Presbyopic patients can help your contact lens practice survive refractive surgery

Issue: November 1995

ORLANDO, Fla.—Optometrists who have been reluctant to work with presbyopic patients should consider this group the challenge and opportunity of the 1990s, said Michael D. DePaolis, OD, at an American Optometric Association contact lens symposium here.

mugshot --- Michael DePaolis.

"It is important for us to realize this may be one of the few, safe bastions as we enter the new millennium," said DePaolis, a private practitioner in Rochester, N.Y., and editor of PRIMARY CARE OPTOMETRY NEWS. "Refractive surgery will take a bite out of our myopic contact lens wearing population, so presbyopic patients are the challenge and opportunity of the 1990s."

The number of presbyopic Americans is expected to swell from 68 million to nearly 100 million by 2005. The number of viable contact lens patients within this group is estimated to increase also, up to 12 million from the current eight million.

Presbyopes are a tough fit

DePaolis acknowledged that optometrists are often disinclined to fit presbyopes and often frustrated in their attempts to satisfy these patients. Difficulties inherent with the presbyopic eye include reversed or reduced lid muscle tonus, inefficient wetting of the ocular surface, increased incidence of various ocular surface anomalies that affect lens centration and visual performance, and reduced visual function and contrast sensitivity.

"Combine this with some of the limitations of first generation multifocal lenses--they cost a significant amount of money, were difficult to fit and were difficult to reproduce if we got a successful fit--and you found many optometrists reluctant to work with multifocal lenses and presbyopic patients," DePaolis said.

New multifocal lenses may solve some problems in a market "plagued with developmental growth limitations in recent years," DePaolis said. As an example, he described a new multifocal lens from Sunsoft Corporation, which is a member of the Essilor group. The lens, which has been approved by the Food and Drug Administration and is currently in marketing trials, will be available in 1996.

DePaolis said ODs will be able to accommodate changes in patients over time with a choice of two profiles. "The power gradation of the profile A lens will accommodate up to about 1.25 D. This lens will work well for your emerging presbyopes," he said. "As the patient matures and the presbyopic needs increase, you can shift the patient to the profile B lens, which has the same base curve and diameter but gives a greater gradation from the near to the distance periphery."

New lens studied

To observe the ease and accuracy of fitting presbyopic patients with the new multifocal lens, DePaolis and his colleagues enrolled 215 contact lens patients in a study. A total of 179 patients, or 83%, completed the study.

According to DePaolis, the main observation was that a base curve of 8.7 mm with a 14.2-mm diameter lens offered clinicians a reliable fitting relationship across a variety of corneal topographies.

"Simply put, this lens centered about 90% of the time," DePaolis said. "About one out of every 10 people who were fitted with this lens experienced movement or decentration that was so excessive that I could not get that ideal visual response. I learned right then and there who it was going to work for and who it was not going to work for."

The overall success rate was approximately 50% and as far as patient satisfaction, DePaolis said, "For those who achieved 20/25 or better distance or near acuity, the majority would purchase the lenses. In the real world situation, this is the question we all ask."