Presbyopia Practice & New Treatment Options

Presbyopia Practice & New Treatment Options

November 02, 2020

What a feeling that is! – As a doctor when you slide the card under the slit lamp to see if the patients are reading it correctly; How dismaying that feeling could be! All doctors know this from personal experience. Truly, there are more exciting new options now for treating presbyopic patients, and doctors are now orienting their practices towards them.

The general practice had been focused on refractive surgery in the past years. While the LASIK market stays significant, the numbers have kept steady. The number of people with presbyopia globally, on the other hand, is large and continuing to grow. It is projected that by the year 2030 there will be over 380 million in the United States and over 490 – 500 million in Western Europe.

In every sense of the word, this presbyopic population is physically active and engaged in activities that require a full range of vision. For instance, 70 percent send text messages, 80 percent use a computer, and 65 percent plan on continuing to work in some capacity after retirement.

These days, people with presbyopia generally may happen to feel younger than their chronological age and are frustrated with reading glasses which, they find, intrude on their lifestyles. For many, it is indeed a sign of aging having reading glasses.

The nature of this condition indeed could be uncomfortable to deal with. Especially, it could be very challenging to explain the concept to hyperopic presbyopes because they may fail to truly understand that their eyes can no longer make the accommodation from distance to near focus.

First and foremost, we try to explain to these presbyopes that if we correct their distance vision, everything up close will be blurry, and they likely won’t be able to read or see anything within arm’s reach without help.

How patients would often respond is that they would say they could read without their glasses, and they wouldn’t want that changed, failing to understand what they have just been told.

They ask us to just correct their distance vision and leave their reading vision as is. Even patients who seem to understand come back after surgery dismayed that they can’t do crossword puzzles or shave their armpits.

Refractive Surgery

Throughout time, surgical options for presbyopes have predominantly involved some form of refractive surgery that resulted in monovision. For many patients, this is considered to be a great option.

According to the reports, the success rate of elective monovision surgery is nearly around 75 percent which more or less coincides with the experience in our practice: even though a contact lens trial before surgery is required to ensure they can adapt, of the 15 percent of patients on which monovision was performed, about a third ended up having the procedure reversed.

In reality, when a patient is given crisp distance vision, there happens to be a wow factor but when the patients can see and function at both near and far – but neither is spectacular – then the responses differ from ambivalence to annoyance.

Also, the other option is the small-aperture corneal inlay. This KAMRA corneal inlay (AcuFocus) procedure helps to provide better near vision without compromising intermediate or distance vision. In detail, the inlay is a 5 µm thick opaque ring and 3.8 mm in diameter with a 1.6 mm central opening.

The aperture design only allows central collinear light to reach the retina. It is implanted monocularly into the non-dominant eye. With thousands of patients now treated, the data show a mean improvement in uncorrected visual acuity (UCVA) from J6 to J1 at near, and 20/40 to 20/20 at intermediate.

Distance UCVA decreases slightly in the implanted eye from 20/16 to 20/20, but binocular distance UCVA remains stable at 20/16. While optometrists can sometimes be uncomfortable with suggesting surgery to patients, much of this concern is alleviated with the corneal inlay, as it can be removed if required.

The procedure is reproducibly and precisely performed; the recommendation is to create a corneal pocket with a femtosecond laser. The technique can be combined with LASIK, allowing myopes, hyperopes, and emmetropes to all benefit. Patient engagement To be a market leader at this intersection of aging baby boomers and new treatment options, the whole practice needs to cater to the presbyope.

The first step is to understand that the presbyope is a significantly different proposition than a LASIK patient. These are 45-60 year-olds at the height of their careers and peak of their spending potential. They tend to be early adopters of technology and are not afraid to try new things.

Whereas LASIK patients like to interview any number of physicians before making a final treatment decision, which is based largely on price, once a presbyope is convinced that you can help them get rid of their reading glasses, they are ready to jump in with both feet.

What prevents them from reaching this point is not knowing that their condition can be treated or lack of a relationship with their eye-care professional.

Staff and physicians can make the first step towards building a bridge to the presbyopic patient demographic by finding out what it means to have presbyopia.

Do you know what it’s like to stop off for coffee after a tennis game and not be able to read the menu, or to go to the market for foods that don’t contain high-fructose corn syrup only to realize that you can’t read the labels?

We advise that if you don’t currently have a presbyope on your staff, hire one! A fellow presbyope is the most likely to understand and relate to a presbyopic patient, making them the most natural and logical patient consultant.

The Approach of Doctors

Performing the KAMRA inlay procedure on the presbyopic patient consultant who will be charged with interacting with these patients is an even better option, as nothing has more weight with potential patients than a live testimonial.

Once your practice and staff are ready, it’s time to reach out to the presbyopes that are already in front of you. Spotlight your presbyopia treatment prowess using brochures, banners, and signs to subtly inform your audience of the problem and its solution.

Incorporate a checklist in the patient chart to remind staff to speak with every patient aged over 40 about presbyopia and your preferred treatment.

Search your patient database for the correct demographic and then create an email and text campaign that has a message that will resonate with presbyopes. Once you have their attention, it’s important to listen to these new patients.

They are entering a stage of their lives where they will likely have multiple comorbidities, and thorough accounting of their lifestyles and all ocular issues will allow you to make the best treatment recommendation.

Also, the patient will need to be guided about their current situation, as well as the changes their eyes will likely undergo in the not-too-distant future. One of the benefits of the KAMRA corneal inlay is that the gain in near visual acuity remains stable over time, even as the presbyopia progresses.

Also, cataract surgery may be performed with the inlay in place, or the inlay may be removed, both successfully. Tease out the entire ocular history to understand their greatest vision-related concerns but be mindful not to give up control of the consultation. Patients are in your practice because they want something done to improve their eyesight.

Engage in the conversation with the assumption that he or she is going to agree to have the inlay procedure: a confident, positive attitude is contagious. You can get fast payback for exceptional customer service by incorporating happy patients into your marketing efforts. This requires a very satisfied patient, which comes from knowing your patient, educating them well, and setting suitable post-operative expectations.

Sincerely ask all of your patients for feedback about their experience, and make any appropriate changes to your customer service or educational materials. Capture a short patient testimonial on your phone or tablet to use as a third-party endorsement. Post these on your Facebook, and YouTube page as well as on your website. Also, use social media networks such as Facebook to become friends with your patients.

A large percentage of presbyopes’ friends, colleagues, and associates are also presbyopes – don’t miss out on the excellent referral service they can provide! The presbyopic population is currently an untapped and underserved patient group. In our practice, the reception for the KAMRA inlay has been phenomenal, both from eye care professionals and patients, which are sometimes the same.

We have found that focusing on the presbyopic market can be rewarding personally, professionally, and financially. To capture the opportunity, you must pay attention to your patient interactions and communications, and provide surgical solutions that meet the unique needs of the presbyope.