Optometrist and Consultant
Presbyopia is a common, age-related vision disorder that affects a majority of individuals 50 years and older.1 Uncorrected and under-corrected presbyopia has been associated with a lower quality of life and difficulties in performing daily activities such as reading, writing, and the use of digital devices.2
Corrective Options for Presbyopia
A variety of corrective options are available to address presbyopia-related visual issues, including eyeglasses, contact lenses, eye drops, and surgical procedures.3,4 Spectacles, encompassing near-vision, bifocal, and progressive lenses, are readily accessible and effective at vision correction, but many wearers find them inconvenient and cosmetically unappealing.5
After spectacles, contact lenses are the most prevalent corrective solution and can be categorized by lens design into single-vision, monovision, and multifocal options. While both single-vision and monovision contact lenses excel in delivering optimal distance and near vision, they are accompanied by noteworthy limitations for presbyopes. Single-vision contact lenses require supplementary correction with reading spectacles, while monovision is associated with undesired reductions in stereopsis and contrast sensitivity.3
Multifocal contact lenses continue to grow in popularity for addressing presbyopia with significant enhancements in both design and performance since first introduced.6,7 The principal advantage of multifocal contact lenses is their integration of multiple prescription strengths within a single lens to correct vision at all distances. Presbyopic patients seeking a spectacle-free corrective solution that works extraordinarily well in most settings may find multifocal contact lenses an excellent option.
Maximizing Multifocal Contact Lens Success through Effective Fitting
Despite considerable advancements in lens design, the dropout rate among multifocal contact lens wearers remains remarkably high, with one study estimating a discontinuation rate of 31% after 12 months.8 Patients mainly attribute this trend to poor visual performance, inadequate handling, and discomfort. Notably, comfort and visual performance are both important prerequisites for the long-term success of multifocal contact lenses.
To reduce wearer dropout, eye care professionals (ECPs) should focus on selecting the appropriate multifocal contact lens during the fitting procedure. An inappropriate contact lens can contribute to a dry ocular surface, negatively affecting both comfort and visual performance. Given that the majority of multifocal lenses available on the market incorporate a center-near design, it is crucial to assess each patient's eye health and lifestyle needs to identify a lens option that is not only easy to fit and troubleshoot but that also maximizes both visual outcome and comfort.
To achieve these goals, manufacturer-provided fitting guides are excellent tools that can streamline the fitting process. Multifocal contact lenses feature complex and distinct optical designs that enable precise vision correction across all distances. Due to the complexity of these designs, a personalized approach is essential for each fitting, customized to the specific lens chosen. Fitting guides facilitate this process by providing excellent starting points for each fitting and offer valuable guidance when troubles arise.
Despite any reservations stemming from past experiences, many ECPs may find it advantageous to embrace these fitting guides. Modern fitting guides are meticulously developed to optimize the fitting procedure for specific contact lens products. They are designed to be user-friendly, effectively mitigating the likelihood of fitting errors and subsequent customer dissatisfaction. For instance, Bausch + Lomb's INFUSE multifocal contact lenses incorporate a 3-zone progressive design that has been associated with an impressive 87% success rate in lens fitting when the fitting guide was used on the first visit and a 99% success rate in two visits. By following the guides, customers have better chances of achieving the desired visual outcomes, and this ultimately saves the practice time and resources.
Patient biometrics are also important to consider during the fitting process, including factors such as pupil size, subjective refraction, lens optic zone, and spherical collaborations. For instance, pupil size dynamically adapts throughout the day in response to ambient light conditions and generally shrinks as part of the natural aging process, resulting in variable contact lens performance.9 A multifocal lens designed with these factors in mind, such as INFUSE contact lenses that are optimized for 7 biometrics, can deliver optimal vision for many presbyopes.
Beyond biometrics, the condition of the ocular surface should also be carefully assessed for abnormalities and diseases. Any ocular surface dysfunction may require management prior to initiating contact lens wear. Furthermore, each patient's presbyopia and correction history should be considered during the fitting process. ECPs should carefully review the patient's presbyopia history before setting the appropriate expectation regarding the visual outcomes achievable with multifocal contact lenses. If the patient has a history of multifocal contact lens use, their previous successes and failures can offer invaluable insights in selecting the most appropriate lens for their current needs.
Above all, patients should be informed that ECPs are ready to enhance their lens-wearing experience whenever they are dissatisfied with their lenses. For example, patients who have issues with lens handling can receive additional training, while patients who desire superior comfort can explore transitioning to daily silicone hydrogel lenses. In particular, patients who experience discomfort due to contact lens dryness may benefit from daily lenses that are designed to maintain moisture, such as Bausch + Lomb's INFUSE or Johnson & Johnson's Acuvue Oasys Max 1-Day lines of lenses. In cases where optimal visual function remains elusive, ECPs can adjust the lens selection to optimize performance.
Multifocal contact lenses can be an excellent option for most presbyopic patients. ECPs need to become familiar with the intricate fitting process to meet the visual needs of an ever-expanding population of elderly patients. Incorporating fitting guides, patient biometrics, patient and disease history, and comprehensive education into the fitting protocol are important steps to set a wearer up for a comfortable and high-performing contact lens-wearing experience.
Ryan Corte, OD, is an experienced leader with a demonstrated history of success working as an optometrist, consultant, speaker, educator, and entrepreneur in the health and wellness industry.
References
- He M, Abdou A, Ellwein LB, et al. Age-related prevalence and met need for correctable and uncorrectable near vision impairment in a multi-country study. Ophthalmology. 2014;121(1):417-422.
- Berdahl J, Bala C, Dhariwal M, Lemp-Hull J, Thakker D, Jawla S. Patient and economic burden of presbyopia: a systematic literature review. Clin Ophthalmol Auckl NZ. 2020;14:3439-3450. Published 2020 Oct 22.
- Katz JA, Karpecki PM, Dorca A, et al. Presbyopia – a review of current treatment options and emerging therapies. Clin Ophthalmol Auckl NZ. 2021;15:2167-2178. Published 2021 May 24.
- Grzybowski A, Ruamviboonsuk V. Pharmacological treatment in presbyopia. J Clin Med. 2022;11(5):1385. Published 2022 Mar 3.
- Hutchins B, Huntjens B. Patients' attitudes and beliefs to presbyopia and its correction. J Optom. 2021;14(2):127-132.
- Morgan M, Woods C, Tranoudis I, et al. International contact lens prescribing in 2019. Contact Lens Spectrum. Published January 1, 2020. Accessed August 24, 2023. https://www.clspectrum.com/issues/2020/january-2020/international-contact-lens-prescribing-in-2019
- Sindt C. How a multifocal contact lens is born. Published December 16, 2009. Accessed August 24, 2023. https://www.reviewofoptometry.com/article/how-a-multifocal-contact-lens-is-born
- Sulley A, Young G, Hunt C, McCready S, Targett MT, Craven R. Retention rates in new contact lens wearers. Eye Contact Lens. 2018;44 Suppl 1:S273-S282.
- Papadatou E, Del Águila-Carrasco AJ, Esteve-Taboada JJ, Madrid-Costa D, Cerviño-Expósito A. Objective assessment of the effect of pupil size upon the power distribution of multifocal contact lenses. Int J Ophthalmol. 2017;10(1):103-108. Published 2017 Jan 18.