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By Melissa Barnett, OD, FAAO, FSLS, FBCLA
June 1, 2026
Turning 40 is an important milestone for many aspects of life, including vision and eye health. For many people, this is when subtle changes begin to appear: reading menus becomes more difficult, contact lenses feel less comfortable, screen time becomes more exhausting and glasses are needed more frequently. Providing optimal eyecare begins with the right questions.
Here are the top questions I ask every patient over 40—and why they matter.
1. IF YOU COULD CHANGE ONE THING ABOUT YOUR CONTACT LENSES, WHAT WOULD IT BE?
This simple question opens the door to honest conversation. Many patients assume mild discomfort, dryness, fluctuating vision or needing readers over contact lenses is “normal.” These are not problems that need to be tolerated. Whether the issue is comfort, clarity, convenience, dryness or near vision, there are often new contact lens technologies and fitting strategies that can help.
2. IS THERE A TIME YOU WOULD LIKE TO BE LESS DEPENDENT ON YOUR GLASSES?
Many patients over 40 start relying on reading glasses, computer glasses or progressive lenses. Some are happy with these options. Others want more freedom for work, exercise, travel, social events and daily life. Asking this question helps uncover specific lifestyle goals. The conversation may lead to pharmaceutical options for presbyopia, multifocal contact lenses, specialty contact lenses or other customized options.
3. WHAT ARE YOU MOST CONCERNED ABOUT WITH YOUR VISION AND EYE HEALTH?
Patients often have concerns they do not mention unless asked directly. They may worry about macular degeneration, bothersome dry eyes, glaucoma, cataracts, diabetes, family history of eye disease or losing independence. This question makes the eye exam more personal, customized and proactive. It also helps patients feel heard, respected and involved in their own care.
4. HAVE YOU EXPERIENCED ANY HORMONAL CHANGES?
Hormonal changes can significantly affect the eyes, especially the tear film and ocular surface. Perimenopause, menopause, pregnancy, thyroid changes, hormonal therapy and certain medications can contribute to dryness, irritation, fluctuating vision and contact lens intolerance. Understanding hormonal history and changes helps diagnose dry eye disease earlier and allows for individualized treatment options.
5. HOW IS YOUR SLEEP?
Sleep and eye health are closely connected. Poor sleep can worsen eye dryness, eye fatigue, presbyopia symptoms and overall wellness. Sleep apnea may also be associated with several eye conditions, including floppy eyelid syndrome, keratoconus, glaucoma and severe dry eye. Asking about sleep provides insight into the patient’s overall health and may reveal patterns affecting comfort and vision.
6. WHAT DOES YOUR COMPUTER WORKSTATION LOOK LIKE?
For many people, visual demands have changed dramatically. Hours spent on digital devices—including computers, phones, tablets and multiple monitors—can contribute to digital eye strain, headaches, neck and back discomfort, dry eyes and blurry or fluctuating vision. I ask about the type of devices used, the number of screens, monitor height, distance, lighting, screen breaks and font size. Sometimes an updated prescription, small ergonomic change or computer-specific lens can make a major difference.
7. HOW OFTEN ARE YOU BOTHERED BY YOUR CONTACT LENSES EACH DAY?
Patients may report that their lenses are “fine,” but when asked more specifically, they admit lens awareness several times a day. They may experience dryness later in the day, need to remove lenses earlier than desired, rely heavily on drops or avoid wearing lenses daily or for extended periods. Daily symptoms can indicate that the lens material, fit, replacement schedule, wearing time or ocular surface needs attention.
8. WHAT DO YOU NEED YOUR VISION TO DO EVERY DAY?
Every person has different visual demands that may require different solutions. At any age, vision care should not be one-size-fits-all. The goal is not only to help people see clearly on the eye chart in the exam room. The goal is to help them function comfortably and confidently in their daily lives.
The most valuable part of an eye exam is often the conversation. By asking better questions, we discover what each patient values, needs and what may be getting in the way of their best vision and eye health. For all patients, especially those over 40, we can and should provide individualized eyecare to improve comfort, clarity, confidence and quality of life.
Special thanks to many members of the Intrepid Eye Society for contributing their top questions they ask patients for this article.
Read more on senior patient care here.
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Melissa Barnett, OD, FAAO, FSLS, FBCLA, is a TEDx speaker and world-renowned key opinion leader recognized for her expertise in dry eye disease, specialty and scleral lenses, keratoconus and presbyopia. Dr. Barnett is an Associate Certified Coach (ACC), credentialed by the International Coaching Federation (ICF). She specializes in mindful leadership, wellness and effective communication, empowering individuals to become their best selves in both their personal and professional lives. |
