Presbyopia is a frustrating, yet inevitable, condition experienced by more than 1.8 billion people around the world, including 128 million in the United States. A panel of experts discussed the options and nuances of presbyopia treatment during a session titled “Cycling the Range of Presbyopia Treatments” at the ASCRS meeting in Boston this weekend.
Marguerite McDonald, MD, FACS, a professor of ophthalmology at NYU Langone Medical Center in New York city, discussed the impact of presbyopia on the lives of patients, noting that the rise of cell phones and increase in screen time impacts the problem of near vision loss. Aging patients may feel helpless, resentful or angry not to be able to read as well as they used to, so patient education about the condition is very important. “I wish I had a penny for every time I heard someone say, ‘My LASIK wore off,’” she said. “That’s a common misunderstanding regarding the nature of presbyopia. Even if you were not the original surgeon, you may be the target and must explain” what presbyopia is and how it can be treated. “We have the opportunity here to offer choices — from monovision or multifocal contact lenses, presbyopia drops, laser vision correction, or intraocular surgery.”
To help patients choose a treatment that best meets their needs, surgeons must be able to describe the aging lens in a way patients can easily understand, explains George O. Waring IV, MD, FACS, founder and medical director of the Waring Vision Institute in Mount Pleasant, S.C. “There is an art and a science to what we do. This is an aspect of the art, to frame this in the context of the client’s journey,” he said.
Dr. Waring suggests using analogies that are easy to understand, such as, “your camera is not taking a great picture,” and avoiding medical terms like “astigmatism,” “multifocal,” or “toric.” “Use client-centric terminology so that things are easily understood and positive,” he suggests. “We want to create an experience with excitement and positive language, because this is a positive event. This is a positive opportunity, and you can tell them with confidence that this will be one of the single most important things that they’ve ever done in their life.”
Presbyopia can be dangerous for older patients, noted Daniel H. Chang, MD, of Empire Eye and Laser Center in Bakersfield, Calif. Multifocal spectacles reduce depth perception, increasing the risk of falling. More than one in three falls are attributable to multifocal glasses, resulting in about 40,000 deaths a year. “Each time a patient comes to us for presbyopia, they are seeking solutions — and there are some great solutions that don’t have that increased risk of falling,” he said.
Dr. Chang noted that surgical treatment of presbyopia must balance three interrelated concepts: visual quality, visual range and dysphotopsias. “Start with maximizing visual quality,” he says. “There is a range of IOLs, and different methods of achieving this. Extended depth of focus lenses, the Light-Adjustable Lens (RxSight) and small-aperture lenses like the IC-8 Apthera (Bausch + Lomb) can extend visual range, whereas multifocal, trifocal and hybrid IOLs promise full visual range, he said. “No lens works for all patients. The more you know your lenses, the more patients you can make happy.”