Contact lenses are enjoying a nice resurgence thanks to recent advancements in materials, designs, and even fitting guides that are helping to make them more functional and comfortable for patients. In particular, the technology of multifocal contact lenses has evolved leaps and bounds above what was available just 10 years ago. The timing of these new offerings couldn’t be better, as we are all well aware of the number of presbyopes emerging and already existing as the general population ages, and multifocal contact lenses give us eye care professionals an effective yet flexible solution for our patients’ daily visual needs.
This edition of Business Matters is dedicated to multifocal contact lenses and how our colleagues are leveraging them in their clinics. Is demand for these lenses increasing? Are dropout rates decreasing? Are multifocals as demanding of chair time as they once were? How should we broach the sensitive topic of presbyopia with our patients? These are the questions we’ll explore inside.
—Pamela A. Lowe, OD, FAAO, Dipl. ABO
The Growing Market of Presbyopes
For the past 33 years, I have maintained a full-scope primary care practice on the northwest side of Chicago. It is a contact lens center of excellence that includes specialty fits, myopia management, and the latest dry eye treatments, along with advanced technology for the early detection of retinal disease. We treat patients from cradle to coffin—every age group starting at 6 months. I’m the sole owner of the practice, but I have two associates who tend to see the 20- to 40-year-old patients (the emerging presbyopes), while I care for the 50- to 70-year-olds, who are all firmly presbyopic. On any given clinical day, presbyopes represent at least half my schedule, and most are patients who have been coming to me for years.
The Presbyopic Pool is Large and Growing
We consider all presbyopes candidates for a multifocal contact lens until we prove otherwise. Although spectacles are vitally important for daily living, the visual freedom that multifocal contact lenses can provide is a huge quality-of-life issue for many people. The presbyopic population has never been larger—eye care professionals are calling it the “Silver Tsunami” (Figure 1). All the baby boomers are firmly presbyopic, Generation X is right behind them, and the oldest millennials are in their mid-40s now. Many of these “emerging presbyopes” want to continue to look youthful and aren’t ready, mentally, to begin wearing glasses, and multifocal contacts are a natural solution. Furthermore, people in general are living longer, and many of them are maintaining active lifestyles—people want and need a range of visual performance that doesn’t include them wearing readers all the time. It’s exciting to be able to offer these presbyopes visual freedom in the form of multifocal contact lenses.
Figure 1. Approximately 215 million people will be 35 years or older by 2035, indicating the rise of the “Silver Tsunami.” 1
Creating Awareness, Countering Resistance
My team and I educate every presbyope about the availability and technology of multifocal contact lenses, because many of them, especially those who don’t need a distance prescription for driving, are unaware that these lenses exist as an option. In fact, market research from 2013 showed that 56% of presbyopes who had previously dropped out of contact lens wear didn’t know that multifocal contact lenses exist.2 We can’t expect patients to ask us about them.
I am prepared to counter my patients’ objections to trying multifocal contacts. If they are reluctant to place an object in their eye, I emphasize the convenience and visual freedom that multifocal lenses provide. For those who are hesitant to commit, I reassure them they can use the lenses as needed. The potential for part-time contact lens wear is definitely an important niche in the market.
Patients who have been former contact lens wearers and either are still in an older model or have dropped out present another opportunity for fitting multifocal contact lenses. These individuals are generally easy to convert to the latest contact lens technology. If we can ascertain why they dropped out or what their pain points are with their current lenses, then we know that the advanced-technology contacts we prescribe can likely solve these issues.
One question I ask current contact lens wearers is, “At what point in the day do you start to feel your lenses or need to use artificial tears?” This question is a great opener to the larger discussion about the superior comfort of advanced-technology lenses.
Detailed Conversations and Diligent Charting Reap Rewards
As primary eye care providers, our job is to inform patients of our findings, listen to what their needs are, and match the visual correction to those needs. Along with each patient’s medical history, my team and I include a social history page in the chart that tells us what they do for a living, how many hours per day they use digital devices, how active they are, etc. This knowledge about the patient’s daily habits helps us look for opportunities where a contact lens might be a good fit for them. Although our practice is well-established and busy, my team and I never consider these conversations to be “extra chair time.” They are invaluable for follow-up purposes, and we chart each one.
We strive to schedule a follow-up visit for a contact lens fit after each comprehensive examination, and this proactive approach has been critical to our bottom line. But, if the patient isn’t ready, at least we’ve presented the option. Frequently, I will see these patients’ names on our schedule for a contact lens fitting before their scheduled annual examination. When I look back at my notes, I know that planting the seed about contact lenses paid off. If the patient hasn’t pulled the trigger on contact lenses before their next visit, then my notes will prompt me to raise the topic with them the next time. Sometimes, there is updated technology I can tell them about, too.
Prescribing Preferences
I want to carry the best contact lens technologies for my patients. Like most of my colleagues, I promote the ease and comfort of the single-use contact lens models. Our percentage of patients in single-use contacts is high, in the range of 85% to 87%, because we don’t talk about reusable lenses unless the patient wants or needs overnight wear (such as medical professionals and emergency first-responders). Because a lack of comfort is the main reason people drop out of contact lens wear,3 I carry lenses that have almost 100% water content at the optic’s surface and high oxygen permeability.4
Closing Thoughts
We optometrists should take a cue from our optician colleagues. Their strategy is to show patients the top-of-the-line frames first—digital progressives with the best optics—and sell the expectation that the performance of those lenses equals their value. Contact lenses are medical devices on the cornea, and thus we need to be talking about their technological advancements that have the potential to make our patients very happy with clear, comfortable vision at a range of distances.
1. By 2030, all Baby Boomers will be Age 65 or older. US Census Bureau. Accessed February 5, 2025. Available at https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-age-65-or-older.html.
2. In a survey of 1,012 contact lens dropouts aged 35-50. Alcon data on file, 2013.
3. Rumpakis J. New data on contact lens dropouts: an international perspective. Review of Optometry. https://www.reviewofoptometry.com/article/new-data-on-contact-lens-dropouts-an-international-perspective. Accessed February 5, 2025.
4. DAILIES TOTAL1® package insert. Alcon, July 2012.
Pamela A. Lowe, OD, FAAO, DIPL. ABO
Medical Director, Vision Source, Chicago
Director, Professional Eye Care Center
plowe@proeyecarecenter.com
Financial disclosures: Consultant and/or Speaker (Alcon, EyePromise, Visible Genomics)
