APPROVAL FROM THE U.S. FOOD AND DRUG ADMINISTRATION (FDA) of the first eye drop to enhance near vision and reduce the handicap of presbyopia is anticipated in late 2021 or 2022. These miotic eye drops constrict the pupil to increase depth of focus.

An easy way for the clinician to think of this is to consider the drops equal to a +1.00 to +1.50 diopter reader. This analogy can help eye care providers select patients who are most likely to benefit, and to demonstrate to patients the near vision improvement they might achieve with these eye drops.

The number of presbyopia patients in America is truly staggering, estimated at 120 million and growing. Many of these patients are emmetropic and have never seen an eye doctor. The launch of drops to treat presbyopia and reduce the dysfunction and quality of life burden presbyopia represents will encourage many of these patients to contact our offices and seek consultations. We must be thoughtful about how we will manage this new influx of patients seeking our care.

Evolving Practice Models

Both optometrists and ophthalmologists will be able to see and treat these patients—but not every eyecare provider (ECP) will find the mild-to-moderate presbyope ideal for their practice. I see at least three practice models evolving.

The first and largest group will include ECPs who provide comprehensive eye care, prescribing and dispensing eyeglasses as well as contact lenses. For these ECPs, capturing presbyopic patients will be of great value, generating complete eye examination fees and the potential purchase of eyeglasses and/or contact lenses. Plus, these patients likely have other treatable, undiagnosed eye problems—such as ocular surface disease, cataract, glaucoma, and retinal pathology—that will generate meaningful work for the comprehensive ECP. If satisfied with their care, these new, middle-aged patients will refer their family and friends to the practice.

New patients are the lifeblood of every practice, and very satisfied 40- to 60-year-olds—especially females—can generate many word of mouth referrals. In turn, these patients will age in the practice and eventually require surgical care, including cataract surgery and perhaps even refractive lens exchange, as their presbyopia progresses.

The second eye care model will be the integrated eyecare practice with ophthalmologists managing the more severe eye disease and surgical patients, and optometrists providing adjunct medical eyecare and vision services. These practices should also seek to capture the middle-aged presbyope, who can initially be managed by an optometrist, and will develop a need for more advanced care provided by an ophthalmologist.

The third practice model is represented by the secondary and tertiary care ophthalmologists who see cases primarily on referral from other ECPs. These physicians will not want the mild-to-moderate presbyope in their practice to displace a new patient slot that could be filled with someone who requires consultative eyecare or surgery. I believe these practices will do best by referring the presbyope to a colleague in their referral network. The practice’s front office team can manage the referral process.

Complete Examinations for Overall Eye Health

Every new presbyopic patient, most of whom will have never been treated by an ECP, deserves a careful and comprehensive eye examination. I believe a meaningful secondary benefit of the approval of presbyopia-treating eye drops will be the earlier detection and timely treatment of much undiagnosed eye disease.

Prepare Now

Eye drops to reduce the handicap and burden of presbyopia will be a significant new opportunity for every eye care practice. It is incumbent upon each of us to decide in advance of FDA approval how we will manage the presbyope seeking treatment, so we are prepared to properly manage this new influx of patients. ■

Dr. Lindstrom is founder and attending surgeon emeritus at Minnesota Eye Consultants, senior lecturer and a trustee of the University Foundation at the University of Minnesota, and visiting professor at the UC Irvine Gavin Herbert Eye Institute. He is a board-certified ophthalmologist and internationally recognized leader in corneal, cataract, refractive and laser surgery, as a researcher, teacher, inventor, writer, lecturer and highly acclaimed physician and surgeon.

Disclosures
Dr. Lindstrom’s disclosures include relationships with Allergan, J&J Vision, Orasis, Minnesota Eye Consultants/Unifeye Vision Partners and Visionary Ventures.