Help keep baby boomers in their contact lenses

" Gas-permeable lenses are a safe and most efficacious modality." — Irvin M. Borish, OD, DOS, Dse, DSO

For many years, baby boomers have been the mainstay of the contact lens industry. But as this essential population ages and becomes presbyopic, practitioners fear that their desire and ability to wear contact lenses may diminish.

“There are about 79 million baby boomers, and the contact lens dropout rate going from the 30s into the 40s is about 60%,” said Robert D. Sloan, OD, FAAO, a practitioner in Chillicothe, Mo. “From the 40s to the 50s, the dropout rate becomes 80%, which is tremendous. To keep them happy, we have to correct their presbyopia. That’s the challenge.”

Special needs of baby boomers

The presbyopic patient must adjust to a new set of challenges and needs when it comes to contact lens fitting, according to Craig W. Norman, FCLSA, director of the contact lens section, Department of Ophthalmology at the South Bend Clinic, South Bend, Ind.

“The special contact lens needs of baby boomers fall into several different categories,” Mr. Norman told Primary Care Optometry News. “One of them is the wearing schedule. Very often, many of the presbyopic patients today are more interested in wearing a contact lens system when they want it, so it is as much part-time as it is full-time.”

Mr. Norman said a practitioner should determine a patient’s desired wearing schedule beforehand and choose a lens that fits that schedule.

Another significant factor in fitting baby boomers is the changing visual needs of presbyopes, Mr. Norman said. “That depends on the level of tasks the patient is doing and trying to come up with the lens system that can work best for those tasks,” he said. “That’s changing rapidly, especially with the increased use of computers.”

Mr. Norman emphasized that computer use is another significant factor in the visual needs of today’s presbyope. “Not long ago, we asked patients if they used a computer. Now, we ask them how many hours a day they use a computer,” he said. “That critical intermediate level is something that needs to be corrected in whatever kind of contact lens system is chosen.”

Rhonda Robinson, OD, a practitioner in Indianapolis, agreed that the prevalence of computer use creates a new set of visual needs for presbyopes.

“It used to be that only computer people used computers. Now, it doesn’t matter what job you do – to some extent, you are probably in front of a computer,” she said in an interview. “Even if you are a monovision patient, you really need a third eye now, because you need distance, near and in-between.”

Physiological factors such as dry eye can also affect the comfort level of presbyopes who wear contact lenses, Mr. Norman said.

“As we get older, many things change physically, not the least of which is the fact that we begin to dry up,” he said. “We lose a lot of the ability of our own natural tears to support the contact lens system. So, dry eyes are much more of a concern for this age bracket than for Generation X.”

Preferred modalities

Choosing the proper lens modality for a particular patient is not necessarily a simple task, Mr. Norman said. “It depends on the patient’s situation,” he said. “For early presbyopes, or patients in their early 40s, we often suggest for them to simply wear reading glasses over their current contact lenses.”

When this approach begins to present a problem for the patient, Mr. Norman said he begins to discuss other modalities. “At that point, we will start to think in terms of offering them either monovision, depending on their tasks, or we will try one of the many soft lens multifocals available,” he said. “I think that depends directly on some of those critical needs that we talked about before.”

Dr. Robinson said multifocals are her clear first choice for presbyopic patients. “Multifocals are my first choice at all times. First of all, I think that binocularity is better than monocularity,” she said. “Also, most of the lenses we use today are simultaneous vision design. It is easier to adapt to simultaneous vision as an early presbyope.”

Dr. Robinson said it is then easier to tweak the patient’s reading vision down the line if he or she has already adapted to the modality.

“It’s easier that way, as opposed to something like monovision. If monovision fails, it is difficult for the patient to adjust to something totally different when he or she is 55,” she said. “You might as well put patients in what is best for them from the beginning.”

Gas-permeable lenses

Mr. Norman added that, for some patients, he prefers gas-permeable lenses.

“We use a significant number of gas-permeable multifocals,” he said. “We think in terms of gas-permeable lenses for patients who have critical vision needs. For those patients, we generally feel more confident that gas-permeable multifocals or bifocals will provide clearer vision.”

According to Irvin M. Borish, OD, DOS, Dse, DSO, professor emeritus at Indiana University, bifocal gas-permeables can be an effective lens choice.

“Gas-permeable lenses are a safe and most efficacious modality,” Dr. Borish said in an interview. “Simultaneous designs are optically efficacious in higher add powers and operative in lower adds when their movement on the cornea is sufficient to cause them to act as alternating designs do.”

According to Dr. Borish, alternating designs in gas-permeable materials allows lens movement and clarity in the distance, intermediate and near zones. “Prism ballast gas-permeable contact lenses move on the eye, compared with soft bifocal contact lenses, where motion is restricted,” he said.

In Dr. Borish’s established technique, the patient must first adapt to single-vision lenses that duplicate the size, thickness, design and prism ballast of the prospective final bifocal ballasted lens. “This permits the design to be altered as necessary to achieve the best adaptation for tear exchange, oxygen supply, lid tension and movement to reach the desired period of constant comfortable wear,” he said.

Designs and manufacturers

Practitioners have differing opinions regarding the best brand of lens for the presbyopic contact lens wearer. Each individual patient’s visual needs and lifestyle must be considered.

“It is challenging enough to fit these patients in bifocal contact lenses to correct their presbyopia, but there is also so much working against us, such as the dryness of the eye,” Dr. Sloan told Primary Care Optometry News. “I’ve had excellent luck with some of the newer lens products, and I have been fitting a lot of the CooperVision Frequency Multifocal (CooperVision, Fairport, N.Y.). It is a really sophisticated lens that is not difficult to fit.”

Dr. Sloan said, with emerging presbyopes, he finds that with the initial D lens, the CooperVision Frequency Multifocal gives patients enough up-close reading help. “The industry is changing, and I know that Cooper is talking about using its Proclear Compatibles materials in the Cooper multifocal,” he said. “And the Proclear Compatibles lens is the only lens approved by the Food and Drug Administration for the treatment of dry eye.”

Dr. Sloan said he anticipates even greater success in fitting the lens with this material. “I think when they switch over to the Proclear Compatibles material, it’s going to help the patients with dry eye,” he said. “They are on track to having a very winning product.”

Another obstacle in lens fitting, Dr. Sloan said, is astigmatism. “I have had good luck with the Opti-Centre UltraVue 2000 Multifocal (Opti-Centre Laboratories, Sherbrooke, Quebec, Canada),” he said. “That lens is being acquired by Cooper and brought into the states. I have had a lot of success with it.”

Dr. Robinson said her first choice is the Bausch & Lomb SofLens Multi-Focal (Bausch & Lomb, Rochester, N.Y.). “You can get great distance vision, reading vision and, of course, in between,” she said.

Mr. Norman said he likes a variety of different lenses, depending on the particular needs of the patient. “In the soft lens arena, you have the Bausch & Lomb SofLens Multi-Focal, the CooperVision Frequency Multifocal and the Acuvue Bifocal (Johnson & Johnson, Jacksonville, Fla.),” he said. “Also, there’s the CIBA Vision Focus Progressives lens (CIBA Vision, Duluth, Ga.).”

Mr. Norman also has several preferences in terms of gas-permeable lenses. “Available are designs such as those from TruForm Optics, Dallas/Ft. Worth, Texas,” he said. “We also think of the LifeStyle Marquis design (LifeStyle GP Co., Lakewood, Colo.), the Essential Xtra RGP Multifocal design (Blanchard Contact Lens Inc.) or the Solution bifocal (X-Cel Contacts/Walman Optical).”

CRT for presbyopia

The FDA approved an Investigational Device Exemption for a study of CRT for presbyopia using the Paragon CRT design platform (Paragon Vision Sciences, Mesa, Ariz.). The study will examine the use of therapeutic lens overnight corneal reshaping for the temporary reduction of presbyopia. It will include more than 200 patients at 15 locations throughout the United States.

“This will probably be the most in-depth clinical investigation of presbyopic treatment using contact lenses ever conducted for FDA approval,” said Bill Meyers, PhD, Paragon’s vice president of science and technology, in a press release.

Dr. Meyers said the study incorporates numerous new procedures to demonstrate both subjectively and objectively how the lens will perform and the level of the unaided vision upon removal under all likely environmental conditions.

“Most previous bifocal contact lens approaches are successful only with early presbyopes having residual accommodation,” Dr. Meyers said. “Final approval of this product will signify a real step forward in the treatment of presbyopia.”

For Your Information:

• Robert D. Sloan, OD, FAAO, practices in Chillicothe, Mo. He can be reached at 409 N. Washington, PO Box 903 Chillicothe, MO 64601; (660) 646-3937; fax: (660) 646-4092; e-mail: rsloan@cmuonline.net. Primary Care Optometry News could not determine if Dr. Sloan has any direct financial interest in the products mentioned in this article, or if he is a paid consultant for any companies mentioned.
• Craig W. Norman, FCLSA, is the director of the contact lens section, Department of Ophthalmology at the South Bend Clinic, South Bend, Ind. He can be reached at craignorm@aol.com. Dr. Norman is a paid consultant for Polymer Technology/Bausch & Lomb.
• Rhonda Robinson, OD, is a practitioner located in Indianapolis. She can be reached at 6137 Crawfordsville Road, Indianapolis, IN 46224; (317) 243-0028; fax: (317) 243-0805. Dr. Robinson is a paid consultant Bausch & Lomb.
• Irvin M. Borish, OD, DOS, Dse, DSO, is a professor emeritus of Indiana University, where an ophthalmic research center is named after him. He can be reached at 23371 Blue Water Circle #114, Boca Raton, FL 33433; (561) 392-5807; fax: (561) 392-6756.
• Bill Meyers, PhD, is vice president, science and technology for Paragon. He can be reached at 947 E. Impala, Mesa, AZ 85204; (480) 892-7602; fax: (480) 507-0232.