Digital vision demands call for new approaches

April 27, 2022

3 minute read


Disclosures: Kannarr reports being a paid consultant for Allergan (an AbbVie company) and Johnson & Johnson Vision Care.

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In the digital age, intermediate vision is extremely important when people use screens for up to 12 hours a day.

The visual needs of our patients evolve as they experience presbyopia, and we need to update the way we think about our vision parameters.

Seeing 20/20 up close on an eye chart at an optometrist is not an accurate reflection of the quality of a person’s eyesight at all distances in real life. Even 20/20 on a proximity card varies from doctor to doctor – how many eye care providers are picky about how close they hold the card? In truth, the standard visual acuity test is performed in an environment that does not represent the real world. It’s no surprise that patients, especially those with presbyopia, have trouble seeing up close in the exam room.

New tools, new times

We know that the Near Type 20/40 is functional for 95% of a patient’s day in terms of working at a computer, reading a magazine, or looking at a phone. That’s why I believe this should be our standard. I have found that whether with the newly FDA-approved Vuity presbyopia correction drop (pilocarpine HCl ophthalmic solution 1.25%, Allergan) or multifocal contact lenses like Johnson’s Acuvue Oasys 1-day & Johnson Vision (which can help relieve digital eye strain), patients see little compromise in their distance vision when corrected to near 20/40 vision. This parameter represents a functional vision that will fit most of their day.

Shane Kannarr, DO

Shane R. Kannarr

Vuity’s approval was based on data from two pivotal Phase 3 clinical studies, GEMINI 1 and GEMINI 2, which included 750 presbyopic participants, ages 40 to 55, who self-administered one drop of the product or placebo once daily in each eye. Both studies met their primary endpoints, with a statistically significant proportion of Vuity-treated participants gaining three or more lines of mesopic, high-contrast, and binocular-corrected near visual acuity, without losing more than one line of visual acuity. corrected distance visual acuity at day 30, hour 3, vs placebo.

In my experience with gout, patients can achieve near or intermediate 20/40, which allows them to be functional for about 10 hours a day. This allows most people to get to work, get home, and keep up with the day’s near-to-do demands. Complaints such as poor vision or feeling of inadequate lighting resolve within a week for most of my patients.

How we respond

To meet the changing visual demands of today’s patients, we have redesigned our 20/40 proximity cards. We’ve repeated the 20/40 line multiple times because we know patients feel best when they can achieve the bottom line. Additionally, we try to recreate real lighting conditions by turning on the lights in the exam room and having patients read their phones.

We also need to talk to our presbyopic patients about self-adjustment to help them see better. Using Vuity as an example, one drop in the morning could give patients 3 or 4 hours of great vision at 16 inches. If they slowly increase the viewing distance as the effect of the drop decreases, they can see well for 8 or 10 hours. I advise patients that during the day they may need to accommodate and ensure they are not crowded on their desks at work; instead, they should maintain a more comfortable distance. Also keep in mind that most computer screens are high contrast, whereas a newspaper (or postcard) is black and white or gray on gray.

Understanding that with varying visual demands in the real world, there can’t be a single solution that always works for all patients, so we need to redefine patient and physician expectations. I think Vuity is a great product that people can use during the work day, and they may need to supplement with progressives at home. I advise eye care providers to develop treatment protocols for presbyopia, instead of a one-size-fits-all approach.

I think we should fully involve patients in an interactive decision-making process, asking them about their needs and how they use their vision on a daily basis. If we expose them to a variety of presbyopia correction solutions, we can discover how each option fits their lifestyle, keeping in mind that presbyopia is a progressive disease.

As optometrists, we must remain open to a variety of treatments and not be afraid of failure. Not everything works perfectly every time for every patient. It’s a process, and we can make adjustments if necessary. With Vuity and other advances in presbyopia in our toolbox, it’s time to rethink how we define and achieve positive outcomes for our patients.

For more information:

Shane R. Kannarr, DO, is in private practice with Kannarr Eye Care in Pittsburg, Kansas. He can be contacted at [email protected]

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