Speaker: Every presbyope is a candidate for contact lenses
LAS VEGAS – Fifty percent of the U.S. population will be at least 50 years old by 2017, and a variety of contact lenses are available for treating their presbyopia, Louise Sclafani, OD, said here at the Global Contact Lens Forum during Vision Expo West.
“Learn what your patients’ visual demands are,” Sclafani said. “Their goal is your goal, and we can work together to make it work. Everybody is a candidate for contact lenses.”
However, presbyopia is not always presbyopia, she said.
“Technology is driving us with accommodative demands and evaporative dry eye disease,” Sclafani said. “Seventy percent of our patients use digital devices, and many use two at the same time. These tired eyes that need to be treated may not be presbyopic.”
CooperVision recently introduced Biofinity Energys, which has multiple front-surface aspheric curves equally distributed across the entire optic zone and concentrates plus power in the front.
“It’s not a multifocal lens; it’s for people who use digital devices,” Sclafani said.
Many people have had perfect vision until they have presbyopia, and it is a slow progression, she said.
“Ease into the conversation with patients,” Sclafani said. “Make it so they can function throughout that time period. Modifying the present contact lens is important. Giving a quarter more plus to both eyes has greater impact up close. Keep them binocular.”
She recommended keeping patients in the same material if it has been comfortable for them.
“That’s one less thing to deal with,” she said.
Over-the-counter readers are fine, but prescribe them, she said.
“The more they’re trying glasses on over the contacts, the more inclined they will be ready to move into the next phase of multifocal vision,” Sclafani said.
Investing the necessary time in these patients is important to keep them from going somewhere else, she said. “Do charge more for those fitting fees,” she said.
Sclafani added that most presbyopes have some degree of ocular surface disease that must be treated.
“Fix that problem and fit them,” she said. “I’ll take them out of lenses for at least a month and treat them with lid hygiene, lubricants, anti-inflammatories, steroids. Now we have Xiidra (lifitegrast) by Shire.”
A number of approaches to presbyopia exist.
“Spectacles are a good option,” Sclafani said, “as are distance contact lenses with readers. Monovision is successful in about 70% of patients. It’s affordable, practice friendly, a safe alternative. Cataract surgeons and refractive surgeons intentionally create monovision patients, and they do well.”
Sclafani said she has a patient who naturally has monovision: -0.75 D in one eye and -2.75 D in the other.
“I would not force binocularity on her,” she said.
She concluded by saying one certain multifocal is not the best.
“You’ll need to try them all,” she said. – by Nancy Hemphill, ELS, FAAO
Sclafani L, et al. The contact lens trilogy: Specialty areas to boost your contact lens practice. Presented at: Vision Expo West; Las Vegas; Sept. 14-17.
Disclosure: Sclafani is an advisory board member, researcher or speaker for Alcon, Allergan, Bausch + Lomb, Brien Holden Vision Institute, CooperVision, EyePrintPro, Shire, Vistakon, ZeaVision, Optos and AEA Seminars.