By Sophia Visanji, OD
The millennial generation is rapidly reaching a milestone no one really enjoys: presbyopia. The growing role of technology in our lives and the increased number of hours we all spend on digital devices has meant that this generation is feeling the effects of presbyopia at a much younger age, beginning with eye strain, eye fatigue and headaches in their mid to late 30s. Not only are emerging presbyopes experiencing weakening accommodation, but their troubles are compounded by other age-related changes, such as the tear film becoming less stable1 and increasing light scatter from the aging lens2 that degrades visual quality.
When patients don’t anticipate these changes, they can present in my office in a panic that something is terribly wrong with their eyes. To avoid this, I like to educate my patients about presbyopia well before they start experiencing symptoms. I explain that it is one of the earliest signs of aging—occurring even before wrinkles or gray hair for many people. I tell them there is no need to worry, because we have solutions to help them deal with it. This conversation evolves over time, because I always try to tailor my recommendations to patients’ current complaints, while also preparing them for future changes. For example, if a patient is having trouble driving at night, we start to talk about cataracts. I tell patients to expect the biggest changes in near vision during their 40s, with the pace of change tapering off in their 50s and 60s. I also set the expectation that annual exams are not just a chance to update their prescription or shop for stylish new frames but are also an opportunity to make sure their eyes are healthy and that we don’t see any signs of diabetes, glaucoma or other conditions.
I also like to provide patients with simple tools they can use at home to help prevent eye fatigue and dryness, including using high-quality artificial tears such as Refresh (Abbvie), Systane (Alcon), or Blink Contacts (Bausch + Lomb) several times a day and warm compresses in the evening a few times a week. I recommend that patients eat a healthy diet, supplement with omega-3 fish oil, and implement the 20-20-20 rule: Take a 20-second break to look 20 feet away every 20 minutes. That can be a real challenge for the ever-connected millennial!
VISION CORRECTION FOR THE EMERGING PRESBYOPE
In the past, it was very challenging to manage the transition to presbyopia with contact lens wearers because they had the expectation of maintaining good vision at all distances—an expectation that was, frankly, almost impossible to meet with early multifocal contact lenses. But since I’ve been fitting the Acuvue Oasys Max 1-Day Multifocal lenses (Johnson & Johnson Vision) I’m finding that patients are much more successful in this lens. First of all, the daily disposable modality is very comfortable for the aging eye. This lens also has advanced hydrating technology designed to reduce evaporation of the tears off the surface of the lens, so it helps patients withstand that natural decrease in tear breakup time that they are already experiencing. Best of all, my patients don’t feel like they are compromising their distance vision to achieve better near vision. I think this clarity of vision is due to the multifocal design that is tailored to pupil size variations across age and refraction.
I introduce multifocal contact lenses based on patients’ lifestyle and complaints, rather than at any specific age. I have patients who are actors or musicians who don’t do as much near work in their profession and may not notice presbyopia as early as those who work at a computer all day. For a patient under age 40 who is feeling tired and fatigued at their desk job every afternoon, I like to start with a low-add multifocal lens in the nondominant eye. This relieves the fatigue and provides just a little more amplitude for their natural accommodation. As presbyopia progresses and their symptoms worsen, I’ll prescribe multifocal contacts for both eyes.
For those who prefer glasses, I also like to start with an introductory solution to presbyopia. I find that if I start a patient in progressive spectacles too early, they get frustrated and can’t adjust. Instead, I offer the Eyezen lenses (Essilor), which have a custom near optimization that reduces and prevents eye fatigue symptoms and improves contrast. The Eyezen lenses are a “baby step” that provides just the right amount of relief for emerging presbyopes.
The millennial generation is a large one. As they become presbyopic, the success of our practices depends on being able to cater to their needs for comfortable, sustainable vision correction that will help them continue to enjoy a digital device-driven lifestyle as they age.
Dr. Visanji is the owner of Aliana Rose Eyewear and East Coast Director of Clinical Care at Zak Eyes in New York City. She is a consultant for Johnson & Johnson Vision. Contact her at sophia@alianaroseeyewear.com.
REFERENCES
- Maïssa C, Guillon M. Tear film dynamics and lipid layer characteristics—effect of age and gender. Cont Lens Anterior Eye. 2010;33(4):176-182.
- Van Den Berg TJ, Van Rijn LJ, Michael R, Heine C, Coeckelbergh T, Nischler C, Wilhelm H, Grabner G, Emesz M, Barraquer RI, Coppens JE, Franssen L. Straylight effects with aging and lens extraction. Am J Ophthalmol. 2007;144(3):358-363.
