Emerging Presbyope Hope
Lens option for low-add or emerging presbyopes meets several needs.
DAWN M. MILLER, O.D., F.A.A.O.
The new generation of presbyopes (A.K.A. baby boomers) is accustomed to having what they want, when they want it, with convenience and affordability. In addition, this group wants to ensure they’ll never grow old, so they do everything possible to maintain a youthful self image. When your exam findings on one of these patients suggest he’s teetering on the brink of needing near-vision help, it’s not surprising for him to meet this news with denial or disbelief.
This is especially true of your emerging presbyopic contact lens patients. So, how should you manage this patient? You could prescribe “readers” to place over his present contact lenses, but baby boomers often view these spectacles as “granny glasses,” which go against their goal of maintaining a youthful image. In addition, mentioning this option reminds this patient of his own mortality — something else he will disdain.
Another option: You could prescribe a monovision or multifocal contact lens, but these products can be difficult to adjust to if the patient isn’t motivated to do so, which is often the case with these highly demanding patients. At a loss? Don’t be. The Biomedics EP (Emerging Presbyope) lens, from CooperVision, is a new option for the low add, or “emerging presbyope.”
The benefits of Biomedics EP
Biomedics EP is a PC hydrogel lens made with omafilcon — a material that contains 60% water. I have found this material to be a problem solver for dryness and comfort, and many of my patients have referred to this lens as one of the most comfortable they’ve ever experienced. What really attracts my emerging presbyopic patients to this lens, however, is that it retains many of the fitting and distance clarity characteristics of the single-vision lenses they are accustomed to.
Biomedics EP supplies up to a +1.50D add for near. The center of the lens is a fulldistance spherical design, which blends into an aspheric intermediate/ near zone that reaches an 8.5mm diameter. Because this lens offers a gentle transition from single vision to multifocal, emerging presbyopic patients who previously wore single-vision contact lenses, those who are first time wearers or those who are dropouts from monovision or other multifocals are much more accepting of it. In addition, these patients also report less nighttime glare and less incidence of the near 3-D effect with the Biomedics EP. This is especially helpful in the most difficult multifocal contact lens patient — the dreaded plano-distance, first-time-for-any-type-of-correction contact lens candidate. These patients are extremely sensitive to any degradation in their cherished “perfect” distance vision.
Patient selection and fitting
My patient selection criteria for this lens is a +4.00D to -6.00D vertexed distance prescription, with up to 1.00D with-the-rule, or 0.75D against-the-rule cylinder with up to a +1.50D add. The lens is available in an 8.7mm base curve, which I’ve found adequately fits the majority of patients. (Even though an 8.7mm base curve sounds flat, the fitting characteristics are such that I have fit patients who would seem to have corneal curvatures that would be too steep, but when I put the lens on, it fits just fine.) Because the lens has only one add power and one base curve, select the properly vertexed regular full-distance prescription for each eye. At the follow-up visit, I have found it helpful to always discuss what the lens has accomplished for the patient first before addressing “problems.” I generally ask about what is going right and then question about what we can try to refine, to help the patient more.
When altering the prescription, ditch the phoropter, use hand-held lenses in free space. A 0.25D change in lens power will generate a greater than anticipated in situ response. I usually put plus or minus 0.25D (depending on whether I am attempting to improve near or distance) over first one eye, then the other, then both and ask which scenario improves vision the most. Then, repeat for the other distance to ensure that your fix of the patient’s complaint won’t be interfering with the vision that was performing well. In my experience, the initial prescription is the final prescription within 0.25D in the majority of cases.
What I have found clinically is that patients are much more accepting of a lens designed to help them with a gentler transition from single vision to multifocal. The more often you try to fit any multifocal option, the more success you’ll generate. And this success won’t only satisfy the needs of your demanding emerging presbyopes, but the needs of some of your pre-teen, pre-presbyopic, lowto moderate-myopic patients and patients who need higher adds.
DR. MILLER IS IN PRIVATE PRACTICE IN GARDEN GROVE, CALIF. SHE IS THE CURRENT PRESIDENT OF THE CALIFORNIA VISION FOUNDATION. E-MAIL HER AT DAWN@BGCGG.ORG.
Optometric Management, Issue: March 2007