Presbyopia literally means ‘old sight’, which is a pretty unflattering translation. It can be defined as the point when near tasks become too difficult for the needs of the patient.
Commonly, patients start to experience problems with their close vision around their early to mid-40s. Typically, people notice that small print is harder to see and they may have to hold the print further away to see it more clearly. They may also have difficulty seeing things close up in dim lighting and complain of headaches, as they may be squinting to see small print. This is often difficult for patients to accept as up until this point they may have had perfect eyesight.
Hypermetropic and myopic patients alike will become presbyopic, although myopes usually fare better than hyperopes. This is because myopes can simply remove their distance spectacles to achieve clearer near vision. The reason for this is best explained with an example.
Simply put, if a myopic patient has a correction of -1.50D and needs a +1.50D reading add, by removing their distance spectacles they will have provided themselves with the +1.50D Add required.
On the other hand, a hypermetropic patient with a +1.50D distance prescription and a +1.50D Add will not benefit from removing their distance spectacles, and their near vision may be worse than when wearing their distance correction.
Although myopic patients can often remove their distance spectacles to read, this is not always practical. The point the reading material needs to be placed in order to see it clearly is closer to the eye, the higher the prescription, and with a -10.00D myope for example could be as close as 10cm. It also may not be convenient for the patient to have to be removing their spectacles all the time.
There are many alternatives available to all patients for correcting their presbyopia, and these include a separate pair of reading glasses, bifocals, progressive power lenses (PPLs), occupational PPLs, enhanced readers and trifocals. Options also exist for patients who want to adapt their existing contact lens prescriptions to help with close work, or for patients who have never needed to have spectacles to try contact lenses to assist.
With such an array of lens types available, it is vitally important to discuss with the patient their needs and requirements, including their working day and leisure time.
A patient may think that a simple pair of reading glasses is all they need, but if they work on a computer, they may not be able to see the screen clearly as it will be further away than when holding a book or smartphone, for example.
They may not realise that they will not be able to see clearly in the distance when they look up in their reading spectacles, and this needs to be explained so the patient can make an informed choice about the lens type that will suit them best.
If the patient drives, are they having difficulty seeing a Sat Nav, or the internal instruments within the car? If so, simple reading spectacles will be no use to them as they need to see clearly in the distance, and the instruments will probably be at a further distance than a reading lens will focus.
In order to avoid any complaints or non-tolerances, a conversation with the patient is very important. You should use a mix of open, closed, probing and clarifying questions to determine the needs of the patient.
An open question could be: “Tell me about your day, and the things you are having difficulty seeing”. A probing question could be: “Tell me more about the position of your computer screen at work”.
A clarifying question could be: “You say you enjoy painting. Is that still life, landscape painting, or both?”
A closed question requires a yes or no answer, and these can be useful to confirm you have correctly understood the patient. For example: “So just still life painting, no landscape at all. Is that right?”
Only when you have a full picture of the needs of your patient can you start to advise them on the available options that will work for them.
In next month’s article, we will look at some of these options, including bifocals, PPLs, occupational PPLs and enhanced readers.
Sue Deal FBDO R is a practising dispensing optician, ABDO College examiner, senior tutor and supervisor for dispensing opticians. She is also a practice visitor and external moderator for ABDO. She was recently awarded the ABDO Medal of Excellence for her outstanding services to the profession.