Presbyopia is one of the most common types of refractive error practitioners will come across, but it is one for which contact lenses are least commonly prescribed.
Presbyopic patients want contact lenses
Patient lack of motivation cannot be blamed for the poor number of presbyopic contact lens wearers. A recent study conducted across five European countries showed that 50 per cent of women in their 40s felt that contact lenses would have a positive effect on their quality of life; and 41 per cent said they would try contact lenses if their optometrist recommended them; 22 per cent said that contact lenses would be their first choice of vision correction3.
In another survey, people aged between 35 and 64 who had dropped out of contact lens wear were asked to give the reasons for their discontinuation. Here, it was found that ‘comfort’ received the most ratings as the reason for the discontinuation (Figure 1)4. However, what factors differentiate older patients from the younger ones that would help explain why they drop out so suddenly when they enter those early presbyopic years?
From this, it is evident that the requirement for better vision is a much more significant factor for successful contact lens wear in those over 40 compared to those aged under 40 and their previous correction had not met this need.
“Patient lack of motivation cannot be blamed for the poor number of presbyopic contact lens wearers.”
Expectations of Compromises in Vision
There is a general acceptance by practitioners that once patients hit their presbyopic years, they should be expected to compromise in some way with their vision. To understand the relative importance of near versus distance vision, people in the same survey were shown the following scale and asked their preference, assuming they had to choose between ‘Perfect near and OK distance vision’ or ‘Perfect distance and OK near vision’. The survey shows that most patients expect not to have to compromise the quality of either distance or near vision for one or the other. The remaining were only slightly more skewed towards those who prefer perfect distance vision (26 per cent) than those who prefer perfect near vision (21 per cent).
Other Changes in the Ageing Eye
Apart from changes in visual demands, the ageing eye presents, a number of other physiological challenges to the optometrist when it comes to fitting contact lenses. This includes its ability to cope with less oxygen due to the reduced endothelial cell function5, 6 and changes in tear chemistry resulting in drier and more uncomfortable eyes7. Although the industry had made many marked breakthroughs when it comes to improving the material properties and comfort of modern-day soft contact lenses to address these physiological changes, innovations in optical design and visual performance do not seem to have received as much attention or appreciation. For presbyopia, this is certainly a significant factor for addressing the penetration of the contact lenses in the presbyopic market.
As well as patient factors, some optometrists’ fear of the challenges, increased chair time and risk of failure can be a major impediment in the prescribing and subsequent uptake of contact lenses in the presbyopic age group. Additionally, practitioners may underestimate patient interest and motivation, which as we have seen, can be quite high.
On occasions where the optometrist does fit a presbyopic patient with contact lenses, monovision has traditionally been the preferred option. Assuming they have surpassed the limitations for prescribing this method, including the necessity for good starting acuity in both eyes and the ability of patients to suppress, patients fitted with this method often return with complaints such as reduced reading times, glare and poor night vision8.
With technological advances in contact lens materials and optical design, multifocal contact lenses are increasingly becoming available and have been shown to provide superior performance to monovision for visual acuity, stereoacuity and overall patient preference9.
Although presbyopia is the one refractive error that is likely to affect all of us during our life time, it is dissatisfying that it is the one for which contact lenses are the least commonly prescribed10, 11. Vision, comfort and physiological factors affecting the patient are certainly all relevant to successful contact lens wear for presbyopes.
However, optometrist motivation, attitudes, confidence, awareness and perception of patient interest and motivation are the key to unlocking the growth opportunity that the presbyopic contact lens market presents.
Aware of the enormous opportunity that the untapped presbyopic market present, particularly as the population ages, the contact lens industry has invested heavily in the research and development of this market.
- U.K. Statistics Authority. Retrieved 21 November, 2008 from www.statistics.gov.uk.
- Mintel Optical Goods and Eyecare report, 2006.
- Challinor, D. Presbyopia plagues daily life claims new research, Optician, 2005; October.
- U.S. Presbyopic Usage and Attidude Study 2004.
- Niederer, RL., Perumal, D., Sherwin, T., McGhee, CNJ., Age-Related Differences in the Normal Human Cornea: A laser scanning in vivo confocal microscopy study. British Journal of Ophthalmology, 2007; Sept;91(9):1165-9.
- Bourne, WM., Nelson, LR., Hodge, DO., Central Corneal Endothelial Cell Changes Over a 10-Year Period. Invest Ophthalmol Vis Sci, 1997;38:779-82.
- Nichols, K., Aging, Hormones and Dry Eyes, Contact Lens Spectrum, 1999; Sept, p21.
- Bennet, ES., Contact Lens Correction of Presbyopia. Clin Exp Optom, 2008;91:3:265-278.
- Kollbaum, PS., Wong, JR., Are Today’s Aspheric Soft Multifocals as Good as Monovision? AAO, 2008.
- Morgan, PB., Efron, N., A Decade of Contact Lens Prescribing Trends in the United Kingdom (1996-2005). Contact Lens and Anterior Eye, 2006, 29(2), p59-68
- Morgan, PB., U.K. Contact Lens Prescribing 2008, Eurolens Research, Manchester University, 2008. Nina Tahhan is an optometrist and professional services manager at Ciba Vision, U.K. This article is based on her original article published in the first January issue of Optician (09.01.09) entitled Opportunities With Presbyopia. This article has been reprinted with kind permission from Optician magazine.