How to combat high contact lens dropout rates in presbyopic astigmats

In an exclusive interview with Optometry Times, Erin Rueff, OD, PhD, FAAO, centered on discussing the problem of contact lens dropout, particularly among presbyopic astigmats. She emphasized how much of this dropout stems from communication gaps rather than purely clinical failure.

Rueff began by highlighting that follow-up is often neglected after prescribing lenses, and clarifies that follow-up does not have to mean an in-office visit; it can be as simple as a text, email, or phone call from staff to check on the patient’s experience. She noted that misunderstandings frequently arise because patients lack precise vocabulary to describe their visual or ocular sensations. For example, patients may use “dryness” as a catch-all term for end-of-day fatigue, discomfort, or even headaches. If the clinician accepts “dryness” at face value and merely switches lenses or stops lens wear, they may miss the true underlying issue.

Instead, Rueff advocates for probing, structured questioning to help patients generate a broader range of descriptors for their symptoms, allowing the clinician to better distinguish between surface dryness, visual strain, refractive issues, or early presbyopic changes. When discomfort remains puzzling, she recommends revisiting objective data: performing a fresh, balanced refraction, reconsidering the need for an add power even in younger presbyopes (eg, around age 39), and thinking more creatively about refractive solutions. This data-driven approach should be combined with communication skills to address “tricky” patients who do not fit neatly into standard categories.

Rueff then turned to presbyopic astigmats as a historically underserved group. For many years, there were limited or unsatisfactory toric multifocal options, leading clinicians to either improvise partial solutions or forgo contact lenses entirely for these patients. This created entrenched habits and a persistent mindset that such lenses are unreliable or not worth pursuing. She argued that, as of 2026, the availability of a comfortable, daily disposable toric multifocal lens represents an important practice opportunity. Clinicians are encouraged to “shake up” old routines, try newer technologies, and re-engage these patients with modern options. Doing so can transform under-served presbyopic astigmats into loyal patients who feel their unique needs are being thoughtfully addressed—potentially increasing return visits, family referrals, and long-term practice growth through a reputation for personalized, forward-thinking care.