Every patient has unique frustrations and lifestyle needs. As optometrists, our ability to think creatively and provide personalized solutions enhances patient satisfaction and expands our clinical offerings. Below are 4 real-world presbyopia case presentations with practical solutions.
Case 1: The Progressive Non-Adapt Who Can’t Read
Patient profile: A 58-year-old low myope currently wears single vision glasses for night driving but still struggles to see his dashboard clearly. He previously failed to adapt to progressive lenses.
Solution: I recommended an antifatigue lens design. My reasoning: it provides sharp distance vision with a subtle reading boost—just enough to help him see without interfering with his distance view. The distance real estate in this lens design is roughly 75% vs 45% in a progressive lens design.
This solution helped remove the majority of aberrations induced from the progressive lens, while still providing magnification. It was a simple, yet effective solution tailored to this patient’s needs.
Case 2: The Hyperope in Denial
Patient profile: A 70-year-old hyperope with “good” uncorrected distance vision was struggling with reading. She occasionally wears her progressive lenses. Her uncorrected visual acuity was 20/40 OD/OS, and her manifest refraction was +1.75 -1.50×090 OU. She divulged she has never been offered contact lenses.
Solution: Upon further questioning, the patient revealed that she disliked wearing her glasses for events, so I prescribed monovision daily disposable contact lenses:
• Right eye: +1.50-1.25x090 (distance optimized)
• Left eye: +2.50-0.75x090 (leveraging astigmatism for near clarity)
The patient told me she was thrilled at how seamlessly she could switch between her glasses for daily wear and contact lenses for social occasions. This was a lifestyle-based solution that expanded my service offerings.
Case 3: The Zoom Fatigue Patient
Patient profile: A 49-year-old therapist who had a stable distance and near prescription reported experiencing new near strain with prolonged screen time. Her progressive lenses, with a +1.50 add, provided 20/20+ distance and J2 near vision.
Solution: Because this patient primarily works at a desktop but also looks at paperwork and moves around, I prescribed a near variable focus lens customized for her workspace. With this dedicated workspace lens, she said she immediately felt less eye fatigue and kept this lens as a second pair at her workstation. This case highlights the value of multiple prescriptions for different tasks.
Case 4: The Perfectly Imperfect Eyes
Patient profile: A 55-year-old emmetrope presented saying he did not like the idea of wearing reading glasses. Examination revealed a +2.00 add requirement.
Solution: Instead of prescribing full-time glasses, I prescribed a multimodal approach:
1. Custom reading glasses to use for his phone and tablet.
2. Presbyopia-correcting eye drops for occasional use, such as during grocery shopping or dining out.
This flexible approach gave this patient control over his presbyopia management, making the transition feel less restrictive.
Clinical Pearls
These cases described show how personalized solutions can dramatically improve patient satisfaction while creating new business opportunities. By offering alternative lens designs, dual-wear strategies, workspace-specific glasses, and presbyopia drops, ODs can better serve their patients and expand their optical and medical offerings. Let’s think beyond standard solutions to ensure every presbyope finds an option that best fits their needs. OM
