APPROXIMATELY 1.8 BILLION people worldwide are currently affected by presbyopia.¹ According to the 2020 report on International Contact Lens Prescribing, only 14% of all soft contact lens fits are for multifocal designs. When considering presbyopic contact lens wearers alone, 52% wear multifocal contact lenses, 10% wear monovision contact lenses and the remaining wear distance-only correction contact lenses with glasses for intermediate and near tasks.²

Some contact lens fitters may avoid multifocal and monovision contact lens fits due to their challenging nature and potential for requiring more chair time. However modern technologies, fitting techniques and appropriate candidacy selection can make all the difference in ensuring success for both the patient and doctor.

Patient Selection

The ideal multifocal contact lens candidate is a longstanding contact lens wearer with early symptoms of presbyopia, who lives an active lifestyle and exhibits motivation to reduce dependency on glasses. While this exact person rarely presents to clinic, it does not mean the remainder of our patients should not be fit in multifocal contact lenses, or at least given the option to adapt.

Although not required, contact lens familiarity is ideal for first-time multifocal contact lens patients because it omits the frustration of learning how to handle contact lenses. Keep in mind these patients’ visual needs are for close vision and they may not have the near visual acuity necessary for insertion and removal. This is particularly the case for patients with both hyperopia and presbyopia.

A younger presbyopic age is preferred over a long-time progressive or reading single vision wearer. The younger the patient, the more of their own accommodative system exists to help get them through their day. They require less of a reading add in the multifocal contact lens itself. Another reason is that many older patients with presbyopia have become accustomed to progressive or reading glasses which accommodate a higher add and provide superior optics compared to a multifocal contact lens.

Last but certainly not least, an excellent candidate for multifocal contact lenses is a person who lives an active lifestyle compared to one who spends hours or entire days on the computer or reading. An active person will require less magnification in their contact lenses compared to one who works at a desk all day long. They would be much more accepting of the functional vision provided by multifocal contact lenses, as many presbyopia patients who pursue contact lens wear are doing it because they do not want to be burdened with glasses any longer.

Establish Realistic Expectations

This cannot be emphasized enough. Although, admittedly, many patients do not understand the limitations of vision correction with contact lenses at the presbyopic age until they go through the process themselves. However, it is crucial to outline a realistic visual expectation prior to starting the refit to a multifocal contact lens.

Preferably, identify the patient’s needs and reason for wanting a multifocal contact lens. Be honest if they tell you that they want to be completely glasses free. Make sure you emphasize that vision will be clearer with glasses than it is with contact lenses. If you are honest from the start, the patient will not be surprised when this is the reality they experience during the multifocal fit process. Many patients are forgiving and willing to accept the limitations as long as they are prepared for what to expect. Most patients are thrilled with the vision they do achieve with multifocal contact lenses and the fact that they do not need to reach for reading glasses to look at a price tag at the store, or juggle multiple pairs of glasses throughout their day.

Know Your Product

Various soft and custom multifocal contact lens options exist on the market to best suit you and your patients’ needs. Contact lens manufacturers have really stepped up and offered more options and expanded parameters for our presbyopic patients than ever before. This stands true for astigmatic presbyopes and those in our older patient population who develop dry eye and require a daily disposable option.

Monthly Disposable Options

Biofinity multifocal contact lenses use Balanced Progressive Technology with two different center-distance and center-near designs, and four add powers up to +2.50.³ The Biofinity multifocal is available in a toric design with cylinder power up to -5.75 in 5 degree increments around the clock.

Bausch + Lomb’s Ultra multifocal contact lens uses a center-near three zone progressive aspheric design. The fitting is streamlined with only two add selections of either low, for up to +1.50 add powers, and high, for +1.75 to +2.50. The Ultra multifocal lens is now available for astigmatic patients with cylinder power up to -1.75 D around the clock in 10 degree increments.

Air Optix multifocal functions with its proprietary Precision Profile Design, utilizing center-near bi-aspheric optics to allow transition between distance, intermediate and reading. It is available in three add powers, including low, medium and high.

Biweekly Disposable Options

The newest multifocal contact lens released to the market is the Acuvue Oasys multifocal with Pupil Optimized Design. It is a center-near three zone multifocal lens with a proprietary pupil optimized design which accommodates for pupil size by both age and refractive error. It also exhibits a hybrid back surface with center aspheric and spherical periphery.

Daily Disposable Options

The Clariti multifocal contact lens utilizes a center near with progressive intermediate and peripheral distance design. This means it transitions from reading, to intermediate near, then intermediate distance, and finally, distance from the center to the periphery. This allows patients an easy transition at all ranges.

Three daily disposable options use the same multifocal design as their manufacturer’s monthly disposable multifocal option. These are Alcon’s Dailies Total 1 (same as Air Optix), Johnson and Johnson’s Acuvue Moist (same as Acuvue Oasys Multifocal), and Bausch + Lomb’s BioTrue (same as Ultra).

The MyDay Multifocal by CooperVision is soon to be released to the market. While the specific design has not been revealed, it is confirmed to be different than any other daily disposable multifocals on the market. More to come with this lens!

Rigid Gas Permeable (RGP) Options

Various custom hard contact lens options exist for presbyopic patients, including multifocal, simultaneous and translating designs.

Bausch + Lomb’s Boston multivision lens offers a back surface aspheric design for distance and intermediate vision with an additional +1.50 add for reading.

Blanchard Lab manufactures two multifocal RGP options, including the Reclaim HD and Essential lenses. The Reclaim HD is a bi-aspheric lens with various custom options to optimize vision at all distances while reducing aberration. The Essential multifocal utilizes both translating and simultaneous technology with a center distance in primary gaze and aspheric periphery with a series of add power options.

Valley Contax also offers three RGP options for presbyopic patients. First, the Golden Eye Aspheric Front Multifocal (AFM) uses a center distance design with front surface aspheric optics and back surface spherical fitting characteristics. This means the provider can change each independently without influencing or having to change the other. Their second option is the Platinum Eye which uses a bi-aspheric simultaneous multifocal design with an aspheric back surface and aspheric front surface for additional add power. Lastly, Valley Contax offers the Buckley Translating lens, or back surface spherical executive bifocal, for those patients who cannot tolerate aspheric optics. Just be sure the person’s lid apposition is tight enough to hold the lens in place.

Use Your Resources

Last and certainly not least, use the resources provided to you by each manufacturer to ensure success with multifocal contact lens fits. There are various apps, websites and fitting guides available to streamline the multifocal fit. In the case of RGP lenses, utilize the consultants to help with any questions or troubleshooting that may arise.

Finally, enjoy providing this to your patients! It can sometimes be challenging but the reward and joy it brings to your patients will be worth every effort. ■

References

1. Fricke TR, Tahhan N, Resnikoff S, et al. Global prevalence of presbyopia and vision impairment from uncorrected presbyopia: systematic review, meta-analysis, and modelling. Ophthalmology. 2018;125:1492-1499, http://dx.doi.org/10.1016/j.ophtha.2018.04.013 .
2. International Contact Lens Prescribing in 2020. Contact Lens Spectrum. January 2021.
3. CooperVision data on file 2020. Rx coverage database n=101,973 aged 14 to 70 years.

Dr. Crowley provides comprehensive eye care at Lexington Eye Associates, a tertiary care group in Massachusetts. In addition to optometric care, she is director of dry eye and professional practice liaison.