What’s Trending in Presbyopia CL Prescribing?

HOT TOPIC

Recent Trends in Presbyopia Lens Prescribing

A recent study published in Contact Lens & Anterior Eye found that the number of multifocal and monovision soft contact lenses prescribed to patients with presbyopia has nearly doubled since 2000. The study, conducted through annual surveys distributed to eye care practitioners in up to 71 countries, analyzed 52,580 presbyopia fits from 20 countries with a focus on patients 45 years of age and older. The findings indicate a significant shift in prescribing practices, with rates of these prescriptions increasing from 26.4% in 2000 to 61.1% in 2023.

The study revealed that multifocal contact lens fittings for presbyopes peaked between ages 50 and 65, but declined beyond age 65, while monovision fittings increased until age 80. Interestingly, multifocal lens use surged again after age 90, potentially due to improvements in visual ability from cataract surgeries. Gender differences were also noted, with 45.1% of soft daily lens fits involving multifocal or monovision lenses among male presbyopes, compared with 52.7% among females, possibly reflecting a stronger cosmetic preference among women.

Additionally, geographical variations emerged, with countries such as Spain showing higher presbyopia lens fitting rates than Taiwan and Japan. Between 2019 and 2023, multifocal lenses accounted for 51% of fits, monovision for 10%, and other corrections for 39%, with notable popularity in New Zealand, Australia, and the United States.

Despite the increase in multifocal and monovision lens prescriptions, 39% of presbyopic soft contact lens wearers received distance correction only, relying on reading glasses for close work. The study suggests that barriers to presbyopia lens fitting could be overcome through enhanced professional education and continued research into optimized lens designs.

My Two Cents

As technology continually improves in all health care sectors, so do multifocal contact lens designs—and those of IOLs. I would anticipate that these numbers rise exponentially as more and more practitioners become familiar with the lenses, older doctors who don’t want to learn start to retire, and the younger doctors who come in to replace them see presbyopic contact lenses as a synergistic way to grow a practice’s bottom line. A huge thanks to the primary contact lens companies continually innovating and developing new lenses to help both our patients who wear the lenses and the doctors who fit the lenses.

OUTSIDE THE LANE

Oral Azithromycin vs Oral Doxycycline for MGD Treatment

A recent meta-analysis comparing oral azithromycin and doxycycline for treating meibomian gland dysfunction (MGD) found that azithromycin had a better safety profile and comparable efficacy in reducing MGD symptoms. This study, published in Clinical Ophthalmology, included data from four trials and a quasi-experimental study involving 612 eyes with MGD. The primary outcomes assessed were symptom score, sign score, and overall clinical response. The results indicated that although there was no significant difference in efficacy between the two antibiotics, azithromycin led to more substantial improvement in conjunctival redness, corneal staining, and meibomian gland secretion. The heterogeneity among the study results was noted, suggesting variability in study designs.

The analysis showed that azithromycin had an earlier and more potent antiinflammatory effect, maintained over 6 months, compared with doxycycline, which may require a longer therapeutic course. Azithromycin also had fewer adverse effects, with some doxycycline users experiencing gastrointestinal issues. The study highlighted that the treatment regimen for oral azithromycin varied from 5 to 21 days, whereas doxycycline treatments were longer.

Researchers emphasized the need for further investigations with larger sample sizes to better understand the long-term outcomes of using oral azithromycin for MGD. This study provides valuable insights into optimizing MGD treatment and suggests that azithromycin could be a preferable option for many patients due to its safety and early efficacy.

My Two Cents

Okay, so this isn’t precisely “outside the lane,” as it directly applies to the exam lane, but whatever, I’m going to break my own rule because this study led me on a deep dive into my treatment for MGD. I’m personally going to start trying oral azithromycin on my patients instead of doxy. I’ll report back in 2025 after I get a few under my belt!

CAN YOU RELATE

As the calendar turns over from 2024 to 2025, I can’t help but contemplate all the changes I’ve made in my clinical practice and acumen over the past year.

Below is a list of my most significant changes.

- I now encourage all my patients—especially those with dry eye, glaucoma, and macular degeneration—to get enough sleep. (Studies have proven the benefits of getting a proper night’s sleep. The product I helped develop, The Dry Eye Drink PM, has taken off in sales as these studies have come out and other doctors realize their patients need better sleep. The new TFOS Lifestyle study changed everything for me.)

- I make an effort to readily discuss myopia management with any patient who is interested. I’m ready to send these patients (and/or their kids/grandkids) to one of my colleagues who is especially interested in these lenses. Thanks to CooperVision and its team for leading the way on this.

- I introduce soft contact lenses to nearly all patients—even our oldest patients and those experiencing mild/moderate dry eye.

- I am ready to pull the trigger earlier and more often with amniotic membranes.

- I have become even more comfortable working with specialty/mail pharmacies for our patients.

- I find ways to employ AI all around our clinic to create educational material, answer questions, etc!

- I started using AR/VR headsets for our visual field patients.

- I have become extremely comfortable discussing the various types of macular degeneration and educating nearly every patient on what geographic atrophy is because of the fantastic marketing and outreach by companies such as Apellis and Iveric Bio.

- I discuss how makeup affects our patient’s corneal surfaces and make informed recommendations.

- In May, I had the EVO Visian ICL (Staar Surgical) implanted during a livestream on our clinic’s Facebook page and essentially became a spokesperson within our practice for how amazing the technology is. Here’s a throwback to the newsletter edition where I recapped the experience.

IMAGE OF THE WEEK

Fibrin plaque.

Paul Hammond, OD, FAAO, @kmkoptometrypro

QUOTE OF THE WEEK

“A new year. A fresh, clean start! It’s like having a big white sheet of paper to draw on! A day full of possibilities!”

— Bill Watterson, cartoonist of Calvin and Hobbes