You know what presbyopia is and how it progresses. But to your patients, it’s never a gradual or expected condition. For them, it seems to happen unexpectedly, all at once. They consider themselves young until one day, they hold up a smartphone, menu or magazine at the distance they always did. But unlike the last time, they can no longer read the words and have to move their arm further away or remove their glasses to try to see.
As the first of 73 million millennials turned 40 last year,1 hard on the heels of 61 million Gen Xers (aged 42 -57 in 20222), it’s time to get more comfortable with the presbyopia conversation. In fact, it will benefit your patients and may even benefit your practice to have the talk earlier to ensure patients know that presbyopia is no big deal, and that you already have solutions for them to improve their vision now and into the future.
“Optometrists face a pretty competitive landscape, especially when patients today have so many ways to meet their needs,” said Brad Oatney, OD, Delaware Vision Center in Delaware, Ohio. “I’ve found that the answer to this is learning how to have a conversation with the patient about presbyopia right now. We are at the doorstep of a presbyopic revolution — there’s such an ocean of need out there of patients whom we can serve.”
Of the 128 million presbyopes in the U.S, only 58 million are wearing progressive lenses.3 The remaining 70 million are out there, “getting by” with single vision lenses, contact lenses which may or may not provide adequate vision, readers, or no correction at all.
Digital devices may be contributing to presbyopia
As the first official generation who grew up dependent on digital devices, your millennial patients may even be facing presbyopia at an earlier age than Gen X or Boomer patients because of their dependence on screens. On average, Americans spend more than 11 hours a day interacting with digital media,4 which equates to checking a phone once every 10 minutes5—or 96 times a day.
As many as 90% of digital device users experience symptoms of digital eye strain, and many studies suggest that the following factors are associated:6
- Uncorrected refractive error, including presbyopia
- Accommodative and vergence anomalies
- Altered blinking pattern
- Excessive exposure to intense light
- Closer working distance
- Smaller font size
The benefits of earlier presbyopia conversations
Whether it’s because of digital devices or not, presbyopia is happening earlier than before. Additionally, as a tech-savvy generation, millennials are likely to ask more about the benefits of progressive lenses and how exactly they work to correct their changing vision needs.
“By letting a patient understand presbyopia and the solutions available, you get them into the progressive cycle earlier, rather than continue with a single vision lens,” added Dr. Oatney. “Getting them in earlier helps them with the adaptation process because it’s more natural. It also gives them more choices, because today’s presbyopic patients have such a variety of needs for close vision. It’s imperative we present a portfolio of options for them.”
Gently transitioning patients into progressive lenses early on when they need minimal ADD ranges can aid in adaptation, while equipping patients with a solution that will grow with them as their ADD power changes over the years.
Talin Amadian, OD and director of Woodley Optometry in Los Angeles, California, agrees.
“The key to success with early presbyopes is to have this discussion when they are in their late 30’s,” she said. “I like to begin talking about progressive lenses before they have vision problems.”
This can also ultimately benefit your business as you provide patients with presbyopic solutions earlier than if they had just stayed in a single vision lens and supplemented with readers. Achieving these benefits can only happen if we put the patient first and imagine the impact they experience with presbyopia. As trained eyecare professionals, we encounter presbyopia so often that it’s easy to overlook the impact and uncertainty patients face when they suddenly have difficulty seeing up close or begin to notice eye strain at the end of the day.
Ultimately, an eyecare professional is an advocate of a patient’s future vision health. It’s important to embrace the challenge of presbyopia, educate patients about the latest technology, and present them with solutions early on, address their problems proactively and provide them with clear, comfortable vision at all distances.
Keys to successful prescribing
What optometrists are seeing lately, is that near point strain doesn’t always start at age 40. Therefore, it’s important to check for presbyopia earlier in your patients and make a thorough assessment of their vision demands, family history, and lifestyle.
“Only after a careful case history has been taken and after I’ve asked probing questions about my patient’s near point demand, do I begin carefully conducting my exam,” said Aleksandra Wianecka, OD, an optometrist in the Vision Source network in New York state.
Leveraging your armamentarium of near point tests will be helpful including negative relative accommodation (NRA), positive relative accommodation (PRA), and near point of convergence (NPC), as well as accommodation and accommodation facility. It’s important to maximize focus at intermediate and near with the lowest possible ADD. The trick to doing that is to make sure your prescription is spot on and not over-minused.
“When it comes to determining ADD power, I focus my measurements on the minimum amount of ADD my patient needs to see comfortably at their specific working distance. This may mean taking a patient from behind the phoropter sometimes and have them simulate where and what they spend most of their time doing and how they work.”
Dr. Amadian also likes to be clear about a patient’s vision goals by asking the following questions:
- How much time do you spend on the computer?
- How many monitors do you use?
- How much time do you spend on your cell phone?
- How much time do you spend reading books?
- Do you do any night driving?
“These questions help me pinpoint exactly what a patient’s needs are and move forward accordingly with the right Varilux® lens,” she said.
Offer the most effective solutions
The best way to show your patients that a progressive lens is right for them is to provide the most advanced solutions available to ensure their success. Your patients crave the clear vision of their youth, which means it’s up to you to choose a lens that allows them to continue to see their world in sharp detail.
Essilor has been at the forefront of lens technology for presbyopic patients since it introduced VariluxⓇ, the first-ever progressive lens design, to the market in 1959. Today, Varilux is the #1 progressive lens brand recommended by optometrists and opticians,7 and 96% of Varilux lens wearers are satisfied with their vision, according to almost 20 studies on more than 1,900 wearers.8
The Varilux portfolio includes several designs, including:
Varilux® X series™
Varilux X Series lenses are Essilor’s most advanced progressive lenses. The lenses feature technologies such as XtendⓇ Technology to help reduce head movement and NanoptixⓇ Technology to help eliminate the off-balance feeling many progressive wearers experience. In addition to providing sharp vision and smooth transitions at any distance, Varilux X Series lenses help extend your patients’ vision within an arm’s reach so they no longer have to struggle to find focus.
Varilux® Comfort Max
Increasingly digital lifestyles often dictate that PAL wearers adopt rigid, uncomfortable positions in daily life. Varilux Comfort Max lenses bring flexibility and all-day vision comfort. Powered by Flex Optim™ technology, Varilux Comfort Max lenses are a tailor-made solution which stretches a wearer’s useful vision zone by up to 46%,9 granting the wearer the postural flexibility to see a given focal point from many angles.
Varilux® Liberty™ 3.0
An ideal introductory progressive lens design for new and young presbyopic patients (available in a targeted ADD power range of +0.75 to +1.50), Varilux Liberty 3.0 lenses deliver an all-in-one balanced vision for a great first-time progressive lens experience. Even those brand-new to progressive lenses experience:
- Easy adaptation
- Smooth transitions between different zones
- Reduced image distortions across all vision zones
As a professional, you know the importance of prescribing the highest quality products to ensure your clients have the best vision possible. In turn, they will reward your efforts with strong relationships, including greater trust and loyalty within your practice.
Stand by your progressive recommendation
Another important tip is to stand by your recommendation. Patients may be tempted to prolong single vision use and hesitate to make the leap to progressives. It’s important as their eyecare provider that you stand firm and let the patient know that you are committed to taking care of their vision over a lifetime—and that your lens recommendations will reflect that dedication.
“If you make progressives your first recommendation and explain why you’re making this recommendation in the first place, it can help with those patients who may be a bit apprehensive when it comes to lens selections,” said Dr. Wianecka.
Lean on your staff to boost patients confidence in PALs
Often an underutilized resource, your staff can reinforce your prescription and recommendation to help patients feel better about their choice to try progressive lenses. Presbyopia can bring up all kinds of insecurities and fears about aging. But a warm smile and reassurance from your staff about how much the patient will enjoy their new lenses to see more clearly can do more than make the patient feel better about their choice—it can also boost their confidence that your practice can guide them through additional vision changes as they arise. These are the kinds of services that build loyalty that can lead to repeat visits and referrals.
“My staff supports and reinforces my lens recommendation and the why behind it,” added Dr. Wianecka. “This happens in the handoff and again in the dispensary to help the patient understand why we are recommending a PAL for them at this stage of their presbyopic journey, how the PAL will work to meet their needs, and how getting into a progressive lens early is going to enhance their visual experience.”
Dr. Amadian also has her staff involved when the patient comes back to pick up their glasses. For example, if a patient was having trouble reading on their phones, the staff encourages the patient to read their phone with their new glasses. This reinforces improvement and allows each patient to move forward more optimistically and enthusiastically, especially if a patient was hesitant to try a progressive lens.
Key takeaways from treating presbyopes
While many new eyecare professionals think that talking about eye disease or surgeries may be the most difficult conversations they will have with patients, some are surprised by how sensitive patients are to their aging eyes. However, the finesse you put into educating your patients, the thoroughness of your exams, and the care and warmth you demonstrate to patients can be lessons that can enhance your entire practice.
“The key is to take the time to educate pre-presbyopes and work with your patients when introducing them to solutions to help with their needs,” said Dr. Wianecka. “Educating your patients about the latest technologies and addressing problems proactively ensures patient satisfaction and builds loyalty to your practice.”
