IN THE WORLD OF PATIENT education and practitioners, we each have our own style and method that works for us in our clinics. For success with that education, and to ensure that it resonates, repetition of my message from visit to visit is critical. I find that my patients value consistent information presented in a “what to expect” style of messaging. In the western medicine framework of “treat/prescribe,” once an issue is found, the approach of “here’s what could be coming/prevention/options” is refreshing for many patients.

Talking to Patients

An ongoing dialogue with each patient helps to lay the groundwork for follow-through on vision care recommendations. When a patient understands how vision changes as we age, I find they are more likely to be open to a wider variety of visual correction options. This specifically applies to presbyopia, a condition that affects millions of patients every year—more patients than glaucoma, dry eye and macular degeneration combined.

Here are some examples of the messaging that I use with patients at various ages to prep them and set expectations for vision, and for presbyopia specifically:

Under Age 18: My primary goal is to ensure your vision is clear, comfortable and performing well for school, learning and extracurricular activities. Let’s talk about how we can achieve that in addition to the protection you need for lifelong ocular health and optimal vision.

Age 18-29: You are in your prime post-graduate and early working years. I want to ensure your vision is not only clear and comfortable for what you do each day, but consistent from day-to-day as well. I will continue to recommend protective strategies and educate you on possible changes in your vision you may notice, such as fatigue at the end of a screen-heavy day.

Age 30-39: In this stage of your life, you may appreciate new options that will keep your vision clear and comfortable. This may include focus-boosting contact lenses or anti-fatigue spectacle lenses. You may notice that your vision suffers when you are tired or have poor lighting, especially when trying to read or work on your digital device. These near vision changes will continue as you approach your 40s, but I will keep you up to date on all of your options for visual enhancement. There are new pharmaceuticals, like eye drops, that are being developed to work with our natural vision as well as enhance vision with glasses or contact lenses.

Age 40+: You may notice that your near vision is changing, and perhaps becoming more difficult to manage. I understand this can be frustrating, but I’m going to give you an update on your current vision and what options you have to manage it, as every patient is unique and has varying demands and expectations. The great news is that options beyond glasses, contact lenses and even surgeries continue to develop, and I expect new pharmaceutical eye drops to soon be available as yet another option to enhance your vision. When available, it will be important for us to have a conversation about whether or not this is an option for you, how it would work, and the importance of regular care to ensure eye health, safety and visual performance.

Discussing the Options

Currently, there are several pharmaceutical products under development for presbyopia.¹ These drops are expected to enhance near vision, both with and without other corrective options, via once or twice daily dosing. Depending on the product, its formulation and efficacy, clinicians will choose what is safest and best for their patients. Considerations will include a patient’s current ocular health and visual status. An example of some questions to prepare for your patients would include the following:

1. What frustrates you the most about your near vision? Are there certain times you notice these frustrations more than others?
2. What kind of work do you do? What about daily tasks or other activities?
3. Do your visual needs change or stay consistent, especially for near vision?

Once you have gathered initial answers and goals, correctly coaching your patient on expectations once treatment commences will be critical. Much like talking to patients regarding multifocal contact lenses or multifocal IOLs, laying the foundation as to what to expect and probable outcomes will put them on the path to success. This will also help you weed out patients who are not good candidates for these therapeutics, such as those with visually demanding jobs that require very precise visual acuities and sustained visual performance. These conversations may include the following points:

• Using this drop will allow you greater flexibility with your vision. However, each patient’s experience is unique based on his or her current visual status, visual tasks, and corrective therapies.
• The goal is to use the prescribed drop as necessary and as indicated for maximum success with minimal safety concerns.
• Understand that the varying formulations of these therapeutics—including the concentration of active ingredient(s) and other supporting ingredients—will feel and act differently for each patient. Finding the correct option for you will include assessing effectiveness while maintaining safety regarding your ocular health.
• Lastly, this drop should be comfortable for you to use as regularly as you need to meet your vision goals.

The more prepared you are to have these conversations, the greater your likelihood of success. This not only applies to your current presbyopic patients, but also to the new patients you’ll likely gain access to as word of this technology spreads. More than 50 million over the counter reading glasses are purchased yearly by Americans.² Ask yourself how many of those patients are seeking out any sort of regular eye care? And how can they even be aware of all the options for vision enhancement?

Assessing Future Potential

When a product or therapeutic becomes available that can address patient needs in a new way, these patients will be steered to our offices, seeking prescriptions and advice. To their own benefit, consider how many disease states will be detected in these patients who would otherwise have not sought out care. With an estimated 30 million Americans suffering from dry eye³, and the probability that the crossover amongst this same patient set is high, those doctors who can diagnose, treat and manage this condition will be set for even greater clinical revenue and success. Add in the possible glaucoma and macular degeneration patients, and the potential becomes even greater. If only a fraction of these OTC readers consumers trickles into our offices, we will be reaching a greater subset of Americans and achieving public health outreach on a scale not yet realized.

An additional benefit is that these new therapeutic products will not be met as stand-alone solutions. Many patients will use them to enhance or supplement their current mode of vision correction, or combine them with other vision-correcting options. Consider the potential multifocal contact lens wearer who could achieve great visual success at computer and near work if their pupil size was modulated, as these therapeutics are set to do. Or, the patient desires to use a progressive addition lens more fully for a variety of activities, but needs greater flexibility with near and distance vision. These are only a few of the examples of possibilities of combination treatments your patients could benefit from.

Start Now

Dialing in your educational groundwork to prepare patients for what’s to come, what to expect, and what options they have—and continuing that dialogue—is likely the top “to-do” item for practice and patient success when it comes to novel presbyopic therapies. Start those conversations now. You will set yourself apart from your peers, positioning yourself for both patient and clinic success. ■

References

1. Grzybowski A, Markeviciute A, Zemaitiene R. A Review of Pharmacological Presbyopia Treatment. Asia Pac J Ophthalmol (Phila). 2020;9(3):226-233. doi:10.1097/APO.0000000000000297.
2. Zebardast N, Friedman DS, Vitale S. The Prevalence and Demographic Associations of Presenting Near-Vision Impairment Among Adults Living in the United States. Am J Ophthalmol. 2017;174:134-144. doi:10.1016/j.ajo.2016.11.004.
3. Paulsen AJ, Cruickshanks KJ, Fischer ME, et al. Dry eye in the beaver dam offspring study: prevalence, risk factors, and health-related quality of life. Am J Ophthalmol. 2014;157(4):799-806. doi:10.1016/j.ajo.2013.12.023.

Dr. Wesley practices at Complete Eye Care in Medina, MN, which she opened in 2008. She is a member of the Minnesota and American Optometric Associations, and lectures, advises, conducts research and publishes on many aspects of the optometric industry.