SECO 2023: Contact lenses for presbyopic patients

Milton M. Hom, OD, FAAO, FACAAI (Sc), caught up with Optometry Times®' assistant managing editor Emily Kaiser to share highlights from his part of the "Presbyopia management panel" during SECO 2023 in Atlanta, Georgia.

Editor's note: This transcript has been edited for clarity.

Kaiser:

Hi, everyone. I'm Emily Kaiser with Optometry Times and I'm sitting down with Dr. Milton Hom who's participating in the "Presbyopia management panel" at SECO 2023 in Atlanta, Georgia. Welcome, Dr. Hom, thank you for taking the time to talk to us.

Hom:

Thank you for inviting me.

Kaiser:

Of course. Can you give us a brief overview of your portion of the panel?

Hom:

Well, you know, the panel is going to cover pretty much all the aspects of presbyopia. My small portion of the panel is going to be referring to contact lenses—more specifically multifocal contact lenses for presbyopia.

Essentially I'm just gonna give an overview of just the designs of the various presbyopia multifocal contact lenses that are out there. Mostly, you can say that the designs are either monocular, or on one side monocular and on the other side, binocular. Mono vision or simultaneous vision. And somewhere in between we have distance lens and a near lens.

Most of the lenses that are out there—multifocal lenses out there by the major manufacturers—are pretty much centered near lenses. So in other words, the near portion is near. And then the peripheral portion is actually distance. And you could probably pretty much take virtually all of the contact lens designs that are out there and pretty much put them in one of those different categories along that spectrum between binocular vision and monocular—or shall we say monovision.

There's one new different type of multifocal that's out there, and it's called extended depth of field (EDOF). And that design is nothing like any of the other designs that are out there. And what EDOF is what they call a virtual pinhole. So as you know, if you have pinhole vision, you'll be able to see all the different distances. But the problem is, of course is that, you lose your peripheral vision. And of course, when you look through a pinhole, you know, the vision is much, much more dim.

So what they do with the EDOF lenses is that instead of having it blocked off and make it into a pinhole, what they do is that they ramp up the plus power all around that small aperture. So it acts like a pinhole and gives you that pinhole effect.

And there's a couple of lenses that are on the market that use that type of optical design. There are also IOLs that use that type of optical design. Finally, there's another lens that is under FDA investigation, and it's [inaudible] lens tech. And essentially what it is, is that it's a contact lens that is that stuck to the to the upper lid. So what the eye translates when they look down, because the lens doesn't move that much because it's attached to the upper lid, when they look down, they're able to see the near portion. And then when they look straight ahead, they're able to see the distance portion. So it's almost acting like a spectacle bifocal, but it's actually a contact list that's attached to the list.

So there's a lot of new and exciting designs that are out there that are being studied for contact lens multifocals for presbyopia.

Kaiser:

Yeah, that's so interesting. And what do you hope that optometrists take away from your portion of the panel or from the panel as a whole?

Hom:

The problem is that as a clinician, you know, and you're working with presbyopes, and you want to go ahead and pick a contact lens for presbyopia, it's really, really confusing, because, you know, everybody will tell you that their lens is the best and it works the greatest and they'll show you data that the patient's preferred it and everybody loves their lenses. But there are distinct differences between the way that they're designed.

So what I wanted to explain really to take away is that you can take the different designs and put them into different categories and kind of understand, you know, what they can do and what they can't do, and kind of relieve that confusion as to which contact lens to go ahead and use for your presbyopic patients.

Kaiser:

Yeah, absolutely. And is there anything else you'd like to cover that we haven't touched on?

Hom:

Really, it's a very, very robust pipeline. And there's some really exciting new designs that are coming up just to be excited about. You know, that contact lenses, there's still a lot of innovation going on.

Kaiser:

Absolutely. Well, thank you so much for taking the time to chat today and I can't wait to hear more.

Hom:

Thank you very much.