I had the pleasure of participating in a SECO specialty lens panel in Atlanta this year. Always trying to modify or break any short-sighted habits, I took the opportunity to take a fresh look at all the GP options available for presbyopia. I had the pleasure of working with Ashley Wallace-Tucker, OD, and Julie DeKinder, OD, both of whom are highly skilled, exceedingly capable clinicians. They presented useful tips on helping to assure success when using GP materials and lenses in correcting presbyopia.

By now, we all know the many benefits of using a rigid GP material such as wonderful acuity/vision especially when correcting astigmatism, less inflammation most of the time when fitted properly, reduced long-term cost, more durability, easier handling and insertion/removal and, in many situations, a better option for the marginally dry eye. Unfortunately, despite their many advantages they only comprise about 1% of all fits.¹ The reality is GP lenses take longer for patients to adapt to, but with newer lens options (sclerals and hybrids), this may no longer be true. In addition, replacement time and cost are different than with soft lens presbyopic options.

Let’s look at the many GP options available today for your presbyopes and younger patients who might benefit from myopia control. I’d like to especially highlight scleral and hybrid options since they are relatively new and provide exceptional comfort for most patients.

Corneal GPs

Three basic designs exist: aspherics, concentrics and translating. Each category has its advantages and disadvantages. For example, aspherics must center well for simultaneous vision and essentially work best for patients who need lower add powers. Translating lenses must hydroplane effectively, and patients must have the right anatomical features to support this requirement. These lenses can be problematic for heavy computer usage. 

Nevertheless, all of these options, especially the concentric designs, are mostly pupil dependent but offer excellent lens options for a wide range of presbyopic patients.

Sclerals

Although these lenses require different solutions with unusual insertion requirements and more chair time, scleral lens options for presbyopia provide incredible vision and comfort. Many manufacturers now offer both concentric and aspheric scleral lens designs. Recent concentric lens options now allow for decentered optics to provide excellent vision. 

Think about scleral lenses when patients are dry. Always remember to check for flexure or residual astigmatism when reasonable acuities are not obtained and keep in mind oxygen demands for each cornea are different.

Hybrid Lenses

The obvious advantages of the hybrid group include excellent vision with its GP material and soft lens comfort provided by the skirt, with its covalent bonding for added strength. Again, these lenses are a great option for myopia control—although not a labeled indication—using a high add power and the option of slightly over-minusing at distance. The SynergEyes lenses are available in a concentric (Duette hybrid) and EDOF (iD hybrid) design. Both designs include UV protection and are available with a Tangible Hydra-PEG coating. Empirical fitting allows for an amazing first fit percentage (84%) by just providing the manifest refraction with add power, horizontal visible iris diameter and keratometry. A wide range for refractive powers, zone sizes on concentric designs (Duette hybrid) and add powers are available.

Takeaways

The best candidates for the options discussed here are motivated individuals, previous GP lens wearers, monovision failures and those who desire more clarity at distance and near. Key points in prescribing any of these lenses are to avoid abrupt or early changes and always test in the “real world” setting with binocular vision. Remember to set expectations after a careful assessment of the patients’ needs, both inside the workspace and outside of work with hobbies or sports. Time spent on the computer is always important to consider as well.

Consider taking another look at the GP lens options for your presbyopes. They have many wonderful advantages and, now that most are fitted empirically, there is less chair time involved and they are much easier to fit than in the past. I’m excited to try more of the scleral and hybrid lens options. You’ll likely be impressed with patient loyalty as well.

1. SECO Contact Lens Summit PART I: GPs, Sclerals and Hybrids for Presbyopia. February 28, 2024. SECO 2024.