Growing Concerns

Helping one of the fastest growing groups, presbyopic individuals, cope with their vision changes.

By Brittany Mitchell, OD

Patients come in every day with concerns about their changes in vision due to presbyopia. Now more than ever, eye care providers have the tools to help patients cope. Patients have many concerns because most do not understand what presbyopia means and how it will change their vision. We are there not only to present them with options, but also to present options that will specifically help cope with our fast-paced technological society. The percentage of the population using computers and other devices increases every day. Most people now demand not only sharp vision at distance and near, but also at intermediate distance.


A high percentage of my patient population is presbyopic, and many patients come in with a variety of concerns. They worry that their vision will worsen to a complete loss of vision. Presbyopia is a life-changing concern, especially for those who have never experienced changes in vision.

Starting in their early 40s, patients are very apprehensive about their changing vision. Many have concerns that wearing glasses, even reading glasses, will cause a permanent decrease in vision. The typical concerns we hear on a daily basis include needing better near and intermediate vision, but still wanting to retain clear distance vision. Patients today rely heavily on intermediate vision with the increased use of computers, cell phones, and tablets.


This aspect of the practice takes more than just prescribing a pair of glasses or fitting contacts. Taking time and presenting options that work for individual patients will best help them cope with their confusing changes in vision.

Many are concerned that wearing bifocals will make them “officially” old. Everyone is looking for the fountain of youth. Luckily, with the technology now available in the eye care toolbox, we have more options to present to our patients.

Instead of using a typical near-vision card, I like to have my patients get out their cell phone or tablet to check their near vision and to see if a given solution helps to improve it. This is how people judge their near vision in real life, so it makes sense to use these devices in the office setting as well.

By providing a range of options, we help patients mentally prepare for what is going to be a successful treatment for their presbyopia. Pushing a patient into a pair of reading glasses or a multifocal contact lens too soon can cause that patient to be more apprehensive and destined for failure.

Most people have no idea what the word presbyopia means, only that their vision is changing. Explaining what is happening to their vision is helpful. I like to explain the process using pictures, eye models, and videos. A visual experience is often more easily understood than any words we can use.


Over the years, a great deal of hard work has gone into improving the options we can provide to our patients to help them through the beginning phase of this vision change.

We can now discuss with patients a range of options, including

  • contact lenses: single-vision contacts with reading glasses for near, monovision, and multifocal options
  • spectacles: reading glasses, bifocals, progressives
  • surgical options: monovision LASIK, monovision refractive lens exchange

In my opinion, we may be too quick to just prescribe a patient a pair of glasses, with, for instance, progressive lenses, and then move on to the next patient. That patient may have been an excellent candidate for multifocal contact lenses, who could then have told all of her friends how amazing they are.

On the other hand, presenting too many options can be overwhelming. Taking a few extra minutes to ask patients what distances are especially important to them, what they would like to be able to see, their hobbies, and their typical daily routine can increase the odds of success. Depending on those answers, the eye care provider can describe a few options that will work with each patient’s lifestyle. For example, contact lenses may be able to give patients freedom from glasses so that they still feel and look young, but also provide vision at all ranges: distance, intermediate, and near.


As near vision starts changing, patients begin to complain of having more symptoms relating to dryness or meibomian gland dysfunction. As we know, aging causes changes to the eyes in this area specifically. I discuss these changes with patients just as I would any other issue, and I give tailored recommendations.

With the aging of the population, the proportion of presbyopic patients in our practices is destined to continue increasing. These patients may require more chair time at first, but once we make them happy, their positive experiences will continue to build our practices practice. Giving patients just a few extra minutes can significantly help them with this transition. Presbyopia does not have to be intimidating your patients.

Brittany Mitchell, OD, sees patients at Alabama Vision Center in Birmingham, Alabama. Dr. Mitchell may be reached at 205- 991-2021;