THERE IS TREMENDOUS excitement as presbyopia treatments expand to include an array of pharmacologic options—truly a holy grail of eye care. But there’s no pretending this is the miracle cure we all wish it would be. Some of the compounds and formulations will work better in some eyes, and there will be patients that these options won’t help. There are always side effects, but some (hopefully most) patients will tolerate these so they don’t have to wear glasses in public. Listening to our patients and determining what’s important to them will be critically important in helping us guide their treatment. It will be up to us as physicians to determine which formulations are most appropriate for each patient, and how to use these medications in conjunction with other methods of treatment.

Not only will we be able to help our existing patients that are already affected, but it is quite possible that our younger patient population may never need to experience untreated presbyopia. With the blitz of direct-to-consumer marketing that is sure to occur from our industry partners, patients who have never seen an eye doctor and are simply ordering reading glasses from Amazon will be interested in using the drops instead, and will come see us. This will give us the opportunity to diagnose and treat this new patient population for any number of other problems that can happen to the aging eye, including dry eye disease and glaucoma.

As we continue to chase the holy grail and with so much focus on the pharmacologic treatments, some would argue that advances in contact lenses and IOLs could easily be pushed to the background. Rather, all ships will likely rise with this greater attention and public awareness of presbyopia management. All technologies will advance, become more nuanced, and our patients’ overall satisfaction sans reading glasses may actually result from a combination of pharmacologic treatment plus contact lens, laser, or intraocular surgical intervention.

In this issue, we will take a deeper dive into some of these topics, with an update on pharmacologic treatments, a discussion of the opportunities they present, and a look at how patients will be learning about them. We also explore how to talk to your patients about presbyopia, protocols for initial management, using IOLs and contact lenses with presbyopia patients, how an integrated OD/MD practice works, and how presbyopia can affect the quality of life of certain sports enthusiasts. ■

Chief Co-Editors

Elizabeth Yeu, MD andJacob Lang, OD

Dr. Yeu joined Virginia Eye Consultants in 2013, has been a partner since 2014, and continues her commitment to residency training in ophthalmology as an assistant professor at the Eastern Virginia Medical School. She is Medical Director of the CVP mid-Atlantic and the Virginia Surgery Center, and sits on the Board of Directors for the Virginia Eye Foundation.

Dr. Lang is the lead optometrist at Associated Eye Care in Minnesota and is the director of their ocular disease residency program. He specializes in cornea and ocular surface diseases as well as therapeutic contact lenses and surgical co-management. He is also adjunct clinical faculty at the Illinois College of Optometry, The Ohio State University, and at Salus University.