Sometimes I think patients would rather you tell them they have a dreaded eye disease than reference what the problem really is… birthdays.

Everybody wants to live forever, but nobody wants the inevitable side effects of, well, living forever. I recently told a very healthy and active 90-year-old, “You’re going to live until you’re 110!” He said, “I don’t want to live that long,” and I said, “I’ll check back with you when you’re 109.”

You want to see a patient glaze over? Start explaining PRESBYOPIA. I always start by asking, “Have you ever seen a Presbyterian church?” This is when 50% of the patients consider jumping off a bridge. My father, growing up, was a Methodist. My mother was a Presbyterian. These two churches were across the street from each other in my little hometown of Montgomery, West Virginia (and yes, the town was named after me. I was just born a hundred years after the town was named after me.)

One time I asked my mom, “If dad was a Methodist and you were a Presbyterian, why were we all brought up in the Presbyterian church?” Her answer: “We decided it would be easier to cool down a Methodist than to heat up a Presbyterian.”

Dr. Montgomery Vickers

So, as the patient facing his first reading eyewear slowly slips into a coma, I teach him that in old Greek (and Vulgar Latin), the root of the word means “ancient,” so the Presbyterian Church is the “Ancient Church” and presbyopia means “ancient eyes.” To the patient, who maybe has never had an eye problem in 43 years, I am certain this is just super exciting to learn.

But, that’s not all. Now I start talking about how, when I see patients like them, the first thing I think of is a hardware store.

That pretty much pushes the patient into catatonia. But wait, there’s more! Now I explain that spectacles are just a tool, like a Phillips head screwdriver or a jackhammer.  

Now, they simply hate me.

Yes, folks, eye doctors invented texting and computers just to drum up business. And it has worked beautifully thanks to presbyopia.

By the year 2030, there will be over 40 billion presbyopes in the world. I just made that up by the way, but still, there will be a bunch of them. A few will show up at your office and all of them are hoping you say, “You’re fine… just increase the font size.” But we are, at heart, interventional by training and, like it or not, their birthdays will mean they need eyewear or something.

My experience clinically is that patients who deny, deny, deny and just fight their near demands all day often end up goofing up the distance vision they have been bragging about since junior high school just to make the nerdy myopes feel jealous. My best presbyopic patient successes often start with them all bent out of shape when I mention the possibility of losing their incredible distance vision, which, by the way, accounts for less than 8.7% of their visual day. I just made that stat up, but they do spend 10 to 14 hours a day at near and less than 30 minutes at 100 yards unless they drive for Uber or Lyft at night or golf.

So, here’s my advice. Just be honest and show how you can make them have a better day if they will only wear “workspace” glasses when drilling down on their computer.  

If this fails, just hover above them like turkey vultures. My mentor, Dr. Bodie, used to tell me, “Don’t give them a bifocal until they beg you for one.” They will.

Dr. Vickers received his optometry degree from the Pennsylvania College of Optometry in 1979 and was clinical director at Vision Associates in St. Albans, WV, for 36 years. He is now in private practice in Dallas, where he continues to practice full-scope optometry. He has no financial interests to disclose.