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Presbyopia is defined as the insufficiency of accommodation to focus on near objects due to reduced amplitude of accommodation. Presbyopia usually begins by the age of 40 to 45—the amplitude of accommodation. Working knowledge of the amplitude of accommodation is necessary to understand the pathophysiology of presbyopia. The amplitude of accommodation is 14 D at ten years of age and reduces to 4 D. In other words, the condition of failing near vision due to age-related reduction in amplitude of accommodation or increase in punctum proximum is labeled as presbyopia. Presbyopia is related to age-related in the lens and age-related decreases in ciliary muscle power. Premature presbyopia can result from uncorrected hypermetropia, premature nuclear sclerosis, chronic simple glaucoma, and presenile weakness of the ciliary muscle. The common symptoms of presbyopia include difficulty in near vision, asthenopic symptoms, and intermittent diplopia. The treatment of presbyopia includes spectacles, contact lenses, and surgical correction. The focus of interest here is presbyopia-correcting contact lenses. Fienbloom first described bifocal contact lenses in 1938. Williamson described the contact lenses with a small biconvex curve portion near the portion on the front surface. The most common presbyopic lenses available bifocal, diffractive, monofocal, multifocal, and simultaneous vision lenses. This activity focuses on types of contact lenses for presbyopia, indications, contraindications, techniques, complications, and clinical significance of presbyopia-correcting lenses. Objectives: Review the types of presbyopia-correcting contact lenses. Summarize the advantages and disadvantages of presbyopia-correcting contact lenses. Outline the clinical significance of presbyopia-correcting contact lenses. Explain the complications associated with presbyopia-correcting contact lenses. Access free multiple choice questions on this topic.

Presbyopia is physiological insufficiency of accommodation that reduces the amplitude of accommodation with a gradual progressive fall in near vision.[1] This is not an error of refraction. Fienbloom first described the bifocal presbyopia-correcting contact lenses in 1938.[2] Williamson then described the bifocal contact lens with a small convex central portion near the anterior surface in 1958. Freeman proposed the concept of pinhole lenses for presbyopic correction in 1953.[3] De Carle described the simultaneous vision lenses in 1957. In 1957-58, Wesley and Jessen described the concentric bifocals with the distance portion in the central axis. In 1958 Jessen further proposed the first multifocal lens, later named the aspheric bifocal contact lens in 1961. The principle of presbyopia-correcting contact lenses depends on selecting a type of lens or correction mode that will correct the near, intermediate, and distant vision.[4] Why is There a Need for a Presbyopia Correcting Contact Lens? Bifocal spectacles or reading glasses require head tilt to near objects, give a restricted field of view, image jump, magnified image, an outward symbol of aging, require switching of spectacles for reading and distortion of images through progressive bifocals.[5]

Punctate epithelial erosions Epithelial abrasions Epithelial defect Foreign body defects Dellen Mucin bells Microcysts Vacuoles Dimple veiling Corneal edema Acute and chronic hypoxia Corneal anesthesia Contact lens-induced keratitis (Microbial - staphylococcal, Pseudomonas, Acanthamoeba, etc.) Sterile infiltrates Corneal neovascularization Limbal stem cell deficiency Corneal scarring Corneal warpage Corneal endothelial damage Blindness[43]

Any patient presenting to the clinic with complaints of defective near vision should be meticulously evaluated to rule out any other ocular pathology. The patient must be made to understand what presbyopia is and what are the management options.[1] Patients willing to use contact lenses should be counseled in detail regarding the contact lenses available and the benefits of one lens over the other. Patients should be explained about contact lens complications and the need to maintain ocular hygiene while applying contact lenses. The examining ophthalmologist, optometrist, and nursing team play a key role in the meticulous management of these patients. The patient should understand that they will require a change of presbyopic correction with age, and there will be a need for contact lens change in the future.[43]

The nursing, allied health staff, and interprofessional team help in patient management by counseling, recruiting the patients to contact lens clinics, and explaining the pros and cons of contact lens wear.[45]

The nursing, allied health staff, and interprofessional team help monitor the patients to determine whether they are wearing contact lenses correctly, explain and check for contact lens hygiene, and check for contact lens fit and cornea condition.[45]