By 2030, 1 in 5 Americans will be 65 or older.1 As the American population continues to age, the demand for presbyopia treatment options has increased.
Many patients are looking for options outside of glasses to correct their intermediate and near vision.
They want choices that fit seamlessly into their daily routine and don’t highlight the fact that their eyes are aging.
Many patients are unaware that multifocal contact lenses are a possibility.
Multifocal contact lenses are an excellent solution for presbyopia and are certainly not a new modality. Yet some eye care providers still struggle with using multifocal contact lenses in their practices.
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Being comfortable with this treatment not only ensures that patients have access to the latest in eye care technology, but it also maximizes the success of the practice from a business perspective.
Here are 4 tips to maximize the potential of multifocal contact lenses in your practice:
1: Plant the multifocal seed.
Presbyopia is a growing market. Over 120 million Americans have presbyopia and many don’t realize they are candidates for multifocal contact lenses.2
Some patients believe that progressive lenses, bifocals, or over-the-counter reading glasses are their only options for correcting near vision problems due to presbyopia.
Other patients have been told in the past that multifocal contact lenses were not an option for them due to their prescription values or the presence of astigmatism.
But the world of multifocal contact lenses has evolved and there are many options for patients of all prescriptions.
A recent study showed that 31 million people buy over-the-counter reading glasses each year, often from a supermarket or drug store.3
As primary eye care providers, optometrists (OPs) have the opportunity to educate patients about all the options available to them to see better and improve their quality of life.
Start by telling patients that multifocal contact lenses can be the primary mode of vision correction or an option for part-time, recreational, or weekend wear. Explain how contacts are designed, how they work and how they can be integrated into everyday life.
Even if a patient declines multifocal contact lenses this year, they may want to reconsider the option in the future.
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Eye care staff members often have unique interactions with patients outside of the exam room, which can provide them with opportunities to educate patients about multifocal contact lenses.
2: Follow the assembly guide.
It is important to follow the fitting guide that accompanies each contact lens. This is especially true for multifocal contact lenses, as different brands have different optical zones and fitting strategies.
Companies often revise their fitting guides as more contact lens data becomes available through patient use. Many clinicians create their own fitting techniques.
It may work a small percentage of the time, but it often ends up with more chair time and patients having poor success with their multifocal contact lenses. It’s a good idea to periodically review the fitting guides for contact lenses that you fit frequently.
I learned this lesson the hard way when I started fitting Alcon’s Dailies Total 1 multifocal lenses many years ago. I followed a similar fitting approach to other multifocal contact lenses on the market which correlated a low/medium/high multifocal lens with the patient’s Addition Power (ADD).
My fitting strategy did not follow the fitting guide and resulted in more chair time, multiple contact lens follow-ups, and patients with poor vision in their contact lenses.
Everything changed when I went back to the assembly guide and followed it. For this particular contact lens, adding +0.25 to the spherical correction and using the lowest ADD possible made it fit the best. These simple changes led to better results with the first trial contact lens and resulted in less chair time and happier patients.
3: Set expectations.
Take the time to set realistic but positive expectations. Instead of looking for a perfect 20/20 for distance and near vision, a more appropriate end point should be functional vision for both distance and near.
Each patient has different visual requirements and functional vision will vary greatly for each patient. It is important to educate patients that they can achieve most daily activities with contact lenses.
Related: Research reveals significant lack of contact lens knowledge among consumers
I also tell patients not to compare their vision in multifocal contact lenses with their vision in glasses, because that’s comparing apples to oranges. Setting these clear expectations lets patients know that it is okay to not achieve a perfect 20/20.
That said, many patients get 20/20 at both distance and near with modern multifocal contact lenses.
In 2021, McDonald et al proposed a categorization of presbyopia that divides the condition into mild, moderate, and advanced categories.4 Their approach centered on classifying presbyopia based on near-corrected distance of acuity rather than age.
In their system, the category of mild presbyopia corresponds to the best corrected visual acuity ranges of 20/25 to 20/40, moderate presbyopia is 20/50 to 20/80, and advanced presbyopia is greater than 20/80 .
Taking this approach to classifying presbyopia is more appropriate and explains why sometimes a 53-year-old patient’s presbyopia may be classified as mild while a 38-year-old patient’s presbyopia may be classified as moderate.
This presbyopia categorization approach has helped me select the best candidates for multifocal contact lenses and set realistic expectations for patients.
4: Embrace new supportive treatment options.
Multifocal contact lenses will not be a perfect modality for all patients, even after setting appropriate expectations and following fitting guides.
One troubleshooting technique I have had success with is using Vuity (Allergan, 1.25% pilocarpine) with a multifocal contact lens in patients who are unable to achieve the clarity they need at a intermediate or near level. Vuity is an FDA-approved premier drug for the management of presbyopia in adults.
Related: Tackling the problem of contact lens abandonment due to presbyopia
An optimized concentration of 1.25% pilocarpine combined with proprietary pHast technology makes Vuity different and more clinically effective for presbyopia compared to pilocarpine.
Vuity, a cholinergic muscarinic agonist, has a dual mechanism of action. It activates the iris sphincter and ciliary smooth muscles to cause extended depth of field and increase the amplitude of accommodation. By making the pupil smaller, similar to pinhole optics, near vision improves.
Vuity has gone through 2 parallel phase 3 clinical trials (Gemini 1 [NCT03804268] and Gemini 2 [NCT03857542]) and included participants aged 40 to 55 who had distance-corrected visual acuity of 20/40 to 20/100.
Clinical trials have shown that at least 3 lines of near improvement in mesopic (low light) conditions have been observed without compromising more than 1 line (5 letters) of distance vision.
Under photopic conditions, 9 out of 10 trial participants saw an improvement in near vision greater than 20/40 under photopic conditions. In full light, a third of the participants were able to achieve 20/20.
Clinical trials have also shown improvement in intermediate vision. The most common side effects of Vuity were conjunctival hyperaemia (5%) and headache (15%).
In my experience, patients who have had headaches have reported them as mild, transient, and occurring only on the first day of using Vuity.
Vuity is taken once daily and becomes effective within 15 minutes of instillation. Most patients report that it lasts 6-10 hours.
If you are using Vuity with contact lenses, the drop should be instilled into the eyes without the contact lens. After 10 minutes, the contact lenses can then be inserted into the patient’s eye. Vuity is a prescription eye drop that can be sent to any pharmacy.
Although Vuity has not been studied in combination with multifocal contact lenses, I have found that in some cases this complementary combined approach allows patients wearing multifocal contact lenses to achieve the improvement in vision up close they are looking for.
1. Rural Health Information Center. Demographic changes and aging of the population. Accessed on 04/22/2022. https://www.ruralhealthinfo.org/toolkits/aging/1/demographics#:~:text=The%20U.S.%20population%20is%20aging,grow%20to%20almost%2090%20million
2. Chang DH. Presbyopia: rethinking the approach to better meet patient needs. Ophthalmology Times®. July 21, 2020. Accessed March 1, 2022. https://www.ophthalmologytimes.com/view/presbyopia-rethinking-approach-to-better-meet-patients-needs
3.VisionWatch. The Vision Council. September 2016. Accessed March 1, 2022. https://www.thevisioncouncil.org/sites/default/files/research/VisionWatch_VisionCouncil_Member_Benefit_Report_September%202016_FINAL.pdf
4. McDonald MB, Barnett M, Gaddie IB, et al. Classification of presbyopia according to severity. Ophthalmol Ther. 2022;11(1):1-11. doi:10.1007/s40123-021-00410-w