Today’s patients want to feel informed — and don’t like surprises. Given this, when is the best time to discuss presbyopia, so that patients are primed for future conversations about multifocal lenses, among other treatment options? Additionally, how, specifically, should this conversation go? After all, no one wants to hear they’re “old.”

Below, we hear from four optometrists who have had experience in broaching this prickly subject at the right time and softening the blow.

THE EARLY BIRD CATCHES THE PRESBYOPE

It seems that the earlier the presbyopia conversation occurs, the better it is received, say those interviewed for this article.

Christopher Wolfe, OD, FAAO, of Exclusively Eyecare, in Omaha, Neb., says that beginning this discussion while patients are in their 30s helps to get it on their radar, and prevent surprises down the road.

“With people already doing so much near work these days, this is the perfect opportunity to mention that, at some point in the future, if they begin to have trouble with that work, there are a lot of options to help them, and reading glasses do not necessarily have to be the solution,” he explains.

In fact, when presbyopia does set in, many patients end up opting for multifocal contact lenses, in particular, as the lenses enable the 40+ crowd to preserve a youthful appearance, while giving them optimum vision and comfort.

Jessilin Quint, OD, FAAO, co-owner of Smart Eye Care, which has three locations in Maine, adds she also broaches the topic of presbyopia when patients are in their 30s.

“Talking to patients in their 20s about presbyopia is simply too young — and they likely won’t remember that conversation,” she asserts. “I have found that the mid-30s is the ‘sweet spot’ to start having a brief conversation about how their vision will change.”

As is the case with Dr. Wolfe, Dr. Quint agrees that even just a brief mention of all the options available at the time of this quick discussion can be helpful, in terms of potentially removing some of the dread that patients might feel.

“I tell patients that we have so many options that, when the time comes, it diminishes this feeling of ‘I’m old, so I have to wear readers,’” she offers. “Readers might be the right option for some patients, but I make it clear that patients can take a very individualized approach to dealing with their presbyopia. I think that eases them into the idea that this change could be coming, but there will be a solution that’s right for them.”

Kriti Bhagat, OD, FAAO, of Galler Eyecare Associates, in Providence, R.I., says that conversations around presbyopia in a patient’s 30s are important for everyone — but, perhaps, particularly important for emmetropes who have never had a vision correction product before, as she finds that visual changes can be the most jarring for this group.

“I feel that having this conversation early on leads to less denial when the time comes that they need to take action,” she explains. “And now that we can offer them so many options, I do feel like it gives them some freedom to make the decision and take control of the situation. It’s not me telling them, ‘You have to do this.’ By starting that conversation early and mentioning the solutions, patients are more likely to come to me and seek an answer.”

Walter O. Whitley, OD, FAAO, of Virginia Eye Consultants, in Norfolk, Va., adds that he thinks it’s important to also educate patients early on that cataracts are another change that will occur even further down the road.

“Oftentimes, as eye doctors, we do see patients through the various stages of their life, and that puts the responsibility on us to inform them of what changes are inevitable with their eyesight,” he explains. “The better educated we can make our patients, the more likely they’ll be to seek early treatment.”

When it comes to patients who present in their 30s for refractive surgery, for example, Dr. Whitley says he is sure to discuss presbyopia and the fact that, although they’ll be less dependent on glasses for distance, changes in the eye will still occur in their 40s, requiring another solution for near vision.

CAREFULLY SCRIPTED, BRIEF CONVERSATIONS

There’s no question that the choice of language used can have an impact on how conversations around presbyopia are received, say those interviewed.

For her part, Dr. Quint says she never uses the words “old” or even “aging” with patients when discussing presbyopia. In fact, she points out that she says things along the lines of, “the more birthdays we have on the calendar, the more changes we can expect.”

“I think creating this feeling that this is something that happens to everyone, and this is ‘merely a sign that you’re a human being,’ takes away some of the stigma around it,” she offers.

Dr. Wolfe says he also refers to presbyopia as “part of the birthday process.” Additionally, he says he likes to explain some of the physiological changes that will be occurring with presbyopia: “I say, ‘As we have more birthdays, the lens inside of our eyes becomes less flexible, so that the muscle has to work harder. As this happens, it can’t change shape as easily to help you see clearly up close.”’

Dr. Wolfe notes that as patients come to understand what is actually occurring, it can make a big difference in their acceptance of presbyopia, which then makes them more amenable to additional discussions about options when the time comes.

These conversations take up very little chair time but provide a huge benefit for both patient and doctor when the long-arm syndrome eventually sets in, says Dr. Bhagat.

“There is no reason to push off this conversation, thinking it will take so much time,” she continues. “If patients are not currently experiencing symptoms, they rarely have many questions. But I find that extra two minutes of invested time in giving patients a heads up about future changes makes the conversation at the time they are experiencing symptoms so much easier — and more efficient: They already have an understanding this was coming and some idea of what it is, so it removes the shock value.”

It is this “shock value” that requires a much longer conversation, Dr. Bhagat points out.

“I have found that new patients who never had a presbyopia conversation with their former eye doctor need more time, as they are caught off guard,” she says.

Dr. Quint agrees, adding that many patients have told her they literally feel like they woke up one day and couldn’t see the same.

“That can be alarming or even scary,” she points out. “But if we have already talked about it, they have a better sense of what’s going on.”

 

 

Presbyopia Physician Magazine

With 115 million presbyopes in the United States and new presbyopia treatments on the horizon, PentaVision Media, publisher of Optometric Management, has launched Presbyopia Physician, a digital supplement to Ophthalmology Management that is for both optometrists and ophthalmologists.

For the latest edition, see bt.e-ditionsbyfry.com .

PREPARATION IS KEY

“I think the fact that this is something that happens to everyone takes some of the stress away, but it’s still something we need to remember that patients aren’t thrilled about,” Dr. Whitley sums up. “The best way to address this is to inform patients of the options. While this is a condition nobody is too happy about, technological advances are making it easier on all of us.” OM