It’s critically important for us to think of presbyopia not as a symptom of aging, but as a condition of the eye. If you’re like me and have lost count of how many presbyopes I’ve seen in my chair, you know how tough it can be to find a solution that will deliver the crisp, youthful vision they crave.
While many surgical and non-surgical options exist for presbyopia, until now, none have been able to completely restore the eye’s natural dynamic range of accommodation1—which can be frustrating for patients who want to be comfortable and for doctors like us who want to provide the best vision possible for those coming to us for that purpose.
Brief overview of presbyopia
Going by the numbers, presbyopia affects about 2.1 billion worldwide2 and approximately 128 million Americans3,4—with numbers growing as millennials continue to age. The first of 73 million millennials turned 40 in 2021, following close on the heels of 61 million Gen Xers, aged between 43 and 58.5 Currently, more than half of adults over 40 have presbyopia, and the majority don’t have corrective spectacles.6
Eyecare professionals (ECPs) may be equally flummoxed, as caring for presbyopes can potentially mean more chair time, additional office visits, and emotional conversations that address aging eyes. But as doctors, it’s our duty to identify, educate, and help solve a condition that our patients entrust to our care.
The challenges facing today’s presbyopes
Vision is the most complex and efficient human sense considering the visual system encompasses all the organs and processes to “see,” from the reception of light through to cortical processing based on the signals received. What this means is that if two people have an identical image of their retinas, they may have different perceptions of that same image.
Just as the pharmaceutical industry is recognizing the necessity of personalized medicine, ECPs are seeking a solution for the personalized vision needs of presbyopes, who might not be a good fit for current progressive addition lenses (PALs) or multifocal contact lenses due to discomfort, blurry vision, eye strain, headaches, and the “swim effect” of the lens design introducing optical image deformations (causing the wearer to feel a bit like they are on a pitching boat).
What is the Varilux XR Series Lens?
The Varilux XR Series from Essilor is the first eye-responsive progressive lens powered by behavioral artificial intelligence (AI). Specifically, “eye-responsive” refers to the consideration and coordination of both lens prescription and a patient’s unique visual behavior for a more intuitive and high-performing solution.
Comprised of three new technologies powered by AI, the Varilux XR Series is designed for more efficient ocular navigation during motion multitasking during both near and far tasks:
- Nanoptix: Includes a dynamic distortion absorber that reduces the impact of the “swim effect,” which many patients perceive as unnatural.
- XTEND: Extends the area of sharp vision within arm’s reach so patients no longer have to move their heads to find “just the right spot” to see a target—or multiple target objects. Traditional progressive lenses typically allow only one target for one-gaze direction. This technology is also responsible for instant sharpness while a patient is viewing multiple targets while in motion.
- XR-MOTION: Delivers binocular optimization according to a specific patient visual-behavior profile to provide: better positioning of the near-vision zone, optimized, sharp binocular vision, and minimized disparities of power and astigmatism.
I’m really excited about what we're about to see happen in this progressive market because Varilux XR represents the best knowledge base that we have today. If you were to take all the learnings of progressive lenses and you create a product that is going to allow for the best outcome through the knowledge and artificial intelligence and all of the millions of data points that have been collected over time on users, then you have the Varilux XR.
That’s pretty awesome: not only have progressives gotten better, but we are able to predict the needs of the person using them more effectively than ever before.
Why do we need new innovations in progressive lenses?
Over the generational developments within progressive lens technology, there have been head and shoulders enhancements in the past decade alone. But digital devices introduce a new level of complexity in visual navigation from near to far. Given that there will be about 125 billion devices by 2030,7 with more than 80 notifications per day,8 today’s presbyopes are switching from distance to near work with greater frequency, necessitating a new approach that can accommodate today’s vision needs beyond what a PAL can accomplish.
It’s estimated that our eyes undergo about 100,000 eye movements in a single day.9 Most of this is due to multitasking from near to far, whether a patient is looking at a watch while golfing, trying to see a recipe while cooking, or viewing a handheld device while focused on something in the distance or periphery.
Introduced in the late 1950s by Bernard Maitenaz, inventor of Varilux progressive lenses,10 progressive addition lenses offered a solution to bifocal lenses by providing a seamless transition between zones of increased ADD power without breaks, ledges, lines, or jumps between distance and near viewing zones. Typically PALs have an optical center at the Prism Reference Point (PRP), which may fall up to 8mm below the Distance Reference Point (DRP), while the Near Reference Point (NRP) might be up to 12 to 18mm lower.
“For some patients, the PRP might be ideal for their vision needs, but other patients might not be able to accommodate these parameters and suffer from dizziness, nausea, headache, and blurred vision.”
Further, distorted peripheral vision might not be able to be resolved, even after a patient tries to adjust to wear for multiple days in a row. Not only is this uncomfortable for patients, but if they can’t wear progressive lenses, then their visual acuity suffers, which can potentially translate to poorer quality of life and loss of productivity.
As we are all aware, if a patient is over 40, they are starting to feel the symptoms of presbyopia, and it’s impacting their quality of life. So it’s our duty to identify, educate, and help to solve conditions impacting patients’ lives with the latest innovations currently available. Where innovation has led us to today is to a more seamless and easy-to-use product, and potentially, a pair of glasses so comfortable our patients don’t notice they are wearing them.
A day in the life of today’s presbyopes
As millennials hit their forties, presbyopia’s impact on society is set to grow even more. This is a generation that grew up with technology, so it’s up to us to talk about presbyopia in a way that makes it clear that there are viable solutions to give today’s patients the best possible quality of life, maximize performance, and enable them to do all the things they want to do without being hindered by reduced vision or discomfort that both can translate into a dip in productivity.
Today’s presbyopes are active, engaged, and multitasking—whether they are chasing young children, spending time outside, or working on multiple digital screens. They are also living in a world with visual demands, unlike any previous generation.
Shifts in patient demographics, combined with the rapid advancement and integration of technology in our daily lives, mean modern presbyopes have more complex needs than those working in the past 50+ years.
What about contact lenses?
Multifocal contact lenses were another important evolutionary milestone, but tend to produce “softer” vision because of the need to balance near and distance refractive corrections. They can also fall slightly short on the level of magnification compared to progressive lenses, which can compromise clarity.
For these reasons, paired with an uptick in eye dryness, multifocal contacts might not work for many presbyopes who desire a crisp visual experience without headaches, eyestrain, or multiple visits to their primary care optometrist.
Personalization and progressive lenses
Standard progressive lenses are typically designed along vertical and horizontal axes. However, our eyes naturally move in a much more peripatetic manner.9 What a patient might desire is a lens that is much more responsive to organic human eye movements.
The personalization of ophthalmic lenses has been a market reality for most of the last decade and takes into account the lens positioning in front of the eyes, ocular anatomy, optics, and the wearer’s posture.
Artificial intelligence in lens design
The Varilux XR design leverages the power of artificial intelligence in order to take patient behavior into account. In an exam, the patient is given a handheld device and asked to perform multiple realistic visual tasks. After more than 1 million data points are created, they are used to make a patient’s “digital twin,” which is used to predict visual behavior and eye movements, which is ultimately factored into the lens design.
Predictive modeling takes into account the following:
- Visual acuity loss
- Postural efforts
- Head movements
- Hand-eye coordination
- Gaze behavior
If you have a measuring device today that is handheld, that really understands the way the individual's eyes are moving right and left and up and down and the way they focus and the way that the person holds a device, you have exponentially more data points to develop a lens that is truly customized based on both the prescription and behavior.
Progressives have gotten better because they've been able to predict the person using them better. What I like about the Varilux XR lens is that if you were to take all the learnings of progressive lenses and you create a product that is going to allow for the best outcome through the knowledge and AI and all of the millions of data points that has been collected over time on users, then you can create progressive lenses that are more intelligent and more customized for each, individual patient.
What are the benefits of binocular optimization?
The prismatic effect on any point in a lens is directly proportional to the power of the lens and the distance of that point from the optical center. Progressive lenses that combine multiple powers across the lens surface might have differences in thickness which could cause undesired prismatic effects for patients who look outside the lens’ optical center, including eye strain and the “swim effect.”
Leveraging behavioral artificial intelligence in lens design can:
- Predict the visual profile
- Assign binocular targets for power and astigmatism
- Perform point-by-point binocular optimization
The XR-motion technology formulates a “digital twin” of the patient in a 3D environment, which is produced from several predictive models based on gaze behavior and accommodation that translates multiple binocular target assignments for power and astigmatism.
The end result is that both lenses are optimized binocularly according to the visual behavior profile to provide:
- Better positioning of the near vision zone
- Optimized sharp binocular vision
- Minimized disparities of power and astigmatism
I'm excited about the fact that we can now look at improving binocularity in people of presbyopic age. If you can reduce the differences between the eyes and the way that the eye has to move within a progressive, you can enhance the way the eyes work together to decrease disparity. Now all of a sudden, you've got visual symptoms that are going to be resolved because of this.
Also, I'm excited from a clinical perspective because I think we're gonna see less eye strain and visual discomfort from patients wearing this versus other progressive lenses. So ultimately, it's all about making sure our patients have peak performance, and this is, in my opinion, an evolutionary step toward getting people back to that ideal state of the eyes.
How to introduce this new technology to patients
I always ask myself if what I’m doing is best for the patient. Ultimately, I think as long as we see new technology as an enhancement to the care that we provide and improving outcomes for the patient, there's a great deal of excitement from doctors. Obviously, both the product and the solution are geared toward the patient’s visual experience. Subsequently, when you're armed with that confidence, a patient is likely to respond favorably to that.
New studies have shown patients are most alert when a doctor says, “I am going to prescribe this for you because...“ Patients typically become more active listeners when learning why their problem exists and what are the potential treatment solutions to help them.
Once I have a patient’s attention, then I try to remind myself to put everything down and just talk to the patient, answer the questions as thoroughly as I can, and explain why I believe this technology is better and what outcomes it can improve.
Tips for introducing new technology to patients:
- Use subtle, in-office educational materials.
- Before the visit, identify the potential patient type coming in and issues that are relevant to them. Email or text them that material ahead of time.
- Arm your staff with knowledge so that they can also identify candidates for new technology that may benefit them.
Final thoughts
In my practice, we tend to approach everything from a patient-centric mentality. Rather than thinking about what's good for me, we ask ourselves what is best for the patient. The rest usually works itself out.
