In Optician, part 10 of the Essential Contact Lens series discussed the correction of presbyopia with contact lenses. The advent of modern designs and materials has coincided with more people over 40 wanting contact lens correction, one that offers both acceptable comfort and clear vision for distance and near in both eyes. This has much to do with the way older people’s lives are far more active and visually demanding than ever was the case previously. This article is one of two source material articles for a new interactive exercise.

The second source article is Crossing the Presbyopia Chasm. This is a discussion of the various influences on the overall market trend towards fitting a multifocal contact lens option over either reading over-spectacles or a monovision single vision contact lens approach to correction. It references two interesting studies as follows:

  • In 2017, Rueff looked at a group of 307 vision-corrected individuals between the ages of 18 and 76 years. In this group, 78% (237/304) reported spectacles as their primary form of correction and 22% (67/304) contact lenses.1 When looking at just the presbyopes, a significantly larger percentage (42.2% vs 23.9 %) were in the spectacles group, reflecting an under-penetration of multifocal contact lenses. However, roughly two-thirds of the spectacle wearers who had worn contact lenses previously said they would actually prefer contact lenses if good vision and comfort could be achieved, and the preference for contact lenses was not significantly different between the presbyopic and non-presbyopic group.
  • In another, more recent, survey of presbyopic contact lens wearers, it was found that, of the 50.8% (n=782) of presbyopes already wearing contact lenses at least part of the time, only 25% of these used multifocal contact lenses.2

So, it would seem that, even though there is a shift towards multifocal contact lens correction of presbyopia, there is still some resistance, partly from the ECP. This interactive exercise is aimed at generating some discussion in this area.

Case Scenario

A 42-year-old, male patient attends your practice having never worn spectacles. Indeed, he has never had an eye test before. It is clear from examination that he is a low hyperope and becoming presbyopic and needs correction for near work. However, when discussing management options, it becomes apparent that he is vehemently opposed to the idea of wearing spectacles. ‘The thought of putting something on his face is not appealing,’ and he mentions several times how his family and friends will see this as a clear sign that he is ‘getting old’.

 

Discuss with a colleague the following:

  • What management options will you discuss with the patient?
  • If contact lenses are to be considered, what would be your first choice of modality and optical design (for example, monovision, centre near multifocal, centre distance multifocal, extended depth of focus) and why?
  • What would you tell the patient to expect regarding their vision with each of your options?

You will then be asked to summarise the key points agreed through discussion that address these questions.

Remember, there are no right or wrong answers, all submissions are read in complete confidence, and the CPD point is an interactive one awarded upon evidence of debating the topic.

Interactive CPD Instructions

In order to log one provider-led interactive CPD point to your MyCPD account, this is what you need to do:

  • Make sure you have read the articles: Essential contact lens practice 10 – Managing the presbyope, by Dr Rachel Hiscox and Dr Katharine Evans, and Crossing the presbyopia chasm, by Dr Meredith Bishop et al.
  • Arrange a time to undertake a discussion on the subject with a similarly qualified registrant; another optometrist or dispensing optician.
  • Read the case scenario and questions (above) and use them as the basis for the discussion with your colleague. Note, the discussion needs to address each of the questions outlined above and must be for longer than 10 minutes.
  • When finished, you then need to send an email to ‘opticiancpd@markallengroup.com’ as follows;
    • Subject box should state ‘Presbyopia Contact Lenses Interactive 7’
    • Please state your name and GOC number
    • Please state the name and GOC number of the person you discussed the matter with
    • Please confirm you had read the source material
    • Please include a summary of your discussion, explaining your views and thoughts on each of the three discussion questions
  • Each submission will be read individually and, where needed, feedback will be given directly. Where the submission meets a required standard, you will receive an email confirming this which you can then use as evidence of completion allowing you to log one distance learning interactive CPD point.
  • A summary of the responses and discussions will appear in a future issue of Optician with comment from the authors 
  • Dr Rachel Hiscox is a Professional Education & Development Manager, UK & Ireland for Johnson & Johnson Vision Care.

Reference

  1. Rueff EM, Bailey MD. Presbyopic and non-presbyopic contact lens opinions and vision correction preferences. Contact Lens & Anterior Eye 2017;40:323–8
  2. Naroo SA, Nagra M, Retallic N. Exploring contact lens opportunities for patients above the age of 40 years. Contact Lens & Anterior Eye April 2022:101599.