Comfortable technologies, easier fits, and attractive features enable patients older than 45 years to stay in contact lenses.
Many of my patients with presbyopia have enjoyed the freedom of wearing soft contact lenses since they were teenagers. Who’s going to tell them that it’s difficult to wear contact lenses past the age of 45 years? They expect to keep wearing contact lenses, and I’m here to help. I won’t deny the hurdles presented by aging eyes such as dryness and crystalline lens changes, but I’m also pleased to tell patients about the excellent multifocal contact lenses now available, many of which are new and exciting. Here’s how I help my patients spend more decades in the contact lenses they love.
Success with multifocal contact lenses largely depends on how good we are at fitting the lens, how well we match a lens to our patient’s priorities, and our ability to communicate well with the patient. These tips help ensure all goes smoothly.
With multifocal lenses, rather than achieve perfect vision at all distances, we strike the right balance for each patient’s needs. Thus, it’s very important that we understand those needs. I talk to patients about their careers, hobbies, daily life, and what frustrates them most about their vision. This gives me a clear picture of whether their demands are greater for near, intermediate, or distance vision. We proceed to satisfy their strongest need while still offering functional vision at all other distances.
Because patients who need multifocal lenses are generally 40 years or older, dry eye disease (DED) management may need to be part of the multifocal contact lens plan.When a contact lens patient has DED signs or symptoms, I explain to them that even the best contact lenses accelerate the drying process. To achieve success with their lenses, we need to address the underlying DED concurrently, which might mean warm compresses, eyelid margin massage, omega-3 oils to decrease inflammation, prescription immunomodulator drops, punctal occlusion, meibomian gland expression, and intense pulsed light treatments. I let patients know that as long as they’re motivated to follow their DED regimen, they can continue wearing contact lenses at age 40, 50, and beyond.
It’s important to set realistic expectations for what a multifocal contact lens will provide for patients. I want patients to understand that as long as they’re willing to give these lenses a try, we have products that can meet and possibly exceed their expectations.
Working together, we review the patient’s needs and lay out their options. I explain that multifocal lenses will do approximately 80% of what the patient wants, but they may still need their glasses in certain situations.
For example, if we optimize the lens for everyday distance and midrange vision, they might find that they don’t see the small print on their medicine bottles. To remedy this, they’re instructed to use some form of additional magnification for those limited situations. I deliver these expectations in a way that doesn’t undermine the lenses; the lenses will give them freedom and, in most cases, vision beyond their expectations.
Patients are very accepting of the reality that these lenses won’t deliver perfection in 100% of situations—especially when the alternative is complete dependence on glasses—and when they know what to expect, they’re happy with the results.
With healthy competition raising the bar for multifocal contact lenses, the lenses availabletoday are far superior to those we fit 5 or 6 years ago. We have many options, and there’s no single choice for everyone. Instead, I do the lion’s share of my fits using a few designs that answer my patients’ most common needs.
Many of today’s multifocal contact lenses utilize a center-near design. Johnson & Johnson (J&J) also incorporates a unique pupil-optimized design in their multifocal portfolio. This technology accounts for the differences in pupil size as they relate to refractive error. Two companies, Bausch+Lomb and CooperVision, also manufacture multifocal lenses that allow us to fit patients with astigmatism.
Blue-light filtering is a new and game-changing addition to multifocal contact lenses (Acuvue Oasys Max 1-Day Multifocal; Johnson & Johnson Vision). Long available in eyeglasses, blue-light filtering is a capability we associate with relieving eye strain and discomfort for patients with long hours of screen use (virtually all our patients today). In addition, as patients with presbyopia age, the proteins that comprise the crystalline lens begin to aggregate, causing light scatter and glare to increase.Blue-light filtering minimizes light scatter, which means it can help with a range of related problems. My patients typically comment that the blue light filtering reduces the distracting starbursts and halos that make them feel uncomfortable and unsafe when driving at night.
Whether patients have DED or experience occasional dryness astear production declines with age, we need to give them the vision they want while helping them be comfortable during the day. Luckily, we have a lot of new lens materials that do an excellent job of retaining moisture. Alcon’s Dailies Total1 material has always been known for its comfort, and now Oasys Max 1-Day is proving itself to be a leader in the battle against dehydration. Moist eyes are more comfortable, and moist lenses maintain superior lens optics. My patients who use a daily disposable modality report sharper vision and better comfort that allow them to wear their lenses longer. The dryness that comes with the aging process is not a significant hurdle when we pick the right lens.
Multifocal fitting isn’t standardized across manufacturers, and each one has its own fitting guide to optimize the lens’ nuances. I’ve seen practitioners make the mistake of trying to use one company’s philosophy to fit a different company’s lens, but it simply doesn’t work. We need to follow each lens’ easy-to-use fitting guide to succeed.
Although we follow the fitting guides, we can also customize the fit. We’re trying to achieve balanced vision, aligning the balance of distance, intermediate, and near vision with the patient’s individual needs. That may mean compromise, which I discuss with patients up front. The manufacturers also provide guidance on modifying the fit of the lenses to achieve the desired outcome. The Acuvue Multifocal calculator (Johnson & Johnson Vision) will not only suggest the initial lenses for the patient to try but also identify the lenses needed to optimize near or distance vision needs.
Multifocal contact lenses are a popular modality in my practice, particularly among patients who have worn contact lenses for years. If you want to offer them to more patients, I encourage you to do so with confidence. Manufacturers make fitting easy, and balancing the right fit is just a matter of weighing which visual needs the patient considers most important.
If you’re just getting started, I recommend that you select 2 designs that appeal to you and become very comfortable with the fitting guides. Start with patients whose needs are straightforward. The lenses are so exceptional today that if you stick to the fitting guide, you’ll succeed. For example, Johnson & Johnson’s online calculator has turnkey simplicity; put in data, and it tells you which lenses to select and which lenses will give you a little more distance or near vision if needed. Once you have a track record of experiences that allows you to feel confident in your approach, the multifocal contact lens process will seem very easy, and your patients with presbyopia will be happy that you’re keeping them in contact lenses.