Winning Hearts and Minds
Multifocals are the contact lens standard of care for emerging presbyopes. Here's how to ensure a smooth transition.
Dr. Schachet: The thinking around multifocal lenses has shifted somewhat, from something we recognize as a business opportunity to treat the growing demographic of presbyopic patients to a standard of care that we don't feel we can deny those patients. We have a duty to provide the best care, and multifocals give patients better vision than monovision, especially over time as presbyopia increases. We all need to get on board if we haven't already done so. The change will ultimately enhance our success and make patients happier, too. What do you tell your colleagues about multifocal lenses?
Dr. Schaeffer: I tell them you have to think of multifocal lenses as a new specialty, a new paradigm in your office. You're creating a compliant patient, which is what we're all trying to do, so think about this new paradigm in terms of how you take care of that patient. Look at how you handle them. How do patients explain their problem to you? How do you state your philosophy on making multifocals, not monovision, number one? How is your staff trained to help? How do you educate patients and follow up with them on the three visits they need?
|We have a duty to provide the best care, and multifocals give patients better vision than monovision, especially over time as presbyopia increases.|
— John L. Schachet, OD
Dr. Kading: It's a specialty within our practice, but we don't have to be specialists to fit them. I think the way you get started, especially if you're a monovision fitter, is to use the fitting guidelines. Start fitting the easier patients — the emerging presbyopes. After 30 fits or fewer, you'll be very comfortable, and you'll be helping patients achieve the full range of vision.
Dr. Sindt: We all have to feel comfortable fitting this modality. Multifocal lenses are the standard of care, so we all have to get there.
|You can't discount a segment this large. You build a practice based on how well you take care of an entire family … It means dealing with all of their medical and refractive issues — from sending them for cataract surgery to fitting them with a multifocal lens.|
— Steve Lowinger, OD
Dr. Lowinger: You can't discount a segment this large. You build a practice based on how well you take care of an entire family, and that means daughter and son, mom and dad, grandma and grandpa. It means dealing with all of their medical and refractive issues — from sending them for cataract surgery to fitting them with a multifocal lens. Saying “no” to fitting emerging presbyopes with multifocals is saying, “I don't want you as a patient.”
You can't build your practice by excluding treatment options or the patients who need them. To me, that's a no-brainer.
WHEN DO YOU START THE CONVERSATION?
Dr. Schachet: Do you wait until symptoms of presbyopia appear to discuss multifocal lenses with your contact lens wearers? Or do you start having that talk proactively as patients approach age 40?
Dr. Sindt: I think it's important to broach the subject before they have a problem. I tell them what they can expect in the future so they're aware that they need to bring those symptoms to my attention. I'm looking for clues such as decreased wear time — anything they can track on their own. If I have a patient who spends most of the day on the computer and perpetually checks his iPhone*, I have the discussion even earlier.
|I tell patients three simple things: 1) This is a new visual system for a new stage of your life. 2) You're going to go through an adaptation period. It could be a day; it could be a month. 3) Each time I see you, our goal is to develop natural, comfortable vision.
Dr. Lowinger: I call it looking in my crystal ball. When patients are 35 or 36, I say, “You'll notice these symptoms over the next few years. Don't worry. You don't have to stop wearing contact lenses and get bifocals with a line across them. We'll be moving you into cutting-edge technology contact lenses.”
Dr. Sindt: That also ties patients to your practice. They'll be back when those symptoms start because they know you can help.
Dr. Schachet: Does anyone wait until symptoms appear?
Dr. Kading: I don't wait until 40 hits and presbyopia starts. My patients in their 30s are working on computers for 8 to 12 hours a day, and then they go home and read on their iPad* and iPhone*devices. They have so many issues related to eye strain and discomfort. They already need three pairs of glasses — computer, distance and sunglasses. When they start showing signs of presbyopia, why keep them in singlevision contact lenses? I explain that it's just like wearing the right sneakers for the right sport. These are the right contact lenses to reduce the amount of effort that their eyes have to put into using their computer. Patients get it. They don't think they're getting old; they understand that they're getting the right lenses for their daily activities.
Dr. Schachet: How do you set proper expectations for multifocal lenses?
Dr. Lowinger: We know what patients are going to encounter during the first week of multifocal lens wear, and we should prepare them. Honestly, I simplify things to the extreme. I say, “I want you to pay attention to three things this week: 1) How do you see far? 2) How are you reading? 3) Are you comfortable? If there are any issues with those three things, then we'll talk about it next week and make any adjustments.” By limiting the conversation to the nuts and bolts, we get to what's important in a more efficient way.
Dr. Schaeffer: I tell patients three simple things: 1) This is a new visual system for a new stage of your life. 2) You're going to go through an adaptation period. It could be a day, it could be a month. 3) Each time I see you, our goal is to develop natural, comfortable vision. And those three things sort of set the stage.
Dr. Sindt: I agree with keeping it simple. Patients don't want lengthy conversations; they just their lenses to work. They're thinking, “You're the professional. Fix me, because I have another appointment in 30 minutes.” I like to let them know that we're putting the near, intermediate and distance correction in front of their eyes at all times. Their eyes know how to see, but it takes a week or so to train or reset their brains.
|My patients in their 30s are working on computers for 8 to 12 hours a day, and then they go home and read on their iPad* and iPhone* devices. They have so many issues related to eye strain and discomfort. They already need three pairs of eyeglasses — computer, distance and sunglasses. When they start showing signs of presbyopia, why keep them in single-vision contact lenses?|
– Dave Kading, OD
It's also important to remember that expectations go both ways. I need to know what a patient expects. I think that's especially important now that we're seeing young multifocal patients who are reading mostly on phones and tablets. That use of their visual system influences how much of an add they're going to need and how early they're going to need it. As we discussed with the question of how early to introduce the lenses, communication gets patients what they need, when they need it, and it helps us create legacy patients — the kind that tell their friends what to expect and who can help fix it. ■