Over the past few years, we have run many of these distance learning interactive exercises. The aim was to demonstrate evidence of a good working knowledge of a topic and then to show further evidence of a discussion about the topic with a colleague. The discussions in some topics, such as obesity and smoking, have been interesting and shown some variation of opinion. In more clinical matters, however, the discussions have tended to show a greater consensus of viewpoint. Not so with this exercise, one which addressed the initial optical correction of a reluctant presbyope who has already expressed a hatred for glasses. Indeed, as the case study exactly reflects my own experience as a presbyope, I confess to some surprise at the discussion outcomes many of you expressed. For this reason, I though it might be interesting to offer a little more detail of the responses.
The Case for Discussion
Your discussions concerned a 42-year-old male patient having never had an eye test before. He was a low hyperope, becoming presbyopic and needs correction for near work. He is vehemently opposed to the idea of wearing spectacles. The ‘thought of putting something on his face is not appealing’ and he insists his family and friends will see this as a clear sign he is ‘getting old’.
You were asked to discuss the following:
Your Views
The vast majority of responses suggested that spectacles should still be advised, even if simply a back up to a contact lens correction. Due to the ‘vehemently opposed’ attitude towards spectacles, only one respondent suggested a mention of the option of a refractive surgery management.
Of the majority suggesting spectacles, whether as back up or sole correction, only 25% mentioned undertaking any further exploration of why he was so vehemently opposed to spectacles.
Some 32% of respondents suggested spectacles should still be pursued as the main, first choice option for correction of near vision and suggested contact lens correction of this patient would likely be problematic for various reasons and so might only be attempted as a second, back-up option.
For those respondents who took on board the patient’s view of spectacles and suggested trying a contact lens management option as first choice (with or without back up specs), the type of contact lens correction chosen did, I admit, surprise me somewhat. This is what you went for:
The were no respondents who opted for an extended depth of focus lens as first choice.
Your Comments
Here are some of the comments received, some of which I thought both surprising and of interest enough to repeat here:
Discussion
We have to be careful in reading too much into these figures as the level of experience of respondents with fitting different designs of contact lenses is not anything that such an exercise controls for, and indeed should not. However, it is clear that there is still a strong preference for monovision and an implied reluctance to attempt a multifocal lens fitting under a presumption that the resultant loss of clear vision will not be acceptable. Indeed, I am curious about where this 80% figure comes from as it was referred to by several respondents.
My own experience is of someone who is lucky enough to still have 6/5 uncorrected distance vision in both eyes but who wears multifocal contacts, due to constantly losing reading glasses and who, when forced to wear specs, finds them inconvenient, always steamed up, and make me look like Albus Dumbledore.
Further Discussion
Am I alone in thinking that, in the case above, monovision as a first choice management plan is out of date? Had this been offered to me, I would have gone elsewhere, unable to understand why one eye would always need to be blurred. Indeed, if percentages are at all to be cited, is ‘50%’ better than ‘80%’? Hand on heart, for this specific case, I expected a simultaneous vision multifocal contact lens to be the obvious choice. What are your views?