For Gen Xers and Baby Boomers, presbyopia is a virtually inevitable part of aging — but that doesn’t mean they’re happily resigned to the process. For many who have already seen their first wrinkles and gray hairs, presbyopia is the first medical issue associated with aging.

“Presbyopia is the anatomical aging process of the eye, caused by continued growth of the lens, which becomes less flexible over time,” explains Mitchell C. Shultz, MD, of Shultz Chang Vision in Northridge, CA. “Symptoms typically begin to appear when people are in their late 30s and early 40s. It becomes difficult to focus on small print, read on a smart phone, or even use a computer. They still have excellent distance vision, but all of the up-close things they do every day become more difficult without glasses or corrective surgery.”

Eyecare professionals see patients with vision problems and ocular diseases every day, but many patients with presbyopia can be a bit different from routine patients — quite simply because they’re not routine patients. They often have had no vision problems and, as such, have never had regular eye exams. To provide the best experience for these patients, it helps to understand these and other common situations that affect their perspectives.

Understanding New Presbyopes

The biological changes taking place are only one part of understanding presbyopia. Because the condition begins when people are in their late 30s and early 40s, it is often one of the first problems related to aging, which makes it particularly distressing.

“One thing to understand about presbyopic patients, especially those who have never had any vision problems, is that presbyopia can be an unpleasant surprise. They have never needed glasses or contact lenses, and now they can’t read or do other up-close tasks. It’s kind of a shock to their system,” says Patti Barkey, COE, CEO of Bowden Eye & Associates and Eye Surgery Center of North Florida in Jacksonville. “For some, it’s the first time they have experienced a defect in their body at all. They have enjoyed clear vision and good health, and they’re not in the habit of going to the doctor. When they hear that there are high-tech ways to eliminate the problem, they’re very happy to come in for an evaluation.”

It makes sense that these patients are frustrated and seeking help. Some new presbyopes have worn glasses for years and now need progressive lenses, while others have never worn glasses and often feel reluctant to start. Suddenly, they’re having trouble at home and at work — reading, using their laptops, and helping their kids with homework. They might try buying readers off the rack and carrying them around (or forgetting them) wherever they go. It’s a tough transition. Yes, there are treatment options, but Dr. Shultz finds education is an important first step.

“When we see patients in their late 30s and early 40s, even those who are not noticeably presbyopic yet, we make them aware of the natural progression of presbyopia. It usually is not discussed with young patients, and as they start to deal with these changes, we often find that they’re completely unaware of what presbyopia is and how it affects virtually everyone,” explains Dr. Shultz. “Even when patients in this age range come to us for LASIK vision correction unrelated to presbyopia, it’s possible that they’ll still require glasses in a few years. It’s important to let them know about the possibility of needing another procedure when that happens.”

Treating Presbyopia

Aside from reading glasses, progressive lenses, monovision contact lenses, and bifocal contact lenses, there are several procedures used to treat presbyopia. Monovision LASIK is one option. Patients also can have clear lens replacement with monovision, multifocal, or accommodating IOLs. Two corneal inlays are available as well — Kamra (AcuFocus) and Raindrop (ReVision Optics) — and patients can have combined inlay-LASIK procedures.

Dr. Shultz explains his approach. “Depending on the patient’s age, eye health, and desire not to wear glasses, there are several different surgical options. For early presbyopes, we can simply perform a mini monovision LASIK procedure with an adjustment to enhance the near vision. We also use the Raindrop intracorneal inlay to reduce the need for glasses,” he says. “For moderate to high myopes, Raindrop is not an option, so we use refractive lensectomy to provide well-balanced vision, although it is an out-of-pocket procedure in these cases. We perform the clear lens procedure with accommodating or multifocal intraocular lenses to improve near vision. We also offer multifocals to moderate hyperopes for whom LASIK or Raindrop will not achieve desired visual outcomes.”

For both Shultz Chang Vision and Bowden Eye & Associates, the fairly new Raindrop procedure has boosted presbyopia surgery rates.

“We use everything in our arsenal, with the choice depending on each patient’s specific needs and wants,” Barkey says. “Raindrop seems to be one of the simplest options. These patients are very tech-savvy, and they respond to a high-tech option. They’re tired of taking glasses off and putting them back on, all day long. They like the fact that the corneal implant is in just one eye, although they can also have LASIK combination surgery for both eyes if they want full vision correction.”

Barkey offers a common example of a patient who’s worn contact lenses for clear vision. He realizes that he can no longer see up close and has to hold reading farther from his eyes. The doctor determines that he is presbyopic. Treatment options include monovision contact lenses or LASIK, both of which can be a difficult adjustment. A corneal inlay would give the patient as much distance vision as possible as well as clear near vision. Patients often go with the corneal inlay, she says, because it is the option that currently best fits the needs of a multitude of candidates. The key is often raising awareness of the available options, beyond drugstore reading glasses.

Marketing Presbyopia Correction

Because many people view reading glasses as one of the inevitabilities of middle age, practices need to raise public awareness of the options for presbyopia correction. Strategies range from the mundane to the unusual. Barkey says some practices have their name and information printed on reading glasses, which they leave at restaurants. When patrons can’t read the menu in the dim lighting, they get complimentary readers that direct them to help with their presbyopia.

On a more traditional track, educating referring optometrists is very important. Optometrists let their presbyopic patients know about the new technologies available to keep them out of reading glasses, and then patients see the surgeon for a free screening.

“We are largely a word-of-mouth and optometric referral practice,” explains Cory Matthews, Patient Services Administrator at Shultz Chang Vision. “We also focus on Facebook, Instagram, and other social media outlets to let patients know how inlay procedures, such as Raindrop, can reduce their need for reading glasses.”

Barkey’s practice is very active on social media as well, particularly Facebook, Twitter, and LinkedIn. “When patients are very happy, we ask them to tell their friends on social media. We actually got all of our first Raindrop patients from Facebook because I told all of my friends about a new procedure to help them use reading glasses a lot less, and many came in for screening. The financing we offer through CareCredit goes hand in hand with marketing efforts because we often include ‘For as low as $35 a month…’ or another reference to payment in the post. For most patients, that offers a very clear picture of how treatment can fit into their budget.”

CareCredit offers tools to help practices market their services, including about 50 million mail and email marketing messages sent to cardholders each year, detailing treatments for which the cards can be used (See “CareCredit Resources”).

Creating A Positive Patient Experience

As a final piece of advice, Barkey points out that many presbyopia patients have spent very little time in any doctor’s office, so patience and efficiency are key to positive outcomes.

“They’re busy. They’re not used to the whole doctor’s office experience, they may not have been having eye exams because their eyes were fine for so long, and they generally don’t like to wait,” says Barkey. “We need to see them quickly to get them out and happy.”

Practices that understand what presbyopes are going through, their busy lifestyles, and how the available options can help are well positioned to create a good patient experience. •

CARECREDIT RESOURCES

Did you know? Not only is CareCredit’s approval process quick and easy, but patients can move forward with treatment without approval — and can pay right away if approved. CareCredit offers a wealth of resources to help you spread the word about financing options.

The CareCredit Social Media Toolkit helps you quickly engage in the online conversation.

• Click and share. Choose from a reserve of prewritten posts and tweets to help you provide key info patients want. With the touch of a button, instantly “share” these posts on your Facebook page and Twitter.

The CareCredit Advertising Toolkit has web resources to help remove the cost barrier during online searches.

• Banners and buttons. Available in a variety of colors and sizes, these can easily be customized and added to your website to let patients know financing is available.
• Easy access. Patients can apply for a CareCredit credit card directly from your website, and come away with a way to fit surgery into their budget.**

The CareCredit Payment Calculator lets patients instantly see how budget-friendly treatment can be.

• Share online. Add the calculator to your practice website to make it easy for potential patients to estimate monthly payments.
• Share in-office. Use in your fee discussions to quickly show how CareCredit financing options can make presbyopia procedures affordable.

**Subject to credit approval