Presbyopia doesn’t happen overnight. Like most optical conditions, it creeps up over time and as it slowly progresses, most folks develop coping strategies long before they decide to have an eye exam. There couldn’t possibly be something wrong with their eyes!

The stages of presbyopia usually begin after age 40. Coincident with an “it’s all downhill from here” time of life, comes denial. “The lighting here is no good,” or “They keep making the print smaller,” are common complaints. The word “bifocal” is never uttered. Some people, especially myopes who can accommodate a little longer than some or take their glasses off to read, can get through this stage without reading glasses.

Resistance to presbyopic progression is futile, however, and there comes a point when approaching age 50 coping strategies fail, and the need for reading assistance is accepted. Even the smug myopes reach a point at which their myopia improves but with a cost to their near acuity. Fortunately, both spectacle and contact lenses offer myriad options for correction. Digital progressives designed using new devices that account for position of wear measurements provide clear vision at all distances and all but eliminate adaptation time.

And don’t forget about contact lenses. Many emerging presbyopes have worn contact lenses for years and won’t give them up. Progressive addition contacts are available in any wear modality and have improved by leaps and bounds in offering clear vision at all distances. Other contact lens options include monovision, in which one eye is corrected for near and the other for distance; and modified monovision, in which a multifocal lens is used on one eye, and a single vision lens on the other, depending on the patient’s visual needs. Like task specific spectacles, some contact lens wearers have different powers of contact lenses for different activities.

As ECPs, we’re tasked with guiding patients through what may be a sensitive issue. Becoming educated about presbyopic solutions will enable us to help find the best option. Barry Santini’s CE course “Coping With Corridors” offers great information about progressive lenses from the basics to advanced designs. Go to 2020mag.com/ce to learn more.

• Linda Conlin
[email protected]
2020mag.com/education