Setting expectations with presbyopia-correcting contact lenses

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Of the 25,000 patients we see at our practice in a year, almost two-thirds have presbyopia. It is my responsibility to not only educate my fellow doctors and our patients about the condition but to offer effective, personalized solutions to meet our patients’ changing visual needs. Multifocal contact lenses are at the center of our practice’s multifaceted approach to addressing presbyopia.

The first soft multifocal contact lens was introduced in 1984,¹ and early models had significant drawbacks, leading many patients to discontinue their use.² As a result, adoption rates continue to vary across the US, so providing recommendations based on patient lifestyle and visual demands and setting realistic expectations with multifocal contacts can be challenging. In addition to patient education, a personalized approach to multifocal contact lens selection helps those with presbyopia understand how these lenses can help them achieve outstanding vision.

Having a dialogue about multifocal contact lenses with patients

Presbyopia is a gradual condition and can often be a catalyst for patients to consider multifocal contact lenses to improve their intermediate and near vision. Not every patient, however, will be ready for multifocal contact lenses at the same point in their eye care journey.

Discovering more about the severity of a patient’s symptoms can help determine the appropriate time for intervention. Some patients have difficulty admitting that they need reading glasses. Once they are ready for an intervention, I introduce the topic of working together to find the most suitable option that meets their unique needs and preferences.

Rather than making assumptions about the type of lens that might work best for each patient, we discuss their initial preferences and past experiences together. I counsel them to consider what the latest multifocal contact lens designs offer that might help them regain clear vision at all distances. I also describe how multifocal contact lens materials, designs, and fitting processes have come a long way in recent years, so even those who have had a negative experience in the past are surprised by how the technological advances can enhance their vision.

I have found that patients are more willing to consider multifocal contact lenses when I am able to discuss them with enthusiasm and confidence. Taking some time to explain the design, comfort, and visual outcomes associated with various multifocal contact lens brands helps patients to consider various options while recognizing that I care about their eye health, lifestyle, and comfort.

Contact lens selection

Getting comfortable with contact lenses across different product portfolios has helped me gain confidence in fitting multifocal contact lenses. It is important to explain the fitting process to patients, especially for those who had a negative experience with multifocal contact lenses in the past, because fitting is not as arduous as it once was. Following the fitting guides while framing and managing patient expectations are keys to successful fits and adoption.

There are many excellent choices, and I have found success recommending and counseling patients regarding daily multifocal contact lenses that feature state-of-the-art technology. These provide hydration and minimize contact lens–related dryness, which are both key for eye comfort and clear vision. For patients who are good candidates, we will discuss brands such as INFUSE One-Day Multifocal contact lenses (Bausch + Lomb), which feature 3-Zone Progressive design that offers seamless transition between near, intermediate, and distance vision; DAILIES TOTAL1 Multifocal (Alcon), which feature a Precision Profile lens design; MyDay multifocal (CooperVision) designed with a Binocular Progressive System; and ACUVUE OASYS MAX 1-Day Multifocal contact lenses (Johnson & Johnson Vision), with pupil optimized design.

If a patient has had success with a previous multifocal design and was happy with the comfort and vision, I will continue to recommend the same design, unless new symptoms or concerns arise. I have found that patients do well with INFUSE One-Day Multifocal contact lenses. These feature a proprietary blend of electrolytes, osmoprotectants, and moisturizers infused into the lens material to minimize dryness and discomfort and optimize the wearing experience. For a patient who is new to multifocals, I lean into 3-Zone Progressive design as my primary recommendation. I might also recommend DAILIES TOTAL1 Multifocal or ACUVUE OASYS MAX 1-Day Multifocal, depending on the patient’s preference.

Setting expectations

Patient education plays a pivotal role in managing expectations with multifocal contact lenses. The benefits and limitations of multifocal contact lenses should be communicated directly to ensure patients gain an understanding of realistic outcomes. Patient concerns such as comfort, visual clarity at various distances, and adaptability to different environments should also be addressed proactively. This helps guide patients toward proper lens selection and sets realistic expectations.

If ocular surface disease is present, the condition is treated and managed before contact lenses are prescribed to ensure optimal comfort and vision. This is especially crucial for patients wanting multifocal contact lenses.

Patients with high degrees of sustained visual demands may not be the best candidates for multifocal contact lenses. On the other hand, those looking for more freedom and flexibility often respond well to multifocal contact lenses. Informed decision-making for multifocal contact lenses involves navigating the diverse visual needs of patients. Recommendations should be based on their lifestyle and daily activities, including work responsibilities and hobbies. We tell patients that our goal is to get them to “20/happy vision.”

Benefits of a contact lens trial

For patients interested in learning how multifocal contact lenses may benefit them, we recommend that they are fit in soft multifocal contact lens trials. We ask them to focus on their vision quality and explain that they should be able to see and do most daily activities comfortably and confidently up to 95% of the time. Night vision while driving or reading in dim lighting can challenge vision quality, so we counsel patients about these situations in advance.

We also ask patients to consider how they feel wearing the contact lens. Some may like the lens but prefer not to wear it all the time. We let these patients know that partial wear is a good strategy for their visual needs.

Within 4 days of a contact lens trial for new multifocal contact lens wearers, one of our staff will contact them to see if they are navigating their real-world experience as anticipated. If they are not completely satisfied, they return to our office for further evaluation. Most patients, however, are satisfied with their lens choice thanks to the care we take during the contact lens selection process.

Neuroadaptation tends to occur more naturally and quickly with soft multifocal contact lenses than with progressive glasses because of concentric rings or aspheric design. These allow gradual transition from one range of vision to the next. With concentric multifocal contact lenses, a central primary viewing zone is surrounded by concentric rings of near, intermediate, and distance powers. Aspheric multifocal contact lenses are designed so that the lens power from the center to the periphery of the lens changes gradually from distance to near or near to distance.³ These design differences can affect each patient’s vision and comfort experience and are often best tested via trial wear.

Expanding the scope

Offering multifocal contact lenses to all patients, regardless of their initial preferences or past experiences, helps expand the scope of vision correction options and enhances patient satisfaction. At the center of the process is a thorough understanding of multifocal contact lens options, as well as setting patient expectations appropriately and using a holistic approach to patient education and personalizing recommendations.

Engaging in open dialogue with patients and addressing their concerns helps patients feel supported in their journey and gives them confidence that they can achieve outstanding vision and enhance their quality of life with multifocal contact lenses.

References:

1. Grant NJ, Fujimoto MJ, Caroline PJ, Norman CW. History of contact lenses. Contact Lens Spectrum. November 1, 2021. Accessed March 16, 2024. https://digital.clspectrum.com/articles/history-of-contact-lenses?article_id=4168040&i=730108

2. Naroo SA, Nagra M, Retallic N. Exploring contact lens opportunities for patients above the age of 40 years. Cont Lens Anterior Eye. 2022;45(6):101599. doi:10.1016/j.clae.2022.101599

3. Heiting G. Multifocal contact lenses for presbyopia. All About Vision. February 27, 2019. Accessed March 19, 2024. https://www.allaboutvision.com/over40/multifocalcls.htm