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Preventing lens dropout with presbyopic patients


We are all seeing an increasing number of presbyopes in our practices, as the baby boomer population bubble enters that stage of life where wisdom causes the loss of focus. There are many challenges we as doctors need to address within this population, including contact lens wear.

We are all seeing an increasing number of presbyopes in our practices, as the baby boomer population bubble enters that stage of life where wisdom causes the loss of focus. There are many challenges we as doctors need to address within this population, including contact lens wear. 

Traditionally, we have blamed discomfort for contact lens dropout, but we know that the level of dropout increases as people become presbyopic.1 Patients think it is too much hassle to continue lens wear as the need for near correction increases. They become increasingly irritated with their inability to see at near.

As I lecture around the country, I am amazed at the number of doctors who tell me they don’t use multifocal contact lenses. They tell me fitting them is too time consuming, and the lenses don’t work that well. They say they can’t charge enough for the extra time and effort it takes. They use monovision, but often tell the patient that even this is not a good way to go. Often they would rather just prescribe multifocal glasses because it takes less time and they make more profit. However, as I wrote in my last article, the value of a contact lens patient far surpasses that of an eyeglasses patient. 

Increasing options for presbyopes

Manufacturers are rapidly developing new lenses for this growing market. New designs will help our presbyopic patients stay in their lenses for life, including styles from Alcon, Bauch + Lomb, and Sauflon. Several new lenses will debut in 2014, including new one-day multifocals. This is a very exciting development, as I find that many of my patients would like to have the convenience of a daily lens, especially if they are wearing single-vision daily disposables. This also is a great way to introduce part-time lens wear to presbyopes who would enjoy wearing lenses for social occasions. New multifocal gas permeable designs also provide excellent optics. And several of our soft-lens specialty companies are producing excellent custom-designed soft and soft-toric multifocals. With this vast array of lenses available, why are we not fitting more?

Patients’ near demands are growing, and our presbyopes are not immune from smartphones, computers, and their wrist monitors. For patients who are just turning 40 or so, I recommend putting a +0.75 D lenses in front of their correction and see their response. If they say, “This is more comfortable,” they may be prime patients to try a multifocal design. These are the sweet spot patients. Using a lower add lens and keeping their distance vision excellent will give them the advantage of better and more comfortable near vision. This also will start them in a multifocal, and once adapted as they age, it will be easier to go with a strong near lens. In my practice, I almost always recommend multifocals first and go to a monovision fit only if the patient cannot adapt. It is important for the practitioner to become familiar with at least 2 different multifocal designs and learn about the lenses’ power profiles. This will give the doctor the confidence to recommend these lenses to their patients. 

We must be confident when talking to our patient about multifocal contact lenses, but most importantly, we need to speak about them in a positive frame. If you don’t show you believe in the lenses you recommend, you will set your patients up for failure. I talk to my patient about my high success rate and how happy my patients are in these lenses. I always smile when I have a new patient in the chair. Often, I mention multifocal lenses, and patients have never heard of them or they tell me their previous doctor said multifocals didn’t work. The companies have developed excellent fitting guides for these lenses and, when using them, you will find your success rate will soar.

Some doctors say multifocal lenses are not worth the time and/or money. Chair time is very valuable, and I have found that I am typically achieving success in 2 visits. But if chair time is becoming excessive, it is time to switch out of multifocals. Patients understand these lenses are more sophisticated and expect to pay more. Don’t be afraid to charge more for the chair time; you have invested in your education and deserve to charge appropriately. Fortunately, these are the patients who have more disposable income and are more willing to spend on their wellbeing. Giving your patients the perception of being younger is a rewarding experience.ODT


1. Rumpakis JMB. New data on contact lens dropouts: An international perspective. Rev Optom. 2010;147(1)37-42. 

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