Customize contact lens selection to avoid dropout in presbyopic patients
By Mark Schaeffer, OD
Dropout among contact lens wearers is a loss for the industry, eyecare practitioners, and patients. Many patients are unaware that new contact lens technologies can potentially afford them opportunities for greatly improved vision compared with what they remember from earlier attempts.
Who Drops Out and Why
Large international surveys have reported that the principal reasons for contact lens dropout were poor vision, discomfort, and lack of motivation.1,2 The type of contact lens may also affect dropout rates; 2 studies found that the highest retention rates were seen in spheric lens wearers, followed by toric and multifocal contact lens wearers.3,4
Still, presbyopes have represented a large portion of contact lens dropouts. Presbyopes are most often older than 40 years of age and may have tried to wear contact lenses years ago. In some cases, presbyopic patients may discontinue contact lens wear because of age-related ocular surface problems, such as dry eye disease.5 For a patient with these symptoms, any contact lens—no matter how breathable—could exacerbate the problem and lead to dropout. However, the newer materials and technologies in today’s multifocal contact lenses are less disruptive to homeostasis on the cornea than earlier generations and may provide clarity and comfort for most presbyopic patients.
Better patient education and ongoing communication are key to introducing new wearers to the opportunities presented by multifocal lenses. Several studies have found that many dropouts will resume contact lens wear if they are educated to the possibilities of an alternative design.1,4
Addressing Dropout First: Starting the Multifocal Lens Conversation
About half of patients in my practice have some level of presbyopia, and many wear contact lenses or have worn them in the past. As with any new patient, I want to know more about who they are, what they do, how they use their eyes throughout the day, and how their vision issues are affecting their daily lives.
Before prescribing any contact lenses, we determine whether patients have any underlying dry eye or ocular surface condition. We give all our patients a dry eye survey and do not assume that the corneal surface is primed for the multifocal lens.
After their exam, I offer presbyopes the choice of glasses or contact lenses to correct their vision. I include contact lenses in the menu of options because the parameters for wearers have expanded. Most of my patients have no experience with multifocal lenses, and they are usually astonished to learn that they can now see both near and far with both eyes. I also find it helpful to remind presbyopic patients of the cosmetic advantages of contact lenses, as well as the freedom from spectacles. These conversations help patients think of vision correction as more than just diagnosis/prescription but rather part of their daily lives.
Choosing the Right Contact Lens for Your Patients
A lens that works well for one patient may not necessarily work for others, and conversely, a lens that does not suit one patient may suit others. We need to be able to select appropriately and switch among different products as necessary. Therefore, the eye care practitioner should be familiar with how brands differ. Each brand has a unique fitting philosophy, fit guide, material, and design, so it is best practice to understand these differences to help address your patients’ vision and lifestyle needs.
DAILIES TOTAL1® by Alcon was the first premium multifocal, with breathable lens material that can help restore the tear lipid layer. CooperVision’s MyDay® multifocal has a binocular progressive design, whereas other lenses have a near-center design, allowing a low add in the dominant eye up to a high add in the non-dominant eye, yet the eyes work together. Johnson & Johnson’s ACUVUE® OASYS MAX 1‑Day provides oxygen and moisture. Bausch + Lomb’s INFUSE® is a premium multifocal lens that features the easiest-to-use 2-step fit guide; there are no calculations and no need to find the dominant eye. As the name suggests, these multifocal contact lenses are infused with ingredients designed to minimize impact on ocular surface homeostasis, which is important for comfort, all-day wear, and symptoms of dry eye.
Each of these brands works well but not for every patient. To reduce dropout, our job is to match the needs of our presbyopic patients with the right multifocal contact lens.
How I Customize Contact Lens Selection
Selecting a multifocal that targets a patient’s needs and expectations can encourage retention. Our practice has a customized approach to lens selection based on patients’ lifestyle factors. I generally start presbyopes with INFUSE® multifocal contact lenses because they are straightforward to fit and work well at all distances. For secondary options, I may lean toward MyDay® or DAILIES TOTAL 1®.
If my patients have been successful with one brand, I find it is helpful to stay in the same family. If they’ve worn Alcon lenses, I start with the DAILIES TOTAL 1®. If they have been happy with Bausch + Lomb, I choose INFUSE®. I explain to patients that we will start with the company they’ve had success with, and I tell them what I like about those lenses—that way they feel comfortable about their choices and are more willing to continue or resume contact lens wear. We can also discuss some newer technologies that can bring them more satisfaction while correcting their vision.
Some patients with astigmatism have been told that they cannot wear contact lenses, or they may have stopped wearing them because the toric lenses were inconsistent in fit. Now Bausch + Lomb ULTRA® Multifocal for Astigmatism provides those patients the ability to see far and up close while correcting for their astigmatism as well.
Clinical Pearls
The following 4 pearls have served me and my patients well in practice.
Explain the differences in multifocal lens design to your patients
A recent survey by the Contact Lens Institute revealed that half of adults do not understand how contact lenses differ.6 Explain differences so that patients understand why you chose a specific multifocal lens. Don’t overcomplicate your explanation; keep it short and be positive and confident. Put the lens on the eye and let patients experience it for themselves. Take them to a window, get them to look at distant objects and then look at their phones. Most will be surprised and delighted.
Provide sufficient, ongoing follow-up
While most of our patients are happy with multifocal lenses on day 1, we have them return in 2 weeks. Having a follow-up appointment already booked provides the sense that they are supported and free to express concerns. We assure them we will continue tweaking their lenses until they are comfortable and satisfied. The sense that they are being well-served is reassuring to our presbyopic patients.
Follow the fit guides
The manufacturers have spent a lot of time and effort to create a pathway for us to fit these lenses efficiently. All brands behave a little differently, so make sure that you are using the correct fit guide and following the right protocols for the lenses you select.
Develop useful relationships
When you have questions, use your field reps as support. They want you to be successful, so have them help train staff. Remember that ours is a relationship business. You are developing a relationship with every patient, staff member, and industry partner. These are ideally mutual relationships. Using all the resources available will help to reduce contact lens dropout, make your life easier, and ultimately keep your patients happy and seeing clearly.
We must continue to be proactive for our contact lens wearers to ensure they are not at risk of dropping out of wear. By educating them on new technologies, getting them into innovative designs, and monitoring for ocular surface issues, we can keep patients seeing clearly and comfortably on their terms.
References
- Pucker AD, Tichenor AA. A review of contact lens dropout. Clin Optom (Auckl). 2020;12:85-94. doi:10.2147/OPTO.S198637
- Dumbleton K, Woods CA, Jones LW, Fonn D. The impact of contemporary contact lenses on contact lens discontinuation. Eye Contact Lens. 2013;39(1):93-99. doi:10.1097/ICL.0b013e318271caf4
- Sulley A, Young G, Hunt C. Factors in the success of new contact lens wearers. Cont Lens Anterior Eye. 2017;40(1):15-24. doi:10.1016/j.clae.2016.10.002
- Young G, Veys J, Pritchard N, Coleman S. A multi-centre study of lapsed contact lens wearers. Ophthalmic Physiol Opt. 2002;22(6):516-527. doi:10.1046/j.1475-1313.2002.00066.x
- Naroo SA, Magra M, Retallic N. Exploring contact lens opportunities for patients above the age of 40 years. Cont Lens Anterior Eye. 2022;45(6):101599. doi:10.1016/j.clae.2022.101599
- Beyond vision: behaviors to attract new & returning contact lens wearers. Contact Lens Institute. Spring 2024. Accessed May 15, 2024. https://www.contactlensinstitute.org/resources/see-tomorrow-beyond-vision/
Mark Schaeffer, OD, earned his Doctor of Optometry from Southern College of Optometry and completed a residency in Ocular Disease at Bascom Palmer Eye Institute in Miami, FL. He serves as Clinical Field Manager at MyEyeDr in Birmingham, AL, where he practices full-scope optometry. He is affiliated with several pharmaceutical companies in consulting for ocular disease and contact lenses.
