations of the Aging Eye When Fitting Contact Lenses

prescribing for presbyopia

Considerations of the Aging Eye When Fitting Contact Lenses

By Jason R. Miller, OD, MBA, FAAO

It's all in your ability to CEE—Communicate, Educate and manage Expectations that will determine the success or failure of your patients. In particular, presbyopic patients are rarely an easy fit. They can be a demanding set of patients and often make you work for their praise. In addition, achieving comfortable contact lens wear and prescribing for this loss of near focus can be a difficult process. In fact, these patients have varying pupil sizes, varying visual demands, varying levels of ocular surface disease and varying levels of experience with contact lenses. But the trends are changing.

Practitioners are fitting multifocal lenses over monovision at an increasing rate (Nichols, 2011). Manufacturers are developing new lens designs and seeking the next big thing, but success depends on your ability to communicate, educate and manage expectations.


After listening to what your presbyopic patients want and need out of their multifocal contact lenses, take a few minutes to explain what the fitting process entails. Let them know it's a process—not a one-time event.


A roadblock can occur when something goes wrong with the process. Educate the patient that this process isn't like taking their spectacle prescription and turning it into a contact lens prescription. Describe the design of multifocal contact lenses and the science behind their visual demands. In order to be successful, the doctor and patient need to be on the same page during the process.


I enjoy getting my patients excited about new treatments and new lenses, but focus on setting realistic expectations.

Let the patient know there are many variables that will determine their success with multifocal lenses and some issues may not surface until the middle of the fitting process.

Stress that the primary goal is reducing their dependency on reading glasses, not eliminating the need for them.

The presbyopic multifocal contact lens wearer needs to understand that there may some situations where a little “extra” magnification may be necessary for small print. If a patient is asking for the best vision while sewing and the sharpest vision for night driving, the patient needs another expectation reminder.

Preventing Dropouts

The #1 key is patience, not patients. The patients will be there and they will continue to come. And it's not the baby boomers everyone is talking about, it's the Gen X-ers (born 1965-1976) that are going to cause this market to explode. These patients have grown up with the soft contact lens industry. They started wearing soft lenses in their early teens and they won't be happy if you take them away from them.

These patients are already unhappy with presbyopia, so make sure you don't over-promise the abilities of multifocal contact lenses. Be honest about the results they can expect. In addition, assess their vision using “real world” targets, such as their cell phone, e-reader or laptop.

Steps to Success

If you follow these steps, your success will increase with this unique group of patients. Business benefits will follow—they may be difficult to please, but they're very loyal and they can be the best ambassadors for your practice. CLS

For references, please visit and click on document SE2011.

Dr. Miller is in a partnership private practice in Powell, Ohio, and is an adjunct faculty member for The Ohio State University College of Optometry. He has received honoraria for writing, speaking, acting in an advisory role, or research from Alcon, Argent Media, Aton Pharma, CooperVision and Hoya. You can reach him at