In the final segment of a 5-part video series focused on presbyopia care, the panel discusses practical strategies for integrating presbyopia-correcting drops into clinical practice, emphasizing proper patient identification, education, and expectation setting. Clinicians recommend assessing patients’ satisfaction with their current vision correction, explaining all available options, and allowing time for patients to adapt to treatment.
Watch from the beginning; go back to part 1.
Nathan Lighthizer, OD, FAAO:
Dr. Brujic, let’s talk practically speaking, getting this into practices and incorporating prescribing into practices. What have been the barriers to adoption that you have seen for some of these presbyopia correcting drops, and how have you addressed some of these barriers to adoption?
Mile Brujic, OD:
Yeah. Nate, I think you probably asked one of the most important questions because when you see a technology that’s going to help somebody, how do you do that in an efficient way that doesn’t confuse the patient? I’ve simplified my discussion for presbyopes. My discussion is very similar to what Dr. McDonald and Dr. Mah tell their patients. Then I say, “Now, here’s the options. There’s glasses, there’s contact lenses, there’s eye drops, and there’s surgery. Let me share with you which one of these options you’re a candidate for and why.” Oftentimes, it has to do with what their current prescription is, what they’re currently wearing, and what they currently want to do or have the ability to do.
One of the things I’ll share with you, Nate, is that durability is so important. That is longevity. Part of the reason for that, and one of those buckets of patients that we didn’t talk about was the contact lens wearer. The one who is a functional emmetrope when they’re wearing contact lenses, single vision. The one who maybe tried multifocals and doesn’t necessarily do well with multifocal optics, can’t handle monovision.
What are the options for that person? Well, it’s either reading glasses just like you, Nate, because you’re a functional emmetrope, or putting some type of drop in before they use the contact lenses. I think the durability and the fact that the mitigating of the eye redness side effects, both of those 2 things have really made this something that’s much more approachable from the eye care community. I think that’s why this drop seems to be being adopted much differently than the predecessors were.
Nathan Lighthizer, OD, FAAO:
Dr. McDonalds, best practices that have worked for you? Maybe some barriers you’ve seen, how you’ve addressed those barriers, and overall just best practices in the presbyopia space with these drops.
Marguerite McDonald, MD, FACS:
Well, if I have a patient coming in for their annual eye exam, for instance, usually while I’m taking the history, I’ll say, “Oh, so you wear reading glasses. Are you happy with those?” Most of the time people say, “Well, what choice do I have?” That’s a red flag. I’m going to complete the exam. I want to make sure they have a healthy retina. Then at the end I say, “You told me that you were unhappy with your reading glasses.” Then I explain that there is an option, a drop, etc. Because I got a clue at the very beginning that sort of sets the tone, I say, “Really, you’re unhappy. We’re going to talk about that when the exam is over.” Then right at the end is when I explain Yuvezzi to them.
Nathan Lighthizer, OD, FAAO:
Yeah. One thing that I’ve found that’s really been a pearl is you have to give this some time as well. They can’t put the drop in 1 time and think, oh, well, that didn’t work or it worked, or whatever it is. I tell them it’s going to take some time. It’s going to take days, if not a week or 2, to get used to your new vision. As we change your pupil size a little bit, we’re going to give this some time. We’re going to give this a week or 2, if not more, to really adapt to your new vision.
We’re in our last 2 minutes here. Kind of our conclusions. One piece of advice and final take-home, Dr. Mah, for the audience, one piece of advice and take-home. What do you think?
Francis Mah, MD:
Well, I think is just like we’ve been saying all evening, basically we need to remember who our patients are. We need to try to decipher exactly what their goals are. The fact that there are so many different options, and we can’t forget any of these options because you never know which patient and what goals they have. There are multiple different options that are out there, and one of these is going to be ideal for the patient that we’ve got in front of us.
Nathan Lighthizer, OD, FAAO:
Dr. McDonald, any words of wisdom?
Marguerite McDonald, MD, FACS:
Oh, I totally agree with Francis. I would just say it’s important to also quickly review anything they might encounter during the first week or 2, maybe a mild headache for a few days, and that that will pass. If you just set their expectations so they don’t become upset, then the acceptance is very, very, very high. I also like to tell them it wears off in eight to 10 hours. “You get up in the morning,” I’ll say to the women, “Throw in a drop, put on your eye makeup without your 10x magnifying mirror. Go to work, you work all day, you go to a restaurant for lunch, you can see the menu. You go back to work, you work all afternoon, then you meet your friends for dinner at a restaurant, you can read the menu. On the way home after dinner, it’s starting to wear off, which is great because that gives you better night vision.” They go, “Yeah, sounds good to me.”
Nathan Lighthizer, OD, FAAO:
Dr. Brujic, in 15 to 30 seconds, what’s your final thoughts?
Mile Brujic, OD:
Just understanding that caring for presbyopes requires a strategy, and it’s making sure that we involve all the tools in our toolbox that we have for patients, making sure that they’re aware of them, and making sure that from a clinician and a patient’s perspective, we’re working together to find what’s in their best interest.
Nathan Lighthizer, OD, FAAO:
Yeah, it’s never bad to have more tools in your toolbox. Again, whether it’s glaucoma, whether it’s cornea, cataract surgery with more IOL options, or in this case, presbyopia. I just encourage everybody, go into this and adopt this and use this. The more you treat patients, the more you’ll come to appreciate this. Big end numbers are powerful end numbers. If you said, “Oh, I tried Vuity once and it didn’t work 4 years ago,” dive back in and use this in more than just 1 patient or 2 patients. The more experience that you get with it, the more you’ll find patients that are the right patients, and you’ll learn from this, and really, it’ll benefit the patients in your practice.
With that, hope you enjoyed our round table discussion on presbyopia management. Thank you, Dr. Mah. Thank you, Dr. Brujic. Thank you, Dr. McDonald. To the Optometry [360] and Ophthalmology 360 community, wishing you well. Have a good day.
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