Educating Patients on Presbyopia Treatments

Some patients experiencing new-onset presbyopia have never needed vision correction, and with today’s rapid advances in technology and medicine, many expect current treatments to restore the effortless near vision they once enjoyed. Because every treatment option involves some degree of compromise, setting realistic expectations from the start is essential. The following action steps and patient-facing scripts can help clinicians explain the condition, identify functional goals, and match treatment options to each patient’s lifestyle and preferences.

EXPLAIN PRESBYOPIA

Defining presbyopia is an important first step in helping patients understand the cause of their changing near vision and develop realistic expectations about treatments.

• Patient-Facing Script. “Like a camera, our eyes have a flexible lens that helps us see clearly at different distances. As we get older, that lens becomes less and less flexible, making it progressively more difficult to focus up close. This normal change is called presbyopia. While we cannot restore the lens’s natural flexibility, we have several treatment options outside of reading glasses that can help to improve your near vision.”

VALIDATE PATIENT FEELINGS

It can be frustrating for patients to learn that this age-related change is progressive and cannot be reversed. We have found it important to acknowledge these feelings with empathy, while also being transparent about the available treatment options.

• Patient-Facing Script. “I know this change in vision can be frustrating, but together we can determine the treatment option or combination of options that best fit your visual needs, lifestyle, and preferences. I also want to let you know upfront that every option involves some degree of compromise. Our goal is to provide the best possible functional vision for the daily tasks and activities that matter most to you, rather than a promise of perfect vision at every distance.”

DETERMINE VISUAL DESIRES

Next, we have found that it’s best to ask the patient about their near visual demands and goals. This helps establish what the patient prioritizes, while also creating a shared framework for treatment selection. A structured questionnaire can help to improve consistency and streamline the discussion. The Intrepid Eye Society’s Visual Demands Audit/Visual Lifestyle Review specifically explores meaningful factors that influence treatment selection, including: occupation visual requirements, hobbies and recreation, digital device use, near-task duration, and low-light/night driving demands (Figure).

• Patient-Facing Script. “So that I can determine the best treatment for you, I’d like to understand where and when your near vision is getting in the way. What matters most to you–reading, seeing the phone, computer work, hobbies, seeing the menu in a dim restaurant, or night driving?”

PINPOINT PERSONALITY

Successful treatment selection depends on much more than a patient’s lifestyle and refraction; it is also contingent on their preferences, adaptability, desire to be glasses-free, and tolerance for the compromises inherent in each treatment. Once a patient’s visual priorities are clear, we find it helpful to determine their willingness to accept the practical compromises associated with each treatment. This helps narrow a broad menu of options to those the patient is most likely to accept and use successfully.

• Patient-Facing Scripts.
• ​Determining agreeability to progressive lenses: “Would you be comfortable wearing full-time glasses that provide seamless distance, intermediate, and near vision? It typically takes about 1 to 2 weeks for your eyes and brain to adapt to the gradual power change among the different areas of this lens.”
• Determining agreeability to multifocal contact lenses: “Would you be comfortable wearing contact lenses that provide both distance and near vision that may not be as sharp as the vision provided by spectacles? It will take about 1 to 2 weeks for the eyes and brain to adapt to the gradual power changes among the different areas of this lens.”
• Determining agreeability to monovision contact lenses: “Would you be comfortable having one contact lens focused for distance and the other primarily for near vision? This can feel different compared with normal binocular vision and may reduce depth perception or crispness in some situations for you.”
• Determining agreeability to extended depth-of-focus contact lenses: “Would you be comfortable wearing a contact lens designed to extend your range of clear vision from distance through intermediate and functional near vision? Know you may still need reading glasses for fine print or low-light situations.”
• Determining agreeability to pharmacologic drops: “Would you be interested in eye drops that temporarily provide functional near vision for daily tasks but not always perfect 20/20 vision? This option is temporary and can be used on an as-needed basis. Potential side effects include mild headaches early on and/or dim night vision.”
• Determining agreeability to refractive lens exchange: “Would you consider a permanent surgical option that replaces your natural lens with an IOL selected to expand your range of vision and reduce the need for glasses? As with any surgical procedure, there are associated risks, such as infection, retinal detachment, or the need for a minor vision touchup afterwards.”
• Determining agreeability to monovision LASIK: “Would you be comfortable having one eye corrected primarily for distance and the other for near to reduce your dependence on glasses? Similar to monovision contact lenses, this can involve compromises in depth perception and visual quality. You can trial monovision with contact lenses before pursuing surgery.”
• Determining agreeability to presbyLASIK: “Would you be interested in a corneal laser procedure designed to expand your range of functional vision, understanding that it may involve compromises in visual quality, contrast, or night vision, and may not provide the same clarity at every distance as your best spectacle correction?”
• Pro Tip.It is always best to under-promise and over-deliver. The patient who understands the potential compromises and that we are striving to provide functional vision for the tasks that matter most, rather than perfection at every distance, often adapt more readily and are more satisfied with their visual outcomes.

PATIENT EMPOWERMENT

We have found that a patient-centered approach to discussing presbyopia—one that normalizes the condition while addressing individual goals, lifestyles, preferences, and treatment compromises—can turn patient education into patient empowerment. The result is fewer return visits, greater satisfaction, and patients who are happy to tell others of their positive experiences with us.