WHAT IS SO COMPELLING AND UNIQUE ABOUT PRESBYOPIA that it requires or justifies a separate publication? Presbyopia is not a new discovery; it’s not on the cutting edge of medical science and diagnosis. In fact, references to a decrease in near vision as we age can be traced back to ancient Egyptian hieroglyphs and are also found in ancient Greek, Roman, Chinese, and Indian writings and drawings. While these same civilizations may have also had treatment options, it is widely held that the first glasses were developed in the 13th century and then the first bifocals in the 18th century by none other than Benjamin Franklin.¹

Obviously, presbyopia is not new, and treatment options have evolved greatly from the first pair of bifocals. So again, why do we have this publication?

Follow the Money

This may sound cynical, but the answer can be found by following the money. Companies are spending millions of dollars researching and developing treatment options for presbyopia. There are articles in each issue of this publication that look at new lenses for glasses, multifocal contacts, multifocal intraocular lenses (IOLs) implants, drops, and surgical procedures. These companies eventually need to bring their products to market, sell them, and get a return on their investment, so they need a forum to educate us on these products and how they can be used to treat our patients.

Because I call out this fact doesn’t mean I think it is a bad thing. It’s just the opposite: as a clinician and a presbyope myself, I am for anything that will help me solve my patients’ problems and improve their quality of life. It’s simply good patient care and good practice care.

Root Cause Analysis

We could easily stop here and say it’s about the money. Instead, let’s take it a step further. I teach a course on prevention of medical errors, and I teach the concept of root cause analysis in determining what causes medical errors. In root cause analysis, we continue to ask questions about why and do not settle for the first answer. We have Presbyopia Physician, and other publications, because companies are spending money on research and development of products. But then we need to ask another question. Why are companies investing in presbyopia? The answer is somewhat multifactorial, but the simple answer is that it’s about the numbers. It is the demographics of our population and a phenomenon in aging referred to as “the graying of America.” Let’s take a deeper look at these numbers.

Aging Population

The last census in 2020 found there are 331 million people in the United States. This is an increase of 17% from the 2000 census of 281 million. For our purposes, what is telling is not that the population is growing but in what age ranges the population is increasing. The median age in this 20-year time period increased from 35.3 to 38.8 years old, and the percentage of the population older than the age of 65 increased from 12.4% in 2000 to 16.4% in 2022.

According to a recent report by the U.S. Census Bureau released in June 2023,² the median age of the U.S. population as of July 2022 has increased and now is 38.9 years old.

Stop and think about this: half of the people that live in the United States are older than 38.9 years old. In fact, 17 states have a median population older than 40. This is largely driven by the Baby Boomers and by their children, who are now known as the “Echo Boomers.” Combine this with a steady decline in birth rates over the past 2 decades and an increase in life expectancy, and the opportunity to provide treatment options for presbyopia is extraordinary.

These numbers put the number of adults with presbyopia in the United States at more than 150 million. Compare this to the estimated 19.5 million children with myopia, and it is easy to see the investment and opportunity in presbyopia, not only for companies and products but also for all of us as providers and clinicians.³

Looking Forward

We have seen this increase in age, but will it continue? The short answer is yes, according to numbers from the 2017 National Population Projections of the U.S. Census Bureau. We will continue to see the shift to an aging population. Here are just a few of the demographic numbers we will see in the next few years.

• The baby boomers born between 1946 and 1964 will all be older than 65 in 2030. This will mean that 1 in 5 Americans will be older than 65 in 2030.
• By 2034, there will be more people older than 65 than those younger than 18, and more than half the population will be older than 40. In 2034 more than 155 million Americans will be older than 65 or younger than 18.
• In 2020, 56.1 million people, or 17% of the population, was older than 65. By 2060, that number is projected to increase to 94.7 million people, or 23% of the population.
• By 2060, 1 in 4 Americans will be older than 65.

It’s Not Just Presbyopia

While here we are focused on presbyopia, we can see how this aging trend will have tremendous impacts on our practices and our society in other ways. In addition to the demand for presbyopia, this aging of the population will also increase the demand for treatment and management of ocular diseases. I have seen estimates that the demand for medical eye care will increase by as much as 30% over the next 15 years. This increase, along with a relatively flat number of providers in both ophthalmology and optometry, makes the opportunities for taking care of patients greater than ever. It will also place a tremendous strain on the entire U.S. healthcare system. We are already seeing this strain and will see many other ramifications. Think about the workforce challenges we will have in 2034 when more than 150 million Americans are younger than 18 or older than 64.

More to Come

With these numbers, it is easy to see why companies are investing millions and millions of dollars in research for treatment options for presbyopia and the tremendous opportunities this fact represents for eyecare providers. In future issues, we will take a closer look into the numbers around various modalities of treatment for presbyopia and the demographics driving utilization. ■

References

1. Benjamin WJ, ed. Borish’s Clinical Refraction. 2nd ed. Elsevier; 2006.
2. America is getting older. US Census Bureau website. Published June 22, 2023. Accessed August 18, 2023. https://www.census.gov/newsroom/press-releases/2023/population-estimates-characteristics.html
3. Fortin P, Kwan J. The myopia management opportunity in the United States using the 2020 census. Paper presented at: Annual Meeting of the Association for Research in Vision and Ophthalmology; May 1-4, 2022; Denver, CO.

Dr. Spear is an industry thought leader with experience in academics, industry, private practice, and consulting. He is a dynamic speaker who looks at the eye care business logically and offers practical and proven insights on increasing practice profitability.