As an optometrist on the wrong side of 40 this subject is rather close to my heart. As mentioned in previous articles, the onset of presbyopia (age related reading problems due to a loss of elasticity in the lens and loss of power in the muscles around the lens) has historically been a big problem for contact lens wearers. The biggest issue is that presbyopes require two prescriptions - one for distance vision and one for reading. Also, we presbyopes typically enjoy a much healthier lifestyle than previous generations, we often enjoy active which still require contact lens wear.
There are 3 potential solutions to the presbyopia problem - multifocal contact lenses, monovision (One contact lens for distance vision and one for reading), or a combination of single vision distance contact lenses with reading spectacles.
It should also be mentioned that there is a very significant subgroup in the population who have never worn glasses until their 40's and wish to be able to read a menu in a dimly lit restaurant without having to succumb to the dreaded reading glasses - they might as well place a sign with their date of birth around their neck!
A huge disparity exists between the common desire amongst presbyopes for 'reduced spectacle dependence' and the actual use of contact lenses in this part of the population. Largely this has been due to the ambivalence of contact lens practitioners to fit these lenses as the success rate tends to be a little lower than with normal single vision lenses. This is a real shame as practitioners who are willing to take on this task will be rewarded with delighted patients who are likely to be much more loyal to their corrective solution.
So our spectacle wearing peers are now wearing varifocal or multifocal glasses and the good news is that all 4 of the major contact lens manufacturers have now developed a multifocal contact lens for the 40-something contact lens wearer.
So taking the 3 solutions mentioned above in turn:-
1. Monovision - I found having one eye for distance and one for reading a little disconcerting - it was acceptable for a social evening and certain sporting activities - fast moving ball sports not being one of them. It should be mentioned though that this is a very successful solution for at least 50% of those who try it
2. Reading glasses over contact lenses tends to be more successful for the person who has been wearing glasses (usually short sighted patients) for very many years - they are usually people whose lifestyle involves very demarcated periods of close work
3. Multifocal contact lenses - if fitted successfully they are the best all round solution. The first time presbyope who never wore glasses while younger returns to "the way they were". The good news is that Bausch & Lomb, Coopervision and Alcon have each now developed a daily disposable multifocal lens which is particularly appealing to the occasional social wearer. The key to success is for the contact lens practitioner and indeed the patient themselves to manage their expectations. The vision will not be exactly as it was when they were 20 - however with a little patience and prescription adjustment this can be a fabulous solution.
To summarise, I am a successful part-time presbyopic contact lens wearer (usually wearing multifocal daily disposable contact lenses) who would strongly advocate contact lens practitioners to recommend a trial of contact lenses to their 40 plus patients and would encourage those patients of a certain age to ask their practitioners to explain their options.
There's a myriad of options out there - Give them a try!Suggest a correction