Typically, presbyopia patients present to an eye care provider after they have tried their own workarounds, like purchasing over-the-counter readers and making the font size on their phones as big as possible. By then, these folks are frustrated by their struggles with near vision and are seeking help. It can be easy to gloss over presbyopia with our patients. Current research shows that patients are leaving our offices 50% of the time hungry for more knowledge and solutions. Instead of approaching presbyopia as a nuisance, we should view it as an opportunity to provide meaningful solutions that will enhance patients' quality of life.
An estimated 128 million Americans are affected by presbyopia with 30.9 million of them wearing over-the-counter readers.1-4 A survey of 797 patients aged 40-55 years revealed that 96% of respondents say that at least 1 daily activity is "somewhat affected" by presbyopia symptoms while nearly half say the impact is “extreme,” and 90% say they are frustrated or irritated with presbyopia.5 Further, although nearly two-thirds of presbyopes seek help from their eye care provider, barely half report obtaining the information they needed, with just 15% of those surveyed indicating that they received printed educational material.6
Simplifying the conversation and being proactive instead of reactive will help us as eye care providers seize the chance to help our presbyopia patients. Being prepared will save an enormous amount of chair time. I recommend asking patients simple questions about their workday, their workspace, and even how many screens they use. It is quite telling to have patients describe how they feel at the end of their workday—asking, how do your eyes feel? Are your neck and back sore? These are the kinds of questions my staff and I ask of every single patient. Technicians can start these conversations; it does not have to all be on the eye care provider.
Address Pain Points
When I walk into the exam room, I already know what the patient's pain points are, and I can address areas where they are struggling. Instead of the presbyopia discussion being a potentially awkward one around aging, patients are grateful to hear there are customized solutions to help them with their near vision. I will prescribe glasses for their workspace, hobbies, or contact lenses depending on their lifestyle needs.
Even with the amazing technology we have today, patients are still curious about other options in addition to glasses and contact lenses. This is when I tell them that presbyopia-correcting drops may soon be available, and they want to know more. There is a sense of relief, similar to how we may tell patients that although they are not a good candidate for LASIK, they are a great candidate for clear lens exchange.
Focus on the solutions that best fit their needs, not all options will be applicable to them. Instead of shying away from the "presbyopia talk," let patients know that you have the expertise to help find what fits their needs and lifestyle.
Marketing Your Practice
In addition to planting the seed with patients, I have started marketing my practice in advance of presbyopia drops being approved. For example, I have begun optimizing my website content for appropriate search terms like presbyopia, reading glasses, near work, etc. When patients search for information, I want my practice to appear near the top of the list. By starting now, my practice can be at the forefront of helping patients with new technology for presbyopia.
With every patient with presbyopia that I see, I talk about what we can do for them today and let them know what could be possible in the future. I tell them I will put them on the VIP list so that the second I have presbyopia drops as an option, they will be the first to know. Given the fact that 30 million people are currently wearing over-the-counter readers, there is an enormous opportunity, particularly when it comes to treating presbyopes. These are patients who in many cases are not people that are coming in for comprehensive eye exams. Imagine how awesome it will be to educate this demographic.
Patients don’t know what they don’t know. For example, I often prescribe a primary pair of glasses for everyday wear, workspace glasses for those with increased visual demand, and sunglasses to everyone! Most people don’t understand how much we can help them. We cannot afford to be indifferent to these opportunities.
Synergistic Not Competitive
This is not going to be the panacea of presbyopia. History tells the story well; when LASIK came on the scene, glasses did not disappear. New technology can certainly be disruptive, but if we embrace it, it is disruptive in the right way. There are tens of thousands of patients who do not know what a comprehensive eye exam entails and have never had one. It is likely that presbyopia drops will be on label for once-daily treatment, lasting anywhere from 6 to 10 hours depending on the product and the patient. Patients will still need a great pair of every day glasses and the rest of the tools in our treatment protocol like sun protection and workspace spectacles will remain relevant.
These drops will have an important role for presbyopes who have challenges staying in contact lenses, either due to ocular surface disease or because they do not have success with multifocals. I see many ways we can grow our practices if we are intentional about it.
Direct to consumer marketing for presbyopia drops will drive patients to our practices. With an influx of patients, we have the opportunity to treat and educate around everything from diabetic eye disease, dry eye disease, glaucoma, and macular degeneration—potentially catching conditions earlier.
Thirty million patients—that is a huge number. We need to ensure we are prepared for it. If patients call practices to inquire about these drops and they do not receive the information they are looking for, they will hang up and find a different practitioner. If you historically have not been an early adopter, become one now with the presbyopia paradigm shift.
1. American Optometric Association website. Care of the Patient with Presbyopia. Optometric Clinical Practice Guideline. https://my.ico.edu/file/CPG-17---Presbyopia.pdf. Accessed May 29, 2021.
2. Zebardast N, Friedman DS, Vitale S. The prevalence and demographic associations of presenting near-vision impairment among adults living in the United States. Am J Ophthalmol. 2017;174:134-144.
3. U.S. Census Bureau. Table 9. Projections of the Population by Sex and Age for the United States: 2015 to 2060 (NP2014-T9). Washington: Population Division. 2014.
4. Vision Council website. https://www.thevisioncouncil.org/sites/default/files/research/VisionWatch_VisionCouncil_Member_Benefit_Report_September%202016_FINAL.pdf. Accessed June 2, 2021.
5. Data on file, Allergan. Survey of 797 patients aged 40-55 years.
6. Data on file, Allergan; Full Quantitative Summary. Survey of 1339 patients aged 40-55 years.
Selina R. McGee, OD, FAAO, is the founder BeSpoke Vision in Oklahoma and is also immediate past-president Oklahoma Association of Optometric Physicians. Dr McGee is a consultant to Allergan; contact: [email protected]