PRESBYOPIA CAN PRESENT TO our chairs in a number of ways. As eyecare providers, we encounter different scenarios daily. We may need to add an urgent visit to our full schedule for sudden vision loss to ultimately determine that a person experienced presbyopia for the first time. The following patient may be an asymptomatic 50-year-old who has unknowingly accommodated their lifestyle with a larger font size, extra lighting, and a longer working distance. After that, we may spend 15 or more minutes counseling the person with the chief complaint of rapidly deteriorating vision year after year on their treatment options and reassuring them that they do not have a blinding ocular disease.

Presbyopia is fascinating because it is simple and inevitable from a physiological standpoint, yet is sometimes difficult to manage. Almost every person will experience it if he or she lives beyond the age of 45. However, it can be challenging to treat due to the emotional and negative impact that it can have on people’s lives. For many people, presbyopia is the first major change to their body as they age, and that fact can be a difficult reality to accept. The modern demands of technology and remote working with hours of accommodative demand are not helpful to the situation.

As eyecare practitioners, we must exhibit empathy, in addition to providing reassurance and treatment options for individuals as they enter this next phase in their visual tour throughout life. Below are various checkpoints and methods to offer support.

Prepare Your Patients

I have found that briefly discussing presbyopia symptoms with my hyperopic patients in their late 30s and with myopic patients in their early 40s has been exceedingly helpful. This is particularly important for contact lens patients, who have likely had clear vision at all ranges since they first started wearing them. Contact lens wearers carry an extra accommodative demand compared to glasses wearers; therefore, they are typically symptomatic sooner than glasses wearers. Also, in my experience, many myopic glasses wearers typically self-manage by simply removing their glasses to read, whereas contact lens wearers do not have the ability to do this.

For this reason, I make sure to add 30 seconds to my exam to explain the earliest symptoms of presbyopia, reassure the patient that this is an expected change to the vision, and assure him or her that treatment options are available when presbyopia presents itself. Frequently, patients return to their next year’s exam memorably saying, “You were right!” and explain that they can no longer easily read medication bottles or the text messages their children hold a foot away from their face. Doing so alleviates any stress and concern that the unaware person may have otherwise experienced.

Know Your Patient

Some patients need a simple explanation, and others need a little more in terms of the physiological side of presbyopia. This is OK and should be embraced. Explain it to them. I also make sure to be very clear that presbyopia is a progressive condition that we expect to worsen each year. I also make sure to be clear we have treatment options at each stage of their condition.

Know Treatment Options

While we do not have the technology to restore the eye’s natural accommodative ability, there are numerous treatment options available. These options include glasses, contact lenses, intraocular lens implants, and topical eye drops. It is important for us to know which may be appropriate depending on the individual’s needs, refractive error, and ocular health status.

Customize Treatment Plans

Be open to your patients in that sometimes there is not a one-size-fits-all approach to presbyopia. This is critical for the advanced presbyope who spends hours on the computer and reads documents all day. I frequently prescribe multiple glasses and contact lens scenarios depending on individual needs.

Presbyopia can be a truly rewarding condition to manage. When approaching the concerned patient, it is important to recognize the emotional implications that it can have for some people’s lives. It is also important to provide information and solutions at each stage of their presbyopia journey. ■

Dr. Crowley provides comprehensive eye care at Lexington Eye Associates, a tertiary care group in Massachusetts. In addition to optometric care, she is director of dry eye and professional practice liaison.