How Will Presbyopia-Correcting Drops Fit Into the Treatment Toolbox?
With a new option available, patient education is key to determining the best choice.
Presbyopia is the reduction of the eye’s ability to focus on near objects and affects 128 million people in the United States.1 Patients sometimes present in shock, questioning what has happened to their near vision. The decreased ability to see up close affects their daily lives, causing headaches, as well as the need for additional lighting and holding objects farther away. Roughly 45% of patients with presbyopia live with near vision impairment due to lack of adequate vision correction.2 In a survey of 1,339 presbyopes aged 40 to 55 years, 90% state that they are affected or irritated with presbyopia.3
The pandemic has led to dramatically increased screen time, putting a higher demand on near vision and causing an early onset of presbyopia. We are seeing patients between 38 and 42 years of age with early symptoms.4 Adults in the United States now spend an average of 3 hours and 48 minutes per day on computers, smartphones, and tablets and check their phones 96 times per day (once every 1 minutes), according to research from Asurion.4 So what do we as optometrists do with this information?
A LOOK INSIDE THE PRESBYOPIA TREATMENT TOOLBOX
Traditionally, we have offered our presbyopic patients glasses or contact lenses to correct their failing near vision, but after 40 years they want to feel young again without the need for correction that may make them appear older.
Environmental changes, such as altering luminance, can significantly affect visual acuity, where doubling luminance levels improves acuity by 1 letter on a 5-letter row.
OTC or prescription reading glasses are the most common option offered to patients with presbyopia as treatment; however, many feel inconvenienced by having to take them on and off to read. Other patients may end up with OTC reading glasses that are not the correct prescription, which could potentially harm their eyes.
Progressive lenses are another option, but can be associated with peripheral blur, a restricted visual field, and impaired depth perception.5
Computer or workspace lenses can improve near and intermediate vision drastically, but still require the hassle of being put on and taken off throughout the day.
Contact lenses can be a great option for someone with presbyopia, but multifocal and monovision contact lens solutions also have limitations. Less than half of patients with presbyopia in the United States are even offered multifocal or monovision contact lens options,6 in part because of the risk of serious eye infections if patients do not follow proper contact lens care instructions. In fact, between 40% and 90% of contact lens wearers do not properly follow care instructions.7 Additionally, contact lenses can be difficult to maintain due to the development of age-related dry eye symptoms and reduced manual dexterity.
Surgical options involve invasive procedures, and patients with mild presbyopia have few permanent options. Surgery may include modifying the optics of the cornea, replacing the crystalline lens, or attempting to restore active accommodation. Although patients undergoing surgery report satisfactory outcomes postoperatively, many eventually still require reading glasses.
It’s important to discuss all of the above options with patients as part of their treatment plan, and with prescription eye drops hitting the market, we have a new opportunity to discuss presbyopia with them and to add a new tool to their toolbox of correction.
A NEW TREATMENT TO CONSIDER
As eye care practitioners, we need to be ready to offer the latest, safest, and greatest options in eye care. Numerous companies are actively researching drops to correct presbyopia, and one company, Allergan, already has an FDA-approved product ready for patients (pilocarpine HCl ophthalmic solution 1.25%, Vuity). These drops are prescription-based and will be a safe and effective regimen for patients. Read more about other presbyopia-correcting drops in the pipeline on page 22. Ideal patients will have mild to moderate presbyopia, and even those who have previously had refractive surgery, such as LASIK and PRK, are candidates for this drop.
With a brand new correction modality available, it will soon be necessary to share information with everyone—staff, patients, and your colleagues. Below are some simple ways to accomplish this in your practice.
Doctor Education
With a pharmaceutical treatment option for presbyopia creating a decreased pupil size, it is important to understand that dynamic pupillary modulation can improve a patient’s near vision and that the topical miotic can also address aberrations that are increased by large pupil sizes without affecting distance vision.
Staff Education
Set aside a scheduled time, possibly with a representative, to discuss the newly FDA-approved presbyopia treatment with your staff. Discuss ways to bring it up to patients, whether by adding it to the check-in form under “interested in” or by having a technician bring it up during a pre-test work-up.
Dissatisfied Patients
Query a list of patients from your EHR who may have returned progressives or reading glasses or discontinued use of multifocal or monovision contact lenses because they were dissatisfied.
Reach Out to Your Target Population
Query a list of patients from your EHR between the ages of 38 and 55 and send an email blast letting them know that a new FDA-approved treatment exists. This will drive patients in for their annual comprehensive eye exams.
Social Media
Use your social media accounts to share the news about the new treatment option on the market.
Patient Education
Educate patients daily, even the pre-presbyopes, that presbyopia will occur, but that there are options available to assist with their vision.
The more education we can offer, the more patients it will drive to our offices. Potentially seeing patients who haven’t had an eye examination in years is huge. It also opens up the opportunity to detect early glaucoma, cataract, and macular degeneration, so it is a great public health benefit.
ACT IN THE BEST INTEREST OF YOUR PATIENTS
For many optometry business owners, the question will be: How can one financially benefit from an effective presbyopia treatment without losing optical sales and without competing with the increase in online sales of contact lenses and eyeglasses? My answer to that question is this: Pharmaceutical presbyopia management will provide an increased demand in eye care services. Our patients should be made aware of all of their options and we as their eye care providers should create a sufficient toolbox of treatment options based on their daily activities.
Like death and taxes, presbyopia will occur at some point in our lives. Management of the condition allows patients to improve how they function when completing the daily tasks of living, as well as their quality of life.
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