The number of Americans turning 40 increases every year—by the year 2010, one-third of Americans will be between 40 and 59 years old.1 There were 74 million baby boomers born between 1946 and 1964, and this demographic makes up a tremendous part of our patient base.

The dollars and cents of the matter: This group wields incredible spending power, and they are going to make educated decisions on where they spend their hard-earned dollars. The business benefits of satisfying such a patient demographic include increased patient loyalty and referrals.

But, aside from such practice benefits, it is simply very rewarding to fit baby boomers with contact lenses, especially since innovations in lens technology have allowed for improved multifocal contact lens options.2 How do we begin to manage these patients? Eye care practitioners need to be more proactive. Just 8% of current lens wearers reported being told about multifocal contact lenses when first complaining about their near vision.3 In addition, 33% of respondents indicated that they would likely seek the services of another practitioner if their current practitioner did not inform them of multifocal options.3 In a 2007 survey by the Contact Lens Council, 40% of the 500 respondents reported that they were unaware that presbyopic contacts could be an option for them. Once discussed, 75% of contact lens wearers and 60% of spectacle wearers were interested in trying them.4

But, there is a massive contact lens drop-off that starts at 45, about the age when presbyopia really settles in.5 Is it the patients or the practitioners? Do patients lack the motivation to try something new which would eliminate their need for reading glasses? Do they not care about their appearance anymore?

Or maybe, it’s the practitioners who are to blame. Do they think that multifocal contact lens fits are more time consuming? Is there is not enough professional satisfaction or revenue in contact lenses to take that extra time?

Most likely, this dropout is a result of both the doctor’s and the patient’s mindset. So, keep in mind that many baby boomers will continue to require better options to correct their vision and maintain their active lifestyles. As such, eye care practitioners are in a position to fit and prescribe the perfect contact lens for each situation.

Improved Technology
The contact lens industry has taken note of this growing demographic and developed new and innovative products. Improved soft, disposable multifocal designs have helped make the fitting process smoother, while providing clearer vision than previous designs.

The lens material is important for various reasons, but understanding the design is the key to ensuring success with multifocal contact lenses. Each design has a different lens geometry, which offers both unique pluses and minuses. Most are relatively easy to fit, but understanding the manufacturer’s fitting guide for each design will make the process much more straightforward. Many multifocal contact lens options utilize simultaneous optics principles, which is important to understand when troubleshooting. For example, if you are using a center-near design and the patient has large pupils, the patient may not achieve great near vision because the pupils will not constrict enough to gain good near vision. And, vice versa—too small a pupil may diminish distance vision.

Improved Materials
Dry eyes may be the most important component in some of these presbyopic patient dropouts. Contact lens wear does interfere with the normal tear film, so it is not surprising that over half of those who drop out of contact lenses do so due to discomfort. According to the National Eye Institute’s Visual Function Questionnaire: Impact of Dry Eye on Everyday Life (IDEEL), approximately 34% of contact lens wearers discontinue use at least once, mostly because of dry eye symptoms. A patient who has a frail tear film, with reduced tear film break-up time and/or decreased production of quality tears, will have difficulty wearing contact lenses successfully.

As contact lens practitioners, we need to create an open forum in which patients can comfortably tell us about any comfort issues they have. We may also need to perform a more detailed analysis of the contact lens fit and corneal health post-wear. These patients require a fluorescein evaluation in order to check for staining and tear break-up times after wearing their lenses. This will help identify those who are at risk and potentially minimize the number of dropouts by treating their underlying ocular condition first. For example, if it is a dry eye situation, the patient may require concurrent dry eye treatment depending on the severity. There could be some underlying meibomian gland dysfunction (MGD) that may be treated prior to successful contact lens wear.

There is a delicate balance between the state of patients’ tear films, the contact lenses they wear and the care systems they use. To enhance the wearing experience for presbyopes, careful assessment of the ocular surface and tear film must include the use of vital dyes. Any underlying issues that may hinder comfort should be treated aggressively.

Stress to your patients the reasons behind recommending a specific care system. If you do not, they will likely switch to a less expensive store brand or private-label solution, which can contribute to discomfort issues. If we are not vigilant about understanding our patients’ care habits, it will ultimately lead to the demise of comfortable lens wear.

Set the Stage
During the pre-fitting conference (PFC), identify patients’ occupations, hobbies and daily visual requirements in order to educate them properly on their available options. Use the PFC to gauge their interest and describe the expected fitting timeline (e.g., customizing the prescription and fit) and appropriate fees up front.

As an eye care practitioner, it is important to keep your toolkit full by keeping current on available presbyopic contact lenses in order to present patients’ options positively, yet realistically.

For example, try to communicate presbyopic fitting in such a way as to avoid the words “compromise” or “loss of vision.” Instead, describe multifocal lenses as “customized” or “balanced,” according to each patient’s visual system. If patients need readers to see the phone book or the print on the medicine bottle, let them know that if you can eliminate their need for reading glasses 90% of the time, it is still a win/win.

Troubleshoot Fit and Vision
There may be cases in which the patient wants more distance and/or near vision. We must be ready to make adjustments in the beginning to satisfy the patient’s needs. Even a small change in the prescription can make a large improvement in the patient’s visual abilities.7

If you made your initial calculations correctly, you are basically fine-tuning the multifocal contact lenses to the patient’s daily visual tasks. Here are a few tips for fitting and troubleshooting presbyopic patients:

• Perform all testing with normal room illumination to simulate real world surroundings.
• Use spherical flipper lenses to over-refract outside the phoropter for both binocular and monocular verification.
• Most importantly, listen to your patients! They’ll tell you what they want during progress checks.

Utilizing presbyopic contact lens options and identifying potential dropouts will not only help you retain current patients, but also help expand your contact lens practice. If we can provide an individualized approach to baby boomers, we have the ability to maximize our patients’ wearing experience, reducing the dropout rate. By embracing the presbyopic population and actively offering them contact lenses to accommodate their special visual needs, eye care practitioners have an opportunity to distinguish their services and cultivate patient loyalty.

So how old is “too old” for contact lenses? With today’s multifocal technologies and fitting techniques, age is no longer necessarily the determining factor for contact lens success!

1. National Center for Health Statistics Data. Available at: (Accessed August 2008).
2. Ritson M. Which patients are more profitable? Contact Lens Spect 2006 March;21(3):38-40,42.
3. Studebaker J. Soft multifocals: practice growth opportunity. Available at: (Accessed March 2010).
4. Contact Lens Council. New survey finds more education on contact lenses and lens care will help consumers see 20/20. Available at: (Accessed March 2010).
5. Pritchard N, Fonn D, Brazeau D. Discontinuation of contact lens wear: a survey. Int Contact Lens Clin. 1999 Nov;26(6):157-162.
6. Lonsberry BB. Dry eye in the office. Rev Optom. 2008 Feb;145(2):52-7.
7. Henry VA. Clinical pearls for fitting soft multifocals. Available at: (Accessed August 2008).