In part 2 of a 5-part video series, the presbyopia expert panel emphasizes the importance of empathetic patient education, explaining presbyopia as a natural change rather than a sign of poor health or simply “getting older.” They also stress individualized, shared decision-making, with treatment options ranging from glasses and contact lenses to presbyopia-correcting drops and surgical approaches based on each patient’s needs and preferences.
Nathan Lighthizer, OD, FAAO:
Dr. McDonald, let’s talk about how this impacts patients’ lives. I’ll give you my quick story. Again, I’m about to turn 45 years old. I’m a plano-sphere. My entire life, I’ve never worn glasses, never worn contact lenses. I really have no interest in wearing glasses or contact lenses. I’ve always seen good in the distance and up close. It’s been frustrating. To have that struggle, going, “Why can’t I see when I need to see?” Obviously, I know what the answer is, being an optometrist, but that’s frustrating to patients. It impacts their lives, whether it’s inside or outside.
Dr. McDonald, talk to us about what patients are telling you and how it impacts their lives.
Marguerite McDonald, MD, FACS:
Well, of course there are the people like you, Nate, who are in their early 40s, and it’s an upsetting shock to realize that they’re aging. Usually, this is the first real sign of aging. It’s very deeply upsetting. But there are other groups, not just the 40-somethings. We get people who come in who had LASIK 20 years ago, and they say, “My LASIK is wearing off. Now I can’t see up close.” Then we have to explain what that means and it’s not wearing off and we explain it. There are people who come in who had premium IOLs and they’re a little unhappy with the amount of near vision that they have after spending so much money on a premium choice.
There are people who come in, like the other day, a 75-year-old lady, very youthful, vivacious. She had cataract surgery when she was 60. Now she’s playing cards with all her friends who just had cataract surgery recently. They all had premium IOLs. She’s the only one left with reading glasses. She’s like, “What can you do for me?” I mean, there are lots and lots of people out there who would like to get rid of reading glasses for a number of reasons.
Nathan Lighthizer, OD, FAAO:
Yeah, no doubt about it. I think that one of the messages is, whether they’re 45 or 55 or 65, there’s just a wide variety of needs that patients come in for. Even in the one patient, they have different scenarios and different situations where they want us to help them solve that problem, that near vision or whatever it is. Dr. Mah, what are the words that you say to patients? How do you communicate this to patients when you give them their different options? Do you go through all of the different options or the quality of vision? How it impacts their lives? What are the words that you tell them?
Francis Mah, MD:
Yeah, I think you’re right. It’s kind of important how we put all of this. I think the first thing that I always try to tell them is, “This is a process where your eyes are just changing.” I tell them, “It’s not that you’re old, but we’re all getting older. We’re all getting wiser and the eyes are just changing.” I tell them it’s a lifelong process. I say, “When we were born, we were able to actually see 2 cm away from our face. Then even at age 5, we’ve lost that.” It’s not that all of a sudden things have changed overnight. It’s just this is a process that’s been going on our whole lives. We actually never knew it. We just kind of lived with it. Now at 40, 45, or 50, it’s at a point where we can’t really flex the lens out to about our arm’s length.
I talk to them about the fact that this is a process that’s been going on. It’s just that we’ve hit a certain point where the lens is just not flexing enough. I do talk to them about the lens and the physiologic properties that are there, that they’re not doing anything. It’s not that they ate something or they didn’t eat something. It’s not a health-associated thing. A lot of people bring up, especially in California, “Can I do something naturally about it, homeopathically about it?” I tell them, “You can try and if it works, you’re ahead of the game as far as diets and exercising and so forth, but as far as we know, there isn’t anything that’s really going to bring back that flexibility in the eyes.”
I do talk to them about different strategies. If they’re wearing contacts or glasses, we go down potentially monovision, for example, or weakening the power. I talk to them about going back to their optometrist to look at all the different strategies, multifocal contact lenses, for example. If they’re interested more in surgery, they’re not a contact lens candidate, then we kind of go down the surgical path. I do tell them that there are FDA-approved eye drops that can help them as well. Just go through all of that. Then also, obviously, there are glasses that they can use as well. Most of the time, they just want to confirm that their eyes are healthy, that there’s not anything going on, that either glasses will help with their vision, and that’s the proper pathway to go, or, “Is there something else that I can do?”
Nathan Lighthizer, OD, FAAO:
I think it’s so important to go through all those options and to really involve the patient in the decision. We’re customizing treatment. Whether it’s glasses, readers, whether it’s contact lenses, multifocal contact lenses, monovision, or as you said, Dr. Mah, our presbyopia drops. Again, surgical options as well in some patients, to involve them and make that decision together so they know that you care, you’re in this for the long haul, and we’re going to tweak this. There’s no one perfect option forever in all scenarios, in that, “We’re going to work and we’re going to get this as good as we can for you, Mr. Jones or Mrs. Jones,” depending on the patient and their individual needs.
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