Many patients stop wearing contact lenses, not because they failed the technology, but because nobody introduced them to a new solution.
As presbyopia develops, long-time wearers quietly reduce their wear time, transition to glasses, or abandon lenses altogether, often without a meaningful conversation about newer technologies or alternative fitting strategies. Research tells us that when dropout patients are reintroduced with a targeted problem-solving approach, 74% successfully resume wear.¹ That statistic alone should challenge us to rethink how quickly we let presbyopes walk out in glasses.
Start With the Right Questions
By this, I mean when a presbyopic patient reports wearing their contact lenses less often, ask them directly, “In a perfect world, would you prefer to wear your contact lenses more, or are you happier in glasses?” That question alone reveals whether a patient has truly chosen glasses or simply feels they’ve run out of options.
We should also anticipate frustrations before patients verbalize them. Based on their manifest refraction, we can predict most of the story: Early hyperopes may struggle at near by the end of the day. Myopes remove their lenses to read. Emerging presbyopes describe fluctuating vision or mounting frustration at work. Name their challenges before they do and patients will not only feel understood, but they may also become far more open to trying something new.
Trial With Intention
A patient who struggled with multifocals last year isn’t necessarily a multifocal failure today. Lens technology evolves, and so does neuroadaptation. When you do a trial, set the stage properly: Multifocal contact lenses require adaptation, just like progressive spectacle lenses, but 20 minutes in the exam chair is not a trial. Encourage consistent wear through the fitting period and reassure patients that the process takes time.
Set Honest Expectations
Spectacle lenses have more optical real estate than contact lenses, which means glasses may still outperform contact lenses for certain demanding tasks. Say that upfront. But also remind patients that small parameter changes can make a tremendous difference. For example, a -0.25 D tweak to sharpen distance vision, a shift in dominant eye strategy, or a move to modified monovision can change everything. You can also consider a distance lens in 1 eye and a multifocal in the other, or asymmetric add strategies when bilateral multifocals plateau. Clinical creativity is what gets patients to success.
Start Lower Than You Think
A patient’s spectacle add power is not necessarily your starting point in contact lenses. Ask patients what they want most from their lenses. A patient who prioritizes distance and intermediate may do beautifully with a lower add than their manifest refraction suggests, if they accept that small print may still require a reader. When patients help define the goal, they’re far more invested in the outcome and far less likely to drop out when the first trial isn’t perfect. Plus, starting conservatively leaves room to increase the add over time as they adapt.
Follow Up Every Time
Releasing a multifocal prescription and hoping for the best is rarely enough, so follow up during the adaptation window through an office visit, phone call, or portal message and troubleshoot early. Presbyopes of all refractive errors prefer contact lenses when good vision and comfort are achieved and our job is to get them there and keep them there.²
Sometimes retention isn’t about new technology. It’s about reintroducing patients to possibilities they thought they’d already lost.OM
References
- Pucker AD, Tichenor AA. A review of contact lens dropout. Clin Optom (Auckl). 2020;12:85–94. doi:10.2147/OPTO.S198637
- Rueff EM, Bailey MD. Presbyopic and non-presbyopic contact lens opinions and vision correction preferences. Cont Lens Anterior Eye. 2017;40(5):323-328. doi:10.1016/j.clae.2017.03.010
