By Mark Schaeffer, OD
August 25, 2021
Presbyopia-correcting drops have finally moved from fantasy to reality with the front-running formulation from Allergan just approved by the Food & Drug Administration (FDA).1 With more than half a dozen other promising agents at various stages of development,2 we will soon find out how these pharmaceuticals fit in with our traditional near-vision treatment options.
An estimated 128 million Americans are affected by presbyopia and about 30.9 million of them wear over-the-counter (OTC) readers to the tune of more than 50 million pairs purchased per year.3-6 These are people who are bypassing eyecare providers offices and instead heading to the drugstore without any real idea of what solution will work best for their needs. With the availability of presbyopia-correcting drops, we will have the opportunity to change that narrative and provide comprehensive eye exams to millions who are not currently being cared for by an optometrist.
If only the patients purchasing OTC readers without seeing an optometrist were interested in drops, that’s over 800 new patients per OD according to the latest American Optometric Association workforce study (which includes part-time ODs as well as those in industry).7 This population over 40 has a higher incidence of conditions like ocular surface disease (8-50 percent), glaucoma (2 percent), macular degeneration (1.7 percent), cataracts, etc.8-11 Based on this data and previous studies, that can translate to up to 400 new dry eye patients, 16 new glaucoma patients (not including those with risk factors or suspects), and 16 new macular degeneration patients for each optometrist in America, all without having to do any marketing or outreach.
Potential to Generate a High Number of New Patients
Rather than competing with progressive eyeglasses and multifocal contacts, these drops will act as a “gateway drug” paving the way for increased revenue because they will surely be used in combination with other solutions. We will be able to better customize treatments for our patients, and the drops may even enhance current technology. With higher success rates when it comes to multifocal contact lens fittings, for example, patients will be happier with their care. Happier patients means more referrals. Glasses and contact lenses are not going away, and people will still be staring at computer screens, and therefore, need other solutions like anti-fatigue and anti-glare spectacles as well as blue light protection.
I see presbyopia-correcting drops allowing us to go above and beyond, creating even more personalized approaches that patients can use at their discretion. It is a technology that will further refine our patient care. As an added bonus, more patients receiving comprehensive eye exams means earlier diagnosing of other conditions like glaucoma and diabetic eye diseases which will improve outcomes and public health. There is no harm in bringing more patients into your office for care!
In preparation for these drops hitting the market, I have been letting my patients know that soon there will be a drop that will boost their near vision. Needless to say, they are excited! I have long discussed presbyopia with my patients, even those as young as mid-to-late thirties. I want them to know what to expect—especially the contact lens wearers who might not be aware of multifocal technology. I want them to understand the physiology and know that there is a solution. The drops will allow patients to stay in their single-vision correction by adding on this treatment to stimulate more natural vision. No one likes to be forced into change, rather they want the luxury of choice.
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Get Staff Buy-in
No matter how fantastic you are in the exam room, nothing new is successfully adopted into a practice without staff support. Everything is always easier when the staff is on board and patients will be much more satisfied with their treatment not to mention be more willing to keep coming back. Happy patients make our job more satisfying, and that starts with a satisfied and happy staff.
We must always remember that the staff spends much more time with patients than we do. We may be obsessed with chair time, but they are doing the troubleshooting, dealing with call backs and scheduling the appointments. Their hard work allows us to focus on increasing patient satisfaction, which is ultimately what will generate more revenue.
Conclusion: Think of It as an Opportunity to Expand Care
I strongly believe that understanding the psycho-social aspect of eyecare makes us better optometrists. We often overlook empathy and the importance of a human connection in our increasingly remote, digital, artificial intelligence-driven world. But compassionate care cannot be delivered through an algorithm. We need to find out what our patients want and then work toward a solution that is tailored just for them. When it comes to presbyopia correction it is not about either/or but rather both/and. With the option of drops to improve near vision, more “and” will help our patients and grow our practices.
1. Allergan, an AbbVie Company, submits new drug application for investigational AGN-190584 for the treatment of presbyopia. https://news.abbvie.com/news/press-releases/allergan-an-abbvie-company-submits-new-drug-application-for-investigational-agn-190584-for-treatment-presbyopia.htm. Accessed June 4, 2021.
2. Grzybowski A, Markeviciute A, Zemaitiene R. Review of pharmacological presbyopia treatment. Asia Pac J Ophthalmol (Phila). 2020; 9(3): 226–233. doi: 10.1097/APO.0000000000000297
3. American Optometric Association website. Care of the Patient with Presbyopia. Optometric Clinical Practice Guideline. https://my.ico.edu/file/CPG-17—Presbyopia.pdf. Accessed May 29, 2021.
4. Zebardast N, Friedman DS, Vitale S. The prevalence and demographic associations of presenting near-vision impairment among adults living in the United States. Am J Ophthalmol. 2017;174:134-144.
5. U.S. Census Bureau. Table 9. Projections of the Population by Sex and Age for the United States: 2015 to 2060 (NP2014-T9). Washington: Population Division. 2014.
6. Vision Council website. https://www.thevisioncouncil.org/sites/default/files/research/VisionWatch_VisionCouncil_Member_Benefit_Report_September%202016_FINAL.pdf. Accessed June 2, 2021.
7. Heath DA, Spangler JS, Wingert TA, et al. 2017 National Optometry Workforce Survey.
Optom VisSci. 2021;98(5):500-511. DOI: 10.1097/opx.0000000000001688
8. Dana R, Bradley JL, Guerin A, et al. Estimated prevalence and incidence of dry eye disease based on coding analysis of a large, all-age United States health care system. Am J Ophthalmol. 2019;202:47-54. doi: 10.1016/j.ajo.2019.01.026.
9. Shah S, Jani H. Prevalence and associated factors of dry eye: Our experience in patients above 40 years of age at a tertiary care center. Oman J Ophthalmol. 2015;8(3): 151–156. doi: 10.4103/0974-620X.169910
10. National Institutes of Health, NEI. Glaucoma data and statistics. https://www.nei.nih.gov/learn-about-eye-health/outreach-campaigns-and-resources/eye-health-data-and-statistics/glaucoma-data-and-statistics. Accessed August 19, 2021.
11. Friedman DS, O’Colmain BJ, Muñoz B, et al. Prevalence of age-related macular degeneration in the United States. Arch Ophthalmol. 2004;122(4):564-572. doi: 10.1001/archopht.122.4.564.
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