I’m a big advocate of daily disposable contact lenses for just about any category of patient, but especially for presbyopes.
A fresh new lens every day is a convenient and healthy way to wear contact lenses. It eliminates some of the factors in noncompliance, such as poor cleaning, forgetting when to change lenses, and not having fresh lenses on hand. In general, I see that my patients in daily disposable lenses have healthier, whiter eyes, and experience fewer problems with blood vessel growth and infiltrates.
They also have a big advantage in terms of comfort. The longer patients re-use their contact lenses, the more likely they are to become coated with protein deposits that create friction between the lid and contact lens. This is especially problematic for presbyopic patients, who already face a number of challenges in maintaining comfortable contact lens wear due to age- and hormone-related ocular dryness, systemic medications, and heavy use of digital devices that reduce blinking and disrupt the tear film.
Currently, about 45 percent of my contact lens patients are in a daily disposable lens. With the highly successful introduction in my practice of 1-DAY ACUVUE® MOIST Brand MULTIFOCAL Contact Lenses from Johnson & Johnson Vision Care, Inc., I expect that percentage will continue to grow.
A New Option for Presbyopes
1-DAY ACUVUE® MOIST Brand MULTIFOCAL isn’t a “one size fits most” lens. Instead, it uses pupil optimization to closely match the lens design to what is happening naturally in the maturing eye and across the range of refractive errors. What that means is that if I pull a -3.50 D lens in a “mid” add, I know that the design of that particular lens has been optimized for the pupil sizes expected for about 95% of the patients with that refraction and add power.
The lens has a unique hybrid back-curve design, helping ensure that the lens centers really well is intuitive in terms of fit. I’m finding it provides very good near, intermediate and distance vision. All of these reasons enhance our opportunity for success.
I tried these lenses on a 69-year-old patient of mine who had been successfully wearing daily disposable lenses for monovision for years. He was so blown away by the improvement over monovision that he wouldn’t even take the trial lenses I offered him, but insisted on ordering a supply right away.
Here are some lessons I’ve learned that make 1-DAY ACUVUE® MOIST Brand MULTIFOCAL Contact Lenses very easy to fit:
- Start with a really good refraction. Be careful not to over-minus.
- Figure out sensory dominance by placing a +1.00 loose lens over each eye in turn. The eye that bothers the patient more is the dominant eye.
- Determine the minimum add power needed to perform desired near tasks, such as reading messages on a smartphone.
- Based on this information, use the fitting guide to pick the best initial pair of lenses.
- If a change is needed to improve either distance or near, follow the fitting guide recommendations.
- Be careful not to make too many tweaks at the first visit—instead, give the patient time to neuro-adapt and see how the lenses function for daily activities.
- Get comfortable with the lens in routine presbyopes before fitting some of your “tough customers.” The lens is a great solution for those folks, but don’t make them your first fits.
The Presbyopia Continuum
I find it is very common for patients to experience symptoms of accommodative strain well before what we conventionally think of as the start of presbyopia. If you listen carefully to their concerns, you will find even before they are aware of any loss of near vision, patients complain about headaches, eye strain, or “tired eyes” at the end of the day. These are early signs that the visual system is struggling with long days of near-point tasks.
Ideally, I like to introduce patients to multifocal lens wear at this stage, rather than waiting until they need a +1.50 add. This is so much easier to do with more—and more comfortable—multifocal lens options available to us.
To that patient who is already doing “fine” in contact lenses, I might say, “I’ve got something I’d like you to try…” and let the lens speak for itself. A successful fit can keep that patient comfortable and seeing well as presbyopia progresses. If the patient doesn’t experience a benefit over what he or she has been wearing, there is nothing lost by having tried out new technology.
New options in multifocal contact lenses are also making it possible to open doors for patients at the other end of the continuum—patients who gave up on contact lenses long ago or maybe have never worn them. With these patients, I tie my recommendation to what it is they say they need or want. For example, an avid golfer might be most interested in being able to see the golf ball and the score card without putting on readers. Some patients would be thrilled to wear regular sunglasses to the beach on vacation and be able to read a book and still see their kids out in the water.
An upcoming trip or special occasion is the perfect opportunity for such patients to see how daily disposable multifocal contact lenses might fit with their lifestyle. “You might not be able to wear them all the time, but let’s try this and see if it can help you do the things that are most important to you,” I tell them. More often than not, that part-time wearer becomes a full-time wearer.
I think we are going to see exciting growth in our practices from being able to fit more patients across the presbyopic continuum, and the latest in multifocal contact lenses makes this more possible than ever.
ACUVUE® Brand Contact Lenses are indicated for vision correction. As with any contact lens, eye problems, including corneal ulcers, can develop. Some wearers may experience mild irritation, itching or discomfort. Lenses should not be prescribed if patients have any eye infection, or experience eye discomfort, excessive tearing, vision changes, redness or other eye problems. Consult the package insert for complete information. Complete information is also available from VISTAKON® Division of Johnson & Johnson Vision Care, Inc., by calling 1-800-843-2020 or by visiting acuvueprofessional.com.
ACUVUE® and 1-DAY ACUVUE® MOIST are trademarks of Johnson & Johnson Vision Care, Inc.