Bifocal and Multifocal Contact Lenses for Presbyopia and Myopia Control

Abstract

Bifocal and multifocal optical devices are intended to get images into focus from objects placed at different distances from the observer. Spectacles, contact lenses, and intraocular lenses can meet the requirements to provide such a solution. Contact lenses provide unique characteristics as a platform for implementing bifocality and multifocality. Compared to spectacles, they are closer to the eye, providing a wider field of view, less distortion, and their use is more consistent as they are not so easily removed along the day. In addition, contact lenses are also minimally invasive, can be easily exchangeable, and, therefore, suitable for conditions in which surgical procedures are not indicated. Contact lenses can remain centered with the eye despite eye movements, providing the possibility for simultaneous imaging from different object distances. The main current indications for bifocal and multifocal contact lenses include presbyopia correction in adult population and myopia control in children. Considering the large numbers of potential candidates for optical correction of presbyopia and the demographic trends in myopia, the potential impact of contact lenses for presbyopia and myopia applications is undoubtedly tremendous. However, the ocular characteristics and expectations vary significantly between young and older candidates and impose different challenges in fitting bifocal and multifocal contact lenses for the correction of presbyopia and myopia control. This review presents the recent developments in material platforms, optical designs, simulated visual performance, and the clinical performance assessment of bifocal and multifocal contact lenses for presbyopia correction and/or myopia progression control.

Quarter of a century of contact lens prescribing trends in the United Kingdom (1996 – 2020)

“…The greater use of multifocal soft lenses versus monovision over the past decade can be attributed to a combination of (a) increasing availability of multifocal designs [11], and (b) advances in optical designs that offer more acceptable vision with multifocal contact lenses than has been available previously [22].…”

Presbyopia – A Review of Current Treatment Options and Emerging Therapies

“…Contact lens selection and a comprehensive pre-fitting evaluation are important in multifocal lens wear, due to patient satisfaction relying strongly on lens centration, pupil size, ocular optics, and neural adaptation. 37,38 The success of multifocal contact lenses can vary substantially across individuals due to differences to blur tolerance, ocular aberrations and neural adaptation. 37 Although the extent to which multifocal and monovision lenses are prescribed for presbyopia varies considerably by country, an international survey report in 2011 revealed the rate of multifocal soft contact lens prescribing was over 3 times greater than that for monovision soft contact lenses (25% compared to 7%), with survey results revealing an overall low rate of presbyopic contact lenses prescribing.…”

“…37,38 The success of multifocal contact lenses can vary substantially across individuals due to differences to blur tolerance, ocular aberrations and neural adaptation. 37 Although the extent to which multifocal and monovision lenses are prescribed for presbyopia varies considerably by country, an international survey report in 2011 revealed the rate of multifocal soft contact lens prescribing was over 3 times greater than that for monovision soft contact lenses (25% compared to 7%), with survey results revealing an overall low rate of presbyopic contact lenses prescribing. 39 However, in more recent years the multifocal market share has grown due to technological advances in lens design, materials and manufacturing methods, as well as the availability of various lens replacement options and the increased practitioner confidence.…”

“…Contact lens selection and a comprehensive pre‐fitting evaluation are important in multifocal lens wear, due to patient satisfaction relying strongly on lens centration, pupil size, ocular optics, and neural adaptation. 37 , 38 The success of multifocal contact lenses can vary substantially across individuals due to differences to blur tolerance, ocular aberrations and neural adaptation. 37 …”

Comparison of short‐term light disturbance, optical and visual performance outcomes between a myopia control contact lens and a single‐vision contact lens

“…Poor visual satisfaction due to photic phenomena, visual fluctuations and inadequate visual quality is the most common reason why presbyopes discontinue multifocal contact lens wear. However, it is unlikely that children, who do most of their activities under good lighting conditions, would complain of these photic phenomena, and the high rates of retention in clinical trials involving DF lenses indirectly confirms this 10,11 …”