Optometric Management

Presbyopes in the 21st Century
How to Profit from Multifocal Soft Contact Lenses
Throw away all your preconceived notions about multifocal contact lenses and revitalize your practice.
By Mary Jo Stiegemeier, O.D., F.A.A.O. , Beachwood, Ohio

One of the great things about being an optometrist is that we're constantly witnessing innovations that improve vision. A notable area of innovation has been in contact lens designs, particularly soft multifocals. They've been a terrific practice-builder for me.

In this article, I'll explain who the "new" presbyopes are and how you can be their go-to practitioner. First, let's take a look at some compelling statistics.

If all emmetropic presbyopes were fitted with contact lenses tomorrow, the total U.S. contact lens market would nearly double.

--Mary Jo Stiegemeier, O.D.

The market for multifocal soft contact lenses is enormous. Of 145 million Americans who require vision correction, 77 million are presbyopic. Presbyopes comprise two key demographic groups:

Contact lens wearers who want to continue to enjoy the comfort and convenience of contact lenses

Emmetropic presbyopes who have never worn vision correction and really don't want to start now.

Surprisingly, nearly one out of four people who require vision correction is an emmetropic presbyope. That's 34 million people, more than 10% of the total population of the United States. If all emmetropic presbyopes were fitted with contact lenses tomorrow, the total U.S. contact lens market would nearly double.

But most of us have yet to tap into the burgeoning demand for soft multifocals. Many practitioners, whether consciously or not, avoid presenting soft multifocals to our patients. When asked why, they most often cite:

Given these reasons, it's easy to see why many of us don't suggest contact lenses to our presbyopic patients. Yet, by avoiding soft multifocals, we're doing a disservice to patients and ourselves.

Most presbyopes are still wearing spectacles. Only one in 10 uses contact lenses, and these usually are spherical lenses for distance-only correction or monovision. Despite huge advances in lens technology, only 3% of presbyopes have been fitted with bifocal or multifocal contact lenses.

Clearly, the market is underserved. Consumer research by CIBA Vision indicates that many of the spectacle-wearing presbyopes would be interested in trading in their readers or bifocal spectacles for contact lenses, even if only for part-time wear.

If you want presbyopic contact lens fitting to be a significant portion of your daily practice, you need to know something about this population. For instance, today's presbyopes:

The key to any successful contact lens fitting is to understand your patient's motivations. This is especially true with presbyopic patients. Simply stated, they want to see well, look good and not tip off their age -- and not necessarily in that order. For most, this translates to freedom from spectacles. Let's analyze these seemingly simple desires.

See well. Presbyopic patients want to see near, far and in-between, and they want you to design the optimal combination of lenses and care system for them.

How do you meet this expectation? Find out about your patient's lifestyle, job and hobbies and then tailor your prescription to accommodate his needs. You'll also need to counsel patients about what to expect from presbyopic correction. (For a hypothetical case on motivation, see "Tale of a Tennis-Playing Philatelist" above.)

Tale of a Tennis-Playing Philatelist

Counseling presbyopic patients about their expectations is time well-spent. I guarantee you'll improve your success rate when you spend some time getting to know your patient. Here's an example.

Frank is a 48-year-old high school math teacher whose hobbies are tennis and stamp collecting. Would I recommend multifocal contact lenses? Absolutely.

I'd tell Frank that multifocal soft contact lenses will afford him excellent vision for his work and other day-to-day activities. And I think he'll appreciate the freedom from eyeglasses for tennis. But when it comes to his stamp collection, I'd explain that he may need additional magnification -- an overcorrection or a hand-held magnifier -- which I can provide.

By explaining this situation up front, I'm reassuring Frank that the need for a bit more magnification for his hobby isn't a failure on the part of the contact lenses.

Forewarned is forearmed, the old saying goes. Never has it been truer than when fitting soft multifocals.

Look good. Presbyopia can be particularly traumatic for someone who's never had to rely on spectacles before. Now, he must reach for reading glasses just to sign a check, order dinner or read a label at the grocery store. He may find this cumbersome and a nuisance.

Also, his family, friends and co-workers aren't used to seeing him wearing eyeglasses and may make comments. Your patient expects you to make this "problem" go away.

Not tip off his age. Many people believe that using reading glasses is an obvious sign of aging. It doesn't matter that the entire Baby Boomer generation is in the same boat. They simply don't want to join the crew.

If you can assure patients that they won't have to tip off others to their chronological age, they'll be motivated to give soft multifocals a fair trial -- even if it means a bit of a hassle adapting to the lenses at first.

In my practice, the key demographic group we target for soft multifocals is comprised of women between the ages of 40 and 55. The demand is very high for soft multifocals among this group. Research has shown that women in this age group, regardless of their history of vision correction, are most likely to buy soft multifocal contact lenses.

The estimated market for women in this age group is $1 billion. In fact, those who wear eyeglasses or have had no previous vision correction are more likely to purchase soft multifocals than any other segment of the market. Also, these patients are the gatekeepers for their families' eye health. If you satisfy these women, you're likely to gain additional patients as well.

Besides women aged 40 to 55, you should consider any patient whose correction falls within the parameter range +6.00 to -7.00D and whose eyes are otherwise healthy. Don't discriminate on the basis of contact lens history or habitual means of correction. You should fit contact lens wearers, spectacle wearers and contact lens dropouts equally.

That said, the ideal candidate has a distance ametropia greater than 1.00D (hyperopia or myopia) and astigmatism less than 1.00D.

Remember to tell the patient that although these new lenses are wonderful, it's not the same as having 16-year-old eyes again. In other words, make sure your patient has realistic expectations.

	The Presbyopia Market at a Glance
	Only 3% of presbyopes wear contact lenses. A generation of contact lens wearers is entering their presbyopic years and wants to stay in contact lenses. Presbyopes are excited about contact lenses and tell their friends about them.

A positive attitude is critical to any successful contact lens fitting. You must be willing to take a few extra minutes of chair time to fit your presbyopic patients.

Thankfully, soft multifocals are easy to fit. A short trial fitting will determine if the lenses will work. No guesswork is involved. So, by investing the time to let your patient give the lenses a firsthand try, you can determine whether your patient will ultimately be a successful wearer.

And the time investment isn't as great as you might think, especially if you train your staff to help you work more efficiently. For instance, your receptionist and examination room technician can prime the patient for you by educating him about his contact lens options. Then, if the patient seems like a good candidate and is willing to try the lenses, your technician can assist with the trial fitting. If the trial fitting indicates a good chance for success, then you should talk with the patient one-on-one. I call this the "show then tell" procedure.

I prefer to take a patient immediately into soft multifocals, rather than create an intermediate step of distance-only or monovision lenses. I do this for two reasons. First, this is a motivating action; the patient has his entire "problem" solved in one step. Second, it reduces chair time and is more convenient for the patient.

2 Minutes for Multifocals

As optometrists, we're caregivers first and doctors second. You have to be willing to add 2 minutes of chair time and really talk to your presbyopic patient. Tell your patient all the options available to him. Ask if he wears eyeglasses or contact lenses. And ask if he's undergone refractive surgery.

During these 2 minutes, don't forget to tell your presbyopic patients about soft multifocals. In my practice, I've found men in general don't ask about the contact lens option. I have to tell them. However, women usually will ask about contact lenses, which isn't too surprising because women wear most of the contact lenses in the country.

I feel that night vision and depth perception are enhanced by multifocal contact lenses as compared to monovision. Also, the patient is corrected for the intermediate distance, which is important because most patients use computers for at least 4 hours a day.

With the "show then tell" procedure, once the patient has experienced soft multifocals, he's enthusiastic and motivated to learn more.

Often, patients are enthusiastic about pursuing soft multifocals once they've had a chance to "kick the tires." In fact, some of our most successful and enthusiastic patients were those who assumed they couldn't wear contact lenses or were afraid to ask. Rather than spend our time explaining how contact lenses could benefit someone who's never considered them (a lengthy process in most cases), we talk only to those who are predisposed to success.

To begin fitting soft multifocals successfully, you need to give up many of your old prejudices and biases. Make a conscious effort to discard previous notions about difficult or lengthy fitting processes. Begin with a clean slate.

In our practice, we gave the lens a chance to impress us, and it did. Fitting soft multifocals is now part of our daily routine -- and a profitable one at that. We've revitalized our presbyopic contact lens practice by:

And with millions of potential patients still out there, we believe our practice will continue to prosper and thrive.

Dr. Stiegemeier is in private practice in Beachwood, Ohio. She lectures throughout the country on contact lenses and performs clinical research.