INTRODUCTION: INCREASING NUMBERS OF PRE-PRESBYOPES AND EMERGING PRESBYOPES

Pre-presbyopes and emerging presbyopes? Who are they? Why talk about them? Why go out and meet them and attempt to understand them?

These are people who are generally aged between 35 and 50, since presbyopia can occur at an earlier or later stage, depending on the person. If presbyopia occurs at the age of 45, then a person aged AGATHE LAURENT Founding Partner de l’institut SpringVoice France YOUNG PRESBYOPES NEEDS between 35 and 45 years would be in the “pre-presbyopia“ stage and after the age of 45 would be in the burgeoning presbyopia stage, known as an “emerging presbyope“.

In 2013, they already represented almost 20% of the world population (this proportion remains true in every major geographic zone – North America, South America, Europe, Africa / Asia / Pacific), i.e. 1.4 billion people!
And statistics show that this figure will reach 1.8 billion in 2050 (Source: United Nations – World population prospects – June 2011).

Knowledge of their needs is therefore a major challenge for professionals in the ophthalmic optics sector.

OBSERVATION: FORTY IS THE AGE OF TRANSITION, THE HINGE AGE BETWEEN YOUTH AND MATURITY.

There are large numbers of pre-presbyopes and emerging presbyopes, and they do not want to be associated with presbyopes. They do not really yet have presbyopia. They are highly active from a professional, social and family point of view and want to stay that way for as long as possible.

They work, play sport, travel, drive, help with their children‘s homework, surf on internet. They look after their family – their children and their parents, they have friends round, spend time with their colleagues …

When you are aged between 35 and 50 there is not a lot of time in which to sit around thinking about yourself!

And yet around the age of 40 the inevitable signs of age appear. This is also the age at which the first symptoms of the eye‘s ageing are felt.

This becomes clear more or less quickly and is more or less easy to deal with. And yet it is impossible to deny any longer when the thread refuses to go through the eye of the needle, text messages on the smartphone seem too small or a metro map starts to blur.

“I realised when doing some DIY under the sink, there wasn‘t much light“. “I‘ve started finding it difficult to read instructions and leaflets i nside pill boxes.“ “On my smartphone or tablet, things sometimes look a bit blurred, distorted.“

An accumulation of embarrassing incidents makes one thing clear and forces resignation to the problem.

Continuity of vision is lost and it becomes increasingly difficult to focus. Near vision and intermediate vision are often blurred. The ordinary, simple routines of everyday life become just that bit more complicated.
One feels more visual fatigue, with the need to rub one‘s eyes, more headaches, a need for rest.

“I get more and more tired when working on the computer, my eyes start to smart.“

FEELINGS: PEOPLE WITH AMETROPIA AND EMMETROPIA SUFFER THE SAME EMOTIONAL CONFLICT!

The pre-presbyope or emerging presbyope is surprised by what is happening to him, he‘s sometimes frustrated or even irritated. For some this awareness can take on an emotional, even “dramatic“ aspect. He wasn‘t ready for it. He doesn‘t want to be the first amongst his friends to become part of the “old“ group.

In fact the pre-presbyope or emerging presbyope is apprehensive about what‘s coming next. He‘s worried about what other people will think, he fears mockery, the social embarrassment of wearing glasses or a change to lenses that he thinks will be too thick.

Quite logically these feelings are all the more disturbing for someone with emmetropia, for whom vision problems are a real novelty, representing a major challenge to the precious freedom he may have boasted about to a friend.
Indeed, for the pre-presbyope or the emerging presbyope, admitting the need for a solution signifies making a big leap into the world of spectacle wearers, into the world of “dependent“ people. It is difficult for him to project himself into this reality. And what is more, he has no experience of the world of vision professionals: “What do I do, where do I start? How do I ….“ He‘s a novice here.

A person with ametropia (myopia, hypermetropia or astigmatism, who has already been wearing glasses for several years) experiences this change with much more resignation. Of course he knows the circuits already, he knows what wearing glasses means. They‘ve been an integral part of his personality for years, sometimes for many years.
However his life now becomes extremely trying. He‘s constantly taking his glasses on and off. He loses them, forgets them. They‘re not sufficient any more; they don‘t do their job as well as they did before. A new form of dependency emerges, obliging him to re-define his habits with more lighting, more zoom on electronic messages and SMS, more distance for reading. “Less comfort and more bother!“.

The pre-presbyope or emerging presbyope women met during the course of the study were actually generally concerned earlier by the issue of ageing.

This reaction is also observed amongst active men for whom these change are associated with lower performance.

Note that there is also a concern about one‘s appearance, a fact observed particularly in China, which also explains the resistance to change.

THE SEARCH FOR A SOLUTION: STRATEGIES FOR GETTING ROUND THE PROBLEM BEFORE MORE “PROFESSIONAL“ SOLUTIONS.

It starts with denial, for as long as possible. “I‘m just a bit tired, I can deal with it“.
The external environment is accused: pollution, screens, lighting. People with myopia take their glasses off to see close up and those with emmetropia rub their eyes more and more often.

“I ask my children to help me“.
“I stretch out my arm further“.
“Sometimes you have to cheat, you have to make more of an effort“.

And when that‘s no longer enough, simple solutions are sought: - ready-made glasses – lots of them, which get scattered around at home and in the car
- drops for dry, tired eyes
- painkillers to relieve headaches
- a magnifying glass for small text

Whilst all the time being aware that this is not the best solution.

“I prefer not to know, maybe I‘m straining my eyes with these (ready-made glasses), but I prefer not to know.“

Cost is unquestionably a factor in these strategies too, particularly for those with emmetropia since they do not know how the system works and how much cover they can expect, they feel much more intimidated.

But in the end they are forced to go to the ophthalmologist when there is no other way out.
This tendency to delay going to get glasses is confirmed by the statistics: of the 29% non-wearers in the 40-50 year old group, probably all of whom have emmetropia, 25% feel that they need some kind of correction. (Source: Essilor)
Very often the first prescriptions are glasses to rest the eyes, but mid-distance or, to a lesser extent, glasses for computer work are also prescribed.

PROGRESSIVE LENSES: STILL RELATIVELY UNKNOWN OR WITH A POOR REPUTATION

Comments made during the study are very revealing:
“You mean those really thick lenses?“
“The lenses that gradually change colour?“
“They cost a fortune, I can‘t afford them.“
“There‘s no way I‘m wearing lenses like my granny!“
“People say they make you feel sick and give you a headache.“

It‘s a fact: some pre-presbyopes or emerging presbyopes know very little about progressive lenses, they‘re wary of them and think that this is not a solution for them.

Those who know about progressive lenses feel that they are far too young to wear them because they are “lenses for old people“. 

In China, the ideas of ageing and presbyopia are very closely linked because the word for “presbyope“ means “old person“. The question of age and ageing is just as sensitive as it is in the West, if not more so. People speak about their age even less willingly and professionals approach this question with care.

And yet those professionals who do sell progressive lenses successfully continue to be amazed by the benefits they offer. These lenses provide greater comfort, enabling wearers to feel efficient for much longer.
Some professionals even go as far as to offer them earlier, sometimes as from the age of 40, if the lifestyle of the person in question appears to be suitable.

This means that the age at which first progressive lenses are worn remains undefined. What is certain is that very few people buy progressive lenses at the age of 45: solutions of easier access (magnifying glasses, ready-made glasses…) are preferred; as was confirmed and explained by the people taking part in our study.

SPECIFIC EXPECTATIONS: PARTNERING AND REASSURING

The pre-presbyope or emerging presbyope still dreams of hearing that a miracle solution exists, which will enable him to regain good vision. He wants to hear that it can all be reversed and that his symptoms are only transitory.

But in the end he resigns himself to the fact because the fatigue is really there. He needs someone to explain to him that this is a natural development; he wants someone to work alongside him and reassure him. 

And he‘s also expecting to be shown the path towards the right solutions which will enable him to continue to carry out all his activities easily, just like before.

THE FUTURE: WHAT CAN THE EYECARE PROFESSIONAL DO?

The pre-presbyope or emerging presbyope would therefore like to find somewhere to sit down and be comforted and this is precisely the role that the vision professional can play.

Our discussions, both with consumers and eyecare professionals, show that there is still a need to go out and meet these forty-somethings, to explain these gradual changes to them and help them to understand and learn to live with them.

One should however remember to explain the causes:

1 - Physiology is as it is; the ability to focus starts to lessen from a very young age, reaching its minimum at the age of 60, it starts by being tiring and then a real problem in terms of near vision.

2 – The environment has changed enormously: we use for longer and longer periods and increasingly closely new devices such as tablets and smartphones, using screens with LEDS incorporated that create more glare and are more dazzling but also with greater resolution, showing finer details that demand excessive efforts from the eye!

Various solutions must be presented, help must be offered to analyse them and they should be available for a trial, with the possibility of changing them until the right solution is found.

This is a fabulous opportunity for eyecare professionals, enabling them to increase their status as experts by helping pre-presbyopes or emerging presbyopes to dedramatize their position and understand the issues in a simple, sincere and benevolent way.

Traps to avoid?
- Stigmatisation: after all, isn‘t pre-presbyopia just another stage in life, in the same way as other times of physical transformation?
It‘s not the first and it won‘t be the last!
- Moralizing: there‘s no need for that!

These days pre-presbyopes or emerging presbyopes are still young. Let‘s help them to stay that way even longer.