“Presbyopia isn’t just a vision problem; it’s a lifestyle disruptor!”
This insightful observation by Dr Margaret Lam highlights the profound impact of presbyopia, a condition affecting an estimated 2.1 billion people worldwide. Dr Lam, Head of Optometry and Professional Services at 1001 Optometry in Australia, was among 20 influential eye care professionals (ECPs) from the Asia Pacific region who participated in the recent Johnson and Johnson Contact Lens Leaders’ Summit in Seoul, South Korea.
Presented here is a summary of discussions at the Summit’s multifocal contact lenses (MFCL) workshop, which focussed on the advantages of proactive MFCL fitting and provided practical strategies to help ECPs maximise fitting success.
Benefits of Proactive MFCL Fitting
The increasing prevalence of presbyopia presents challenges and opportunities for ECPs. By proactively recommending MFCLs, practitioners can enhance patient satisfaction, strengthen professional expertise, and grow their practice.
The attendees discussed their reasons for proactively recommending and fitting MFCLs:
- Building Loyalty and Referrals
Time investment. Investing time in explaining MFCL options fosters patient loyalty, encouraging return visits and referrals. As Ho Wei Lin, Head Optometrist at Paris Miki Singapore, stated, “loyalty is my motivation, from a business sense, as well as a differentiator”.
Differentiation. Offering MFCLs as a standard practice sets ECPs apart, enhancing overall business success. Kang Lian Lee, President of the Singapore Optometric Association and owner of OJO Optometrist, provided a personal example of this by noting, “after fitting a patient with MFCLs, she brought in the whole office the next month”.
- Professional Growth
Scope of practice expansion. Embracing MFCL fitting keeps ECPs at the forefront of vision correction innovation. Jeff Tang, Director and Optometrist of Berlin Optical Hong Kong remarked, “I’m a fan of technology; as soon as something new comes into the market, I’ll introduce it to my patient, I always suggest the best”.
Reputation enhancement. Consistently recommending advanced solutions, like MFCL, boosts the ECP’s standing as a leader in their field.
- Personal Satisfaction
Life-changing outcomes. Helping patients achieve better vision can be incredibly fulfilling, enhancing job satisfaction, “there’s a sense of achievement when you restore clear vision,” said Mr Lee Kang.
Dr Lam shared her five-step communication strategy designed to help ECPs confidently fit presbyopes with MFCLs
Effective Patient Communication
Effective patient communication is key to successful MFCL practice. In her inspiring session, Dr Lam shared her five-step communication strategy designed to help ECPs confidently fit presbyopes with MFCLs.
- Reframe expectations:
- Set realistic expectations without discouraging the patient. For example, don’t say, “they will not be as clear as your glasses”. Instead say, “these lenses are designed to prioritise what you need most: vision for reading, computer and your phone, with good vision for distance as well”.
- Use language that emphasises gain, not loss, e.g., “let’s get you freedom from your glasses”.
- Explain the fact that it may take time for the brain to adapt. “These lenses provide a different way for your brain to process vision, you will find your vision will improve over the next couple of weeks.”
- Share the lifestyle benefits, don’t sell the lens:
- Connect the benefits to the pain points your patient has identified. Highlight how the MFCLs address their needs, e.g., “these contact lenses are designed for those, like you and I, who need to focus on both distance and close up”.
- Explain the science to boost engagement:
- Describe the technology behind the lens, e.g, “let me share with you how these specific MFCLs work” then explain the centre near design and how the pupils constrict when the eyes look up close.
- Encourage increased brightness for reading to promote pupil constriction, optimising lens performance.
- By explaining the optics, you empower patients to take control of their environment to minimise MFCL limitations.
- Always commit to follow up appointments:
- Clearly outline the next steps upfront, e.g. “I’ve prescribed a customised CL design. Remember it may take time to adapt to the vision.” Then explain that “in nine out of 10 patients the prescription is correct, however in one out of 10 we may need to tailor the prescription to give you a little sharper vision for distance or reading”.
- Book a follow up on the spot, “let’s book an appointment in two weeks’ time”.
- Handle objections like an expert:
- Don’t be defensive when explaining what to expect with MFCLs. Never say, “CL vision will be worse than glasses”. Instead, explain the trade-offs with confidence and conviction.
- When presented with concerns about the performance of the lenses, emphasise the positives. If asked, “will my distance vision be blurry?”, respond by saying, “you may lose about 1–2% of your distance vision, but then you gain about 100–200% more vision up close. So what you gain is worth it for a little bit of soft focus in the distance”.
Chair Time
A number of the ECPs mentioned the extra time that MFCL discussions, rather than the fitting process itself, may require. However they also acknowledged the value that MFCL patients bring to their practice.
Dr Lam observed that in these instances, time should be viewed as an opportunity. “Yes, multifocals take a few extra minutes, but all good things take time. The ethical, clinical, and business upside dwarfs the modest time investment,” she said.
Mr Lee agreed, adding that establishing a routine built on experience, helps limit time as a fitting impediment. “After a handful of cases, the extra minutes disappear,” he said.
multifocals take a few extra minutes, but all good things take time. The ethical, clinical, and business upside dwarfs the modest time investment
Fitting Tips to Maximise Success
Ensure the Refraction is Updated
- Start with an up-to-date prescription, maximising plus in the distance correction.
- The duochrome (red/green balance) test is effective for maximising distance plus, ultimately reducing spherical aberration and minimising visual compromise.
Assess for Ocular Dominance
- The sensory dominant eye is the eye most sensitive to plus defocus; adding plus to this eye would further degrade binocular vision.
- Sensory ocular dominance is determined by alternating a +1.50D trial lens in front of each eye while the patient is looking at a distance target, with distance correction. Whichever eye is more uncomfortable or blurry is the dominant eye.
- Many ECPs are using the sighting method to determine ocular dominance, however the sensory method tells us which eye has the greatest sensitivity to plus defocus. Most MFCL manufacturers recommend the sensory method over sighting, to achieve successful fitting.
Use of Fit Guides
- Fit guides streamline the MFCL fitting process, minimising chair time, and offering confidence and guidance, especially for less experienced practitioners.
- These guides are unique to specific CL brands. They are created based on each manufacturer’s design as well as knowledge gained during the clinical trial phase of development, and are generally available as digital, online tools.
Fit guides streamline the MFCL fitting process, minimising chair time, and offering confidence and guidance
Lens Assessment Techniques
- Prioritise ‘real-world’ vision assessments over consult room vision charts. Prescription refinements can be made as recommended in the manufacturer’s fit guide if required.
Conclusion
The group concluded that proactively recommending multifocal contact lenses benefits everyone – enhancing patient satisfaction, strengthening practice reputation, increasing patient loyalty, and fostering professional development. By implementing the strategies outlined in this article, eye care professionals can achieve successful MFCL fittings and significantly improve their patients’ quality of life.
