Pauline Xu, BOptom is a research optometrist at the Brien Holden Vision Institute, Australia.The main modality of presbyopic correction is still spectacles, and the presbyope is a largely under-represented demographic in the contact lens wearing population. The contact lens industry has responded, in recent years, by introducing several new contact lens products for presbyopic correction. To investigate the ways in which this change has affected the habits of practitioners, a survey of contact lens prescribing patterns for presbyopes was conducted in 38 different nations between 2005 and 2009.
Morgan PB, Efron N, Woods CA. An international survey of contact lens prescribing for presbyopia. Clin Exp Optom 2011;94:87-92.
About the fitting survey
The authors distributed survey forms to a maximum of one thousand randomly-selected practitioners (ophthalmologists, optometrists and/or opticians) in each country included in the study. The survey was sent at the same time each year during the five-year period (2005-2009). The same format, hard copy or electronic copy was sent each time.
The practitioners were asked to record data from the first 10 contact lens fittings performed after receipt of the survey. The lens wearers surveyed were categorized into presbyopic (greater than 45 years of age) and pre-presbyopic (15 to 44 years of age). The analysis reported in this paper was on the presbyopic population surveyed, with fitting types subdivided into three categories: (1) multifocal, (2) monovision and (3) non- presbyopic.
Regions included in the study
This interesting study collected information from 38 countries around the world; 95% of the data came from North America, Europe, Middle East and East Asia, and 5% came from one country in South America and one in Africa.
There was a considerable difference in the prescribing trends for presbyopia across countries. For instance, 70% of soft lens fittings in Portugal were for presbyopia, whilst fittings in Singapore were on presbyopes. The authors found a relatively higher proportion of female wearers across the age range of the population surveyed, which is suggestive of a stronger focus on cosmetic appearance.
Predominant prescribing trend: Distance vision contact lenses with spectacles
Out of 16,680 contact lens fittings for presbyopes, the majority (63%) were fitted with distance vision contact lenses in conjunction with reading spectacles. This trend is indicative of under-prescribing of contact lenses designed to correct presbyopia, which may be due to:
- a lack of technical knowledge, training or clinical confidence, as well as lack of product awareness and media exposure in some geographic locations;
- preconceptions that these types of contact lenses (monovision and multifocals) are associated with vision compromise, which may cause patients to lose confidence in their practitioners;
- a perception that contact lenses currently on the market may not fully meet the needs of presbyopes with respect to vision and comfort.
Multifocal fittings over monovision
Data from this study showed more multifocal fittings (25%) than monovision fittings (7%). The greater uptake of multifocal lenses is not surprising given the improvement in lens design and increase in multifocal options in recent years. It also reflects practitioners’ positive attitudes in adopting current generation multifocal lens technology.
Under-prescribing of contact lenses designed to correct presbyopia
Overall, this study found that practitioners under-prescribe contact lenses designed to correct presbyopia. The authors suggest that more training is one strategy that might change contact lens practitioners’ attitude and practice, and that clinical and laboratory research in the field should be intensified in order to understand the needs of presbyopic patients and to improve their success with contact lenses.
On the positive side, this study found that well-adapted presbyopic patients are more likely to wear lenses on a full time basis. The variety of new contact lens designs and materials available on the market offer an excellent opportunity for the practitioner to manage presbyopia. Recommending the appropriate design may satisfy the visual needs of the presbyopic patient.
