Defining and Maximizing Success with Multifocal Contact Lens Wear7:00 AM
|Love this promotional graphic from Hobson Eye Associates: "Ask use|
about multifocal contact lenses.. Yes, we even have dailies!"
Obstacle 1: Comfort
The single biggest reason that contact lens wearers "dropout" of lens wear and return to glasses is due to comfort. In fact, studies show an average of 16% of lens wearers dropout every year in the US. In the population over 40, several other factors contribute to comfort issues beyond the contact lens material itself:
- increased computer and digital device use
- increased incidence of underlying dry eye disease, especially in women
- increased incidence of demodex infestation in the eyelid (increasing ocular discomfort)
When paired with underlying ocular dryness and poor environmental conditions due the amount of time spent on digital devices where our blink rate slows by as much as 66%, the population age 40 and up can find comfort with contact lens wear an absolute disaster.
To maximize success:
|What would you do when this patient asks: "Can I wear contact lenses?" |
My answer? Yes, but we may have to do a few things to get your eyes
ready first! via
- Talk about work environment -- that means better lighting, proper ergonomics, avoiding ceiling fans or vents pointed towards the face, and taking more breaks. Read our posts about Computer Vision Syndrome to learn more
- Treat underlying dry eye. That mean's educating when we see dryness in the patient even if they don't have symptoms, because contact lens wear will make these problems much worse!
- Look at the lids! We know that demodex is out there in high numbers, and using a targeted treatment and educating daily lid hygiene can make all the difference.
- Offer daily disposable contact lenses; thinner and more moisturized lens options can increase comfort and lead to longer and more frequent wear times.
Obstacle 2: Vision
When I talk to my patients about contact lens wear over 40, I always talk about the compromise they should expect in vision. For years we have been told to educate expectations before initiating a fit, but as doctors we may be dissuading potential happy contact lens wearers with our perceptions of how contact lenses will fail them. This year's GSLS report showed that only about 9-12% of all contact lens fits in the US are for soft multifocal contact lenses, and only 29% of contact lens wearers that are presbyopes are fit in multifocal contact lenses. The numbers suggest that we just aren't recommending multifocal contact lenses for our patients in this category. Our own feelings that the patient will be disappointed in the results likely show through in our discussion -- but what if we frame "success" to the patient in a more achievable way?
A great take home from the GSLS was a presentation by Dr. Amy Dinardo who spoke about how to define success with multifocal contact lens wearers. Research out of the Michigan College of Optometry looked at patients that considered themselves successful multifocal contact lens wearers. Happy patients reported vision and wear times that may come as a surprise:
Successful Multifocal Contact Lens Wearers:
- Don't Expect Perfect Vision: (patients were asked to score vision 1-5 with 5 being perfect)
- Distance Vision: 4.3 out of 5
- Intermediate (computer) Vision: 4.31 out of 5
- Near Vision: 3.89 out of 5
The take home here is that patients do have a reported compromise to vision in all ranges, but they are still happy and consider themselves successful lens wearers!
- Don't Expect All Day Comfort:
- Average lens wearing time was only 10.1 hours in patients that considered their lenses a success.
- Use Glasses With Their Contact Lenses Sometimes
- 25% of successful lens wearers used glasses over their contact lenses for certain activities (like reading small print or driving at night).
Also of note from Dr. Dinardo's study was why lenses failed in some patients. No surprise, comfort and vision were the two main reasons. Of the patients who discontinued lens wear, 92% reported it was due to unacceptable near vision and 50% reported unacceptable distance vision. As more improved lens design options come to market the hope is that more people can find success. My real take home from this study was to encourage my patients about what success means. So often I've found that patients feel that having to use additional glasses -- even for small font in really dim lighting -- feels like the lenses "aren't working" for them. Or that if they can't wear their contact lenses for 18 hours a day then these lenses aren't comfortable enough for them. As their doctor, we need to establish up front what we want them to be able to achieve, and set goals appropriately that can be realistically met. My new discussion will go something like this thanks to Dr. Dinardo:
Success in multifocal contact lenses means about a 4 out of 5 in visual clarity at all distances. It means you'll see well for about 80% of your daily visual needs, but night driving or small font or dim lighting will be more difficult. It means you can expect as much as 10 hours of comfort before needing to use a rewetting drop or take the lenses out and switch to glasses. And successful contact lens wearers can expect that under certain conditions you'll need a pair of OTC readers for small print or poor lighting.