contact lens management

Today's Emerging Presbyopic Patient

Will current contact lens offerings satisfy the members of Generation X?

GREGORY J. NIXON, O.D., F.A.A.O.

I'm reminded again and again of the previously reported impending impact that the changing dynamics of population growth would have on the contact lens industry when the baby boomer generation reached presbyopic age. However, as the majority of boomers are at least approaching their mid-50s, there is still a significant decline in the number of contact lens wearers in presbyopic age groups.

In fact, industry research data from Gallop reports that 56 % of patients ages 18 to 34 use contact lenses as a vision-correcting device, in contrast to only 30 % of patients ages 35 to 49. Further, a mere 11 % of patients ages 50 to 64 wear contact lenses.

While the number of mature presbyopic patients wearing contact lenses appears strikingly low by comparison with the other age groups, these percentages don't solely represent the percentage of patients dropping out of contact lens wear. Granted, a number of existing wearers do drop out of lens wear due to age-induced dry eye discomfort and presbyopic challenges. But, we must also realize that when today's baby boomers were in their 20s, contact lens wear wasn't as commonplace as it has been in recent decades. This lies in stark contrast to the current contact lens market.

Today's emerging presbyopes comprise members of Generation X (e.g. those born during the mid to late 1960s and 1970s) who in large part have grown up as successful contact lens wearers. As this new generation ages, the question remains whether current products will adequately address the key issues of comfort and vision correction that can afford these patients the opportunity to continue as successful contact lens wearers throughout their presbyopic years.

I feel that the emergence of numerous multifocal lens designs available in contemporary materials allow for great opportunities to meet the needs of emerging presbyopes.

Benefits of silicone hydrogel

First, a growing number of existing wearers are currently wearing silicone hydrogel spherical lenses, which provide high-oxygen-permeability. This permeability enables enhanced corneal health for a lifetime contact lens wearer. Arguably, the silicone hydrogel material lenses also address many of these patients' ocular dryness issues. This latter point is particularly significant, as age-related ocular dryness and discomfort often results in contact lens drop outs. Thankfully, silicone hydrogel multifocal lenses are available to maintain these patients' corneal health and allow ocular-dryness-prone patients to continue comfortable contact lens wear.

In regard to vision correction, today's emerging presbyopes are a different breed than those of the baby boomer generation. In the advanced technology age in which they have grown up, they utilize many devices that require enormous near focus demands. Remember: A majority of these patients regularly use a mobile phone, text message and spend a significant number of hours on a computer — whether for work or surfing the Internet. All these activities demand clarity of small text through a wide range of intermediate and near distances for prolonged periods of time. The good news: Today's multifocal contact lenses can provide clear binocular vision at all distances. And in addition to correcting near blur, they can also successfully address eye fatigue, asthenopia and extended-near-work-induced headaches — extremely common among these patients.

Providing visual benefits

For example, a 40-year-old female contact lens wearer with a corrected near acuity of 20/15 O.U. recently presented complaining of fatigue and eyestrain at works' end from prolonged computer use. She was currently wearing spherical single vision silicone hydrogel lenses which provided good comfort and distance vision. However, she reported experiencing blurred distance vision after extended periods of near focus. Examination revealed a best-corrected-visual-acuity of -1.75 -0.75x169 O.D. and -2.25 sph O.S. Her PRA measurement was plano, and other binocular testing was within normal limits.

I refit her in a silicone hydrogel multifocal contact lens (PureVision Multi-Focal, Bausch & Lomb) with parameters of -2.00 Low ADD O.U. The lenses provided a stable fit with adequate centration and movement O.D. and O.S. Further, they afforded her clear distance acuity (20/20-1 O.D., 20/20 O.S.) with a plano over-refraction in each eye. The result: The patient reported a marked decrease of eye-strain and fatigue with near and computer work and a complete elimination of blurred distance vision after reading.

Also, even though she didn't initially complain of near blur, she did note an enhancement in text clarity in addition to the improved visual comfort.

The well-suited solution

As demonstrated by this case, the expanding parameters of multi-focal lens options in contemporary materials and designs are well suited to meet all the comfort and vision needs of today's emerging presbyopes.

These products can allow existing contact lens wearers to continue to enjoy a lifetime of clear, comfortable lens wear despite their presbyopic correction. As practitioners, it's our role to educate these patients about the availability of these products, so they can benefit from the quality-of-life improvements they offer, and we can benefit from their dispensing. OM