Think of eye drops as an add-on to other vision care products, not just a replacement.
By Susan J. Gromacki, OD, MS, FAAO, FSLS
The contents of this article are informational only and are not intended to be a substitute for professional medical advice, diagnosis, or treatment recommendations. This editorial presents the views and experiences of the author and does not reflect the opinions or recommendations of the publisher of Optometry 360.
Presbyopia-correcting eye drops should have a place in every eye care practice. But, not surprisingly, some doctors are concerned that this relatively new treatment category could displace other vision-correction options, affecting optical shop revenue. From my experience thus far, that’s not the most accurate way to think about eye drops for presbyopia. In my practice, the most common scenario is that eye drops are an “and” not an “or.” Additionally, presbyopia-correcting eye drops bring in new patients—emmetropes who have never worn glasses or contact lenses—to our practices, in some cases for the first time. These patients are candidates not only for eye drops and eyewear but also for ocular health examinations that they may have been missing in the past.
I’d like to share 4 stories of patients in my practice who have benefitted from a combination of presbyopia-correcting eye drops as an adjunct to more traditional optical shop products.
The Avid Golfer
One longtime patient who recently started using presbyopia-correcting drops is a 47-year-old man who has a high-pressure corporate job but loves to golf on the weekend. He wears progressive addition spectacles at work and is very happy with those, but he has always preferred to wear contact lenses when he golfs because he doesn’t like how the glasses slip down on his nose or fog up when he wants to enjoy being out on the course. Unfortunately, as he became more presbyopic, he was having trouble seeing the scorecard. Putting reading glasses on over his contact lenses would undermine why he is wearing contact lenses in the first place, and, at the time, I didn’t want to refit this part-time contact lens wearer into a multifocal lens. Presbyopia-correcting eye drops have been the perfect solution because he can use them just on golf days; the effect lasts for a full 18 holes plus lunch and drinks afterwards.
The Aging Presbyope in Monovision
I have been fitting monovision contact lenses for years and with great success, but I am always concerned about the impact on binocular vision. A 65-year-old patient of mine illustrates this nicely. She has been doing well in monovision, but as she reached full presbyopia and needed a +2.50 add for the non-dominant eye, the large discrepancy between the 2 eyes meant that she was essentially monocular at distance and at near. This can affect visual acuity, quality of vision, and depth perception. A previous trial of multifocal contact lenses was not successful. At her last visit, instead of continuing monovision, we opted to fit her with single-vision contact lenses for distance and then prescribe presbyopia-correcting eye drops to help her see up close. With this strategy, she gained binocularity and better distance vision, while the eye drops help her with near vision. She’s very happy with the outcome.
The Office Worker in Multifocal Contact Lenses
Presbyopia-correcting eye drops can also be a strategy to keep patients successful over the long term in multifocal contact lenses. Another patient of mine, a 61-year-old woman who wears multifocal contact lenses, has been doing well in her multifocal lenses for several years, but at her last annual visit, she told me she was struggling to read spreadsheets and fine print at work. She was in a mid/high add pair of multifocals, so the next step could have been to go to a high/high add combination. While every multifocal contact lens design is a little different, we know that, generally, as presbyopia increases, there is more of a disparity between the near and distance zones of the contact lens; this can compromise distance vision. With presbyopia-correcting drops, I was able to keep this patient in the same multifocal contact lenses, avoid going to a high add in both eyes, but still give her the stronger near vision she wanted for reading fine detail at work.
The Sun Worshippers
Finally, a couple that I treat have a house on the water and spend a lot of time on their boat. They both have purchased sunwear in our optical shop. The wife is an emmetrope who wears designer plano sunglasses, and the husband has prescription sunglasses. They are both just starting to be bothered by the loss of near vision. Prescribing presbyopia-correcting eye drops for them has dual benefits. As a miotic, the drops are constricting the pupil, which not only improves reading vision when they are wearing sunglasses, but also makes them more comfortable by blocking out some of the sun’s rays. It has been a nice option for patients like these; they buy fashion sunglasses, put the eye drops in, and then are able to do everything they desire at the pool, beach, or out on the water.
Focus on Lifestyle Benefits
Every patient’s needs are different, and response to eye drops can vary. The presbyopia-correcting eye drop I prescribe most often is YUVEZZI (carbachol 2.75%/brimonidine tartrate 0.1%, Tenpoint Therapeutics), because it is a convenient once-daily single drop and has a nice balance of durability and tolerability. Unlike earlier-generation drops that sometimes caused dimming or significant redness, I haven’t heard complaints about either of these side effects from my patients on YUVEZZI. I tell patients that the effects last about 8 to 10 hours, so they need to take that duration of activity into consideration. Office workers may want to delay instilling the drops until right before they leave for work so that the pupil effects will cover them throughout their workday. If their goal is only to enhance near vision for a shorter period of time, I may opt for a shorter-acting eye drop such as QLOSI (Orasis Pharmaceuticals).
With every patient, I try to consider how all the options at my disposal—glasses, contact lenses, and eye drops—can best fit their lifestyle, and which combination of products will fully meet their visual and comfort needs. It is important for us as doctors not to pre-judge what our patients are willing to pay for but rather to educate them on options and offer the best technologies available to us. Anytime I prescribe eye drops or contact lenses, I emphasize that the patient should always have a good pair of backup glasses for all distances for times when they can’t wear their lenses or when the effects of eye drops have worn off. Because of this, there has been no negative impact on optical shop revenue. If anything, increased awareness of presbyopia has brought new patients into our optical shop.
Presbyopia-correcting drops represent a great opportunity to meet patients’ lifestyle needs. I urge colleagues to keep an open mind about all of the different types of patients in our practices who can benefit from these drops, often in combination with other vision correction strategies.
Susan J. Gromacki, OD, MS, FAAO, FSLS, is an optometrist and Director of the Contact Lens Service at First Sight Vision Care in Fulton, Maryland. Contact her at [email protected]. Disclosures: She is a consultant for Bausch + Lomb SVP, Glaukos, Johnson & Johnson Vision Care, Scope, Tenpoint Therapeutics, and Viatris.
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