Getting Presbyopic Patients to Stick With Our Team

Presbyopic patients can be the most rewarding patients to build a practice around because they have varying needs, and meeting those needs creates practice loyalty. Here, I discuss the three action steps we can take to meet their many needs and, therefore, create their loyalty to our practices.

1. OFFER AN ARRAY OF
TREATMENT OPTIONS

Let’s remember that between 40 and 60 years of age, we have 20 years of prescription changes to guide these patients through. And, research backs this up. Specifically, “An initial steep increase in add requirement beginning in the early 40’s becomes relatively slower but still of significance beyond the mid-50’s,” according to a study in Ophthalmic and Physiologic Optics.¹ Additionally, data from 4,000 exams over 23 years by one optometrist in one private practice reveals the presbyopic prescription saw its largest increase in patients 40 to 50 years of age. Specifically, the average was 0.12 D annually, or approximately 0.25 D every 2 years.²

As a reminder, this patient population can benefit from single-vision lenses that provide individual viewing distances, progressive spectacle lenses that eliminate the dreaded line in the lens, presbyopia drops, computer spectacle lenses, prescription sunwear, antireflective coating to reduce glare while driving at night, and monofocal or multifocal contact lenses. Regarding multifocal contact lenses, in particular, I have prospective patients who call daily asking whether I fit multifocal contact lenses.

Something else to keep in mind: Those 45 to 64 years of age have the highest income, according to a recent US Census Bureau report.³ Additionally, they are among the highest-spending consumers, according to the Bureau of Labor Statistics.⁴ Further, according to The Vision Council’s 2025 Market inSights data, frames purchased by individuals age 35 and older totaled $5.61 billion in sales. Perhaps these data are the reason I have found that this patient population is more willing to pay for the convenience of acquiring their eyewear or contact lenses from me versus shopping for a deal.

2. MANAGE CATARACTS CONSISTENTLY

As we are providing presbyopic patients with tools to prevent them from experiencing the effects of what age is doing to their vision, we are also starting to diagnose age-related cataract. According to the classic Beaver Dam Eye Study, the cumulative occurrence of nuclear cataract grew from 2.9% in patients 43 to 54 years of age to 40.0% in patients 75 years of age and older.⁵

With this diagnosis comes guidance from us regarding IOL selection, evaluating and/or treating the ocular surface prior to surgery, and surgical comanagement.

3. ANTICIPATE AGE-RELATED 
EYE DISEASE

Let’s not forget that age-related eye diseases, such as AMD, dry eye disease (DED), and glaucoma, can start to appear in these 40+ patients. In one recent study on the prevalence of AMD, the study’s authors estimated that 18.34 million people in the United States 40 years of age and older had early-stage disease, while 1.49 million had late-stage AMD.⁶ When it comes to DED, those between 45 and 54 years of age had a higher risk of diagnosed DED versus those 18 to 34 years of age.⁷ Regarding glaucoma, a recent study reveals an estimated 4.22 million people in the United States have glaucoma, with 2.56% of them 40 years of age and older. What’s more, 0.91% of this age group was experiencing vision-affecting disease.⁸

Considering the associated diagnostic and follow-up visits to monitor disease progression, in-office DED treatments, and the scope-of-practice expansion of photobiomodulation for AMD, along with glaucoma surgeries, we have much to offer to 40+ patients. More importantly, we can make significant quality-of-life improvements in these patients when it comes to age-related eye disease.

OPTOMETRY’S IDEAL PATIENT

I recently turned 40 and started extending my arms to see my phone. I had to chuckle, as I realized I am now optometry’s ideal patient. Perhaps my own experience with presbyopia now impacts how I interact with these patients. Regardless, I will continue to focus on them, as they are the primary reason my practice has survived and thrived.