In part 1 of a roundtable series, experts in presbyopia care explore the growing impact of presbyopia on patients and the challenges clinicians face in educating them about the condition. The group emphasizes that presbyopia can carry both functional and psychological effects, while highlighting the expanding range of treatment options. With more technologies available, clinicians are increasingly focused on developing individualized management strategies based on patients’ lifestyles, preferences, and visual needs.
Nathan Lighthizer, OD, FAAO:
Hello, everybody. Hope you are doing well. My name is Dr. Nate Lighthizer. I’m an optometrist and faculty member at the Oklahoma College of Optometry. Welcome to Ophthalmology 360 and Optometry 360. We’ve got a roundtable discussion on all things presbyopia. There’s been a lot going on in the presbyopia space over the last 5 years, and I am joined tonight by 3 experts in the field of optometry and ophthalmology: Dr. Francis Mah, Dr. Mile Brujic, and Dr. Marguerite McDonald. Welcome, all.
Mile Brujic, OD:
Thank you, Nate.
Marguerite McDonald, MD, FACS:
Thank you.
Francis Mah, MD:
Thank you.
Nathan Lighthizer, OD, FAAO:
We’re going to talk on presbyopia. We all know it’s this age-related onset hits people in their early- to mid-40s. It was never going to happen to me, but I turned 44 earlier this year, and by God darn it’s now affecting me, and it’s getting blurrier and blurrier. My arms need to be longer and longer. We know this age-related onset and the impact on vision that it has.
Dr. Mah, why don’t you kick us off. What you see in your practice and just a general overview in presbyopia and what patients are telling you?
Francis Mah, MD:
You’re absolutely right. I mean, it impacts everybody eventually. For me, the biggest impact was my wife. My wife at 40 never wore glasses and she said, “I can’t read. I’m having some difficulty. You can finally do something for me, so figure out what I can do.” I think she was implying for me to do some surgery on her. Well, I went to the local drugstore, got her some reading glasses, gave her the reading glasses. She was so disappointed, and she said, “Geez, why did I marry you? I should have married a dermatologist or plastic surgeon.” The thing is that people, I think number 1, they just don’t understand. They don’t know why they can’t see. Number 2 is, when they come to the realization that they do need reading glasses, I think it hits them that they’re getting older, and that’s a psychological thing that I think really impacts a lot of people.
I think that’s something that we need to be cognizant of when we see these people, because a lot of times we see them and we say, “Oh, your eyes are normal. You’re just getting older and you need some reading glasses.” Well, that’s a big hit to a lot of people that are coming in. My practice is a little different in that it’s more surgical. I do see a lot of patients who are coming in for LASIK, for example, and they’re emmetropic and they’re like, “Okay, I heard great things about LASIK. I want to have LASIK.” Then I have to peel back and say, “Hey, it’s not really to make your eyes 20 years old again. There’s all these other factors.” There’s things that we can do, but have to go through the whole educational process of accommodation, the loss of accommodation and so forth.
Nathan Lighthizer, OD, FAAO:
Dr. Brujic, you’re in Ohio private practice optometry. You see everything from front of the eye to the back of the eye, dry eye to retina, and everything in between. The impact that you see in patients’ presbyopia, they’re coming in for a variety of things in your practice. What are they asking you for? What are you telling them?
Mile Brujic, OD:
Well, it’s humbling. The reason why I say that is there’s nothing more frustrating for a patient and a clinician to not be able to fix a problem, and that’s really where presbyopia is. We have ways to manage it, but we can’t truly fix it. It’s also discouraging when we share with people what the options are and they don’t want to place contact lenses on their eyes, they don’t want to wear glasses, and they don’t want surgical options. New opportunities are really now available to us that help us change that discussion. Nate, I’ll tell you the biggest difference over the last 3 to 4 years is that presbyopia isn’t treating a condition now. It’s actually putting together a strategy for these people because it affects so much of their livelihood, so much of their everyday basis. It really has turned into a, let’s take a step back, let’s put together a strategy, and let’s figure out what’s going to be best for you. It’s one of the things that I’m most encouraged about with some of the new technologies.
Nathan Lighthizer, OD, FAAO:
Yeah, we have options now. We have more tools in our toolbox that we can talk about with patients, and that’s a wonderful thing. It also adds a layer of complexity when we have a patient in the exam lane to talk about multiple different options and figure out which one is best for them.
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