Presbyopia

In 2005 the first Generation X'ers turned 40, and in 2006 the first Baby Boomers turned 60. Of the estimated 100 million presbyopes in the United States, only a small percentage (2-3 percent) wear bifocal contact lenses. Successfully fitting bifocal contact lenses can build a practice and meet many patients' needs.

Options

Historically, when a contact lens wearer became presbyopic, one option presented to the patient was to wear contact lenses for distance and a pair of spectacle readers for near. Of course, considering that many initially chose to wear contact lenses in order to free themselves from wearing glasses, most patients balk at this suggestion. Monovision was another common option presented to patients, but this modality compromises binocularity and can cause problems with night driving. Also, while intermediate distances are not a problem in the beginning, as the presbyopia progresses, intermediate demands are not met. When bifocal contact lens designs became available, this option was often presented as the last option unless the patient had visual demands that made the first two options less desirable.

Today there are several good bifocal soft contact lens options for patients. In most cases, the options can be presented in the following order:

• First Option: Bifocal contact lenses
• Second Option: Modified monovision--using one bifocal lens and one single vision lens OR two bifocal lenses with the power of one eye (usually the dominant eye) adjusted for distance and/or the nondominant eye adjusted for near
• Third Option: Monovision
• Last Option: Distance contact lenses with spectacle readers

Each patient, however, should be fit according to his/her needs and lifestyle. Having an open and creative mind can help meet the visual demands of the more challenging patients.

Patient Education

Many patients, when they become presbyopic and are fit in bifocal contact lenses, want as good of vision as they had when they were younger. This idealist view can create unhappy patients, so it is best to provide the patients with reasonable expectations at the onset. There are several ways to communicate what to expect with the patient, as in "There will be some give and take in order for you to see in the distance and at near as well as have good binocular vision--and not have to wear glasses." Also, tell the patients that if they can do 80 percent of what they need to do with the bifocal contact lenses, this is considered a success. If readers over the bifocals are needed for very small print, that is an acceptable solution. If the patient reads for pleasure for several hours in the evening, spectacles may be the better choice. All of these expectations should be presented and discussed at the fitting.

Adaptation

All soft bifocal contact lenses use simultaneous vision, and there will be some adaptation required. The lenses should be allowed to settle properly before checking visual acuities. Be sure to inform the patients that the brain must adapt to the new visual system over the next week.

	URL: http://www.opt.indiana.edu/ce/clsoftbi/intro.htm Revised: June 19, 2006
	IU Optometry home page: http://www.opt.indiana.edu/ Comments (content): Dr. Susan Kovacich at skovach@indiana.edu Comments: Web Administrator Page design and coding: Terri Greene Copyright © 2006, The Trustees of Indiana University