How to Handle the Plano Presbyope

Presbyopia is one of the primary reasons patients come into our offices for an examination. I’ve heard it every which way, from “my arms are too short” or “my font is too small,” to patients having to take screen shots of menus and zoom in on their phones in order to read better.

When the patient sitting in your examination chair is already wearing some type of vision correction device, the conversation about how to deal with presbyopia seems rather simple. It essentially consists of an upgrade in technology. The conversation sometimes isn’t so smooth, however, when the patient has never worn glasses or contact lenses. So, what’s the best way to handle the plano presbyope?

HANDLE WITH CARE

For most emerging presbyopes who never previously needed vision correction, this may be their first eye examination or at least their first examination as an adult. This is a perfect opportunity to showcase our skills as eye care providers and convey to them the importance of regular eye examinations.

Take the time to thank these patients for choosing you for their first significant experience with an optometrist and explain what you can do for them. Use the technology in your practice to educate patients about the many ways you can help diagnose diseases that would go unseen without an examination.

Emerging presbyopes may be in denial or any of the other stages of grief (Figure) because presbyopia is a sign of aging.¹ Today’s presbyopic patients want to live active lifestyles and don’t want to be slowed down by their visual needs.

ONE SIZE DOES NOT FIT ALL

As we talk generally about the people in this category, remember that each patient who sits in your examination chair leads a different life. That’s why it’s so important to get a thorough history and gain an understanding of what each patient does on a daily basis.

I like to ask patients what they do day to day instead of focusing on work or hobbies first. This allows them to tell me what matters most to them. It also spares me the embarrassment of later uncovering news of a recent layoff, an inability to find work, or other social issues that can affect my rapport with a patient.

The recommendation you make at the end of an examination must address whatever you discussed during the visit. If there is no strong correlation or relationship between your recommendation and the patient’s main complaint, he or she will head to an optical, whether in your practice or elsewhere, confused about and doubting the results.

The patient has chosen you to be his or her expert, so speak like one! Make sure you understand your patient’s needs by listening and asking questions about his or her lifestyle, and also find out what motivated him or her enough to come to you. Decide on a treatment plan, explain alternative options, and then listen to the patient again. From there, be willing to make changes and adapt to each individual patient’s needs. Don’t limit your decision to one solution, as patients may need multiple combinations to fit their various activities.

Remember that your patients likely have social networks of many other individuals navigating similar issues. They may even come to you talking about friends who have run the gamut of treatments. Let’s discuss some of the treatments these friends may have mentioned and examine how each treatment option stacks up for our patient.

THE FRIENDS OF THE PRESBYOPE

“I Have a Friend Who Wears Those Dollar Store Cheaters.”

Let’s be clear: This self-treatment is probably the worst option for patients. Use this opportunity to talk about the downsides of over-the-counter readers. For example, they’re not made to fit one’s visual needs, and they merely magnify objects.

For patients who bring up this option, consider prescribing single-vision glasses for near use. Explain to the patient that new lens technologies allow him or her to have clear and comfortable vision with anti-glare and blue light protection for those who stare at computer screens all day.

Consider this option for patients who never get up from their reading material or computer. This scenario is common these days, with the dramatic increase in working from home, virtual school, social media use, etc.

“I Have a Friend Who Had Progressives and Hated Them.”

There are hundreds of progressive lens models available, so saying that someone hated them is like saying you don’t like all SUVs because you had a bad experience with one make and model. Progressives have numerous features, options, and designs that can make a big difference.

Highlight the flexibility of progressive lenses to the patient who needs to go back and forth from far to near working distance without changing his or her vision correction. Explaining to patients that they can wear progressive lenses as needed instead of full-time helps ease them into spectacle wear. Letting patients decide when to wear them can increase motivation and success.

Consider this option for someone who is likely to be mobile throughout his or her day and needs to see at multiple distances within a short period of time.

“I Have a Friend Who Wears Contact Lenses for Far and Near.”

With today’s multifocal contact lens technology, it’s getting easier to satisfy patients’ needs. Just make sure you discuss and set realistic expectations.

Consider this option in patients who need full-time back-and-forth vision but who don’t want to wear glasses.

“I Have a Friend Who Wears a Contact Lens in One Eye Only.”

Monovision contact lens wear can be a good option, but it’s typically better reserved for the early stages of presbyopia because of the small degree of induced anisometropia. A patient considering monovision contact lens wear must be educated on the depth-perception issues and the need to adapt to the vision it provides. Some patients do not tolerate monovision because they find the vision too difficult to handle.

Consider this mode in patients who do not do well with multifocal contact lenses but still want a similar experience.

A WELL-INFORMED PATIENT IS A HAPPY PATIENT

Don’t forget to educate your patients with presbyopia about what’s coming next. Also, don’t neglect to tell your patients who are prepresbyopic that there will soon come a time when they will need a solution for their near vision.

These discussions also give us a chance to talk about a new category of treatment that will be coming in the very near future: presbyopia-correcting eye drops. The landscape of this patient base will change with the introduction of these therapies.

The plano presbyopic patient doesn’t have to be a difficult patient. Taking the time to understand, educate, and recommend options with compassion and competence can make this patient’s experience smoother and minimize the disruption to his or her day-to-day life.