THE TREND OF AN AGING POPULATION has been well documented in many developed countries,1 leading to significant demand for presbyopia-related vision correction. In the United States alone, presbyopia affects an estimated 83.0% to 88.9% of adults aged ≥45 years old—about 131 million individuals, based on the latest census data.2,3 This growing demand, together with technological innovations, has contributed to continuous growth in presbyopic correction with contact lenses (CLs).4,5
Today, patients with presbyopia have 3 primary options to correct their refractive error with CLs: supplemental spectacle correction, monovision CLs, and multifocal CLs.6 Supplemental spectacle correction can be inconvenient due to the need for extra reading glasses on top of the CLs. Monovision CLs are associated with reduced depth perception and can be challenging to adjust in some patients. Multifocal CLs provide optimized visual performance over the entire visual range, allowing wearers to transition between near and distance vision seamlessly.
Selecting the Appropriate Power Profile
In the multifocal CL category, various innovative lens designs are available that achieve corrected vision at both near and far. For instance, Alcon’s multifocal CLs (Dailies TOTAL1) use a Precision Profile® Design with the highest plus power in the center that gradually decreases toward the periphery. Bausch + Lomb’s multifocal CLs (INFUSE) feature a unique 3-Zone Progressive Design—near at the center, intermediate in the middle, and distance at the peripheral—that provides consistent power within each zone and a smooth transition between zones. CooperVision’s MyDay multifocals use a Binocular Progressive System™ to give maximized distance and near vision. Johnson & Johnson’s ACUVUE brand of lenses employs a Pupil Optimized Design to work with the natural aspects of the pupil and create clear zones at distance and near.
With numerous multifocal CL options, eyecare professionals should carefully consider each patient’s unique needs to select the appropriate power profile that maximizes visual performance and patient satisfaction. Because a majority of presbyopia cases first develop during the patients’ working age, a correction solution that supports extended computer use is required. For these individuals, a CL power profile that seamlessly transitions across the entire visual range is crucial in supporting work that demands quick changes in focus.
For individuals in the postretirement age group, the ability to see both up close and far away is critical, especially during outdoor activities. For instance, an avid golfer requires sharp reading vision to view a scorecard and distance vision to read the greens effectively. Conversely, a presbyopic person who enjoys activities at home, such as arts and crafts, may prioritize sharp near and intermediate vision to improve functionality with their hobbies. As each daily activity presents its own visual challenges, a personalized approach to multifocal CL selection is pivotal to ensuring a good fit for each patient’s lifestyle.
In addition to selecting the appropriate lens design and power profile, careful adherence to the fit guide can improve patient outcomes. Lens manufacturers dedicate considerable effort to creating fit guides that optimize visual performance. A careful evaluation of the fit guide should be an integral part of all patients’ fitting experiences, whether they are new to multifocal CLs or have previously received an incorrect or uncomfortable prescription.
Enhancing Patient Satisfaction
As one of the most common conditions attributed to aging, presbyopia can have an adverse psychological effect. Numerous studies have shown that a negative self-perception of old age contributes to faster aging, as indicated by significant associations with worse health, lower life satisfaction, higher dementia risk, and shorter lifespan.7–10
Among the visual correction solutions used to manage presbyopia, reading glasses are by far the most popular.11,12 However, reading glasses are also stereotypically associated with old age and considered by many presbyopic people to be both cumbersome and inefficient in daily use.
For these patients, multifocal CLs are an attractive option that improve cosmetic appearance without sacrificing visual performance. Specifically, multifocal CLs provide a greater level of flexibility in visual performance, while eliminating the need to carry or adjust reading glasses.
Wearing CLs can also help the wearer feel more active and youthful, leading to a healthier psychological state and greater social well-being. In a recent survey, 67% of presbyopic and pre-presbyopic individuals reported preferring to wear CLs over other correction options.13
In general, superior visual performance is closely linked to greater patient satisfaction among presbyopes. These individuals seek a correction option that not only is comfortable and discreet during daily use but also delivers uncompromising performance. For many patients, an appropriate multifocal CL can meet all these criteria and provide greater satisfaction than other visual correction options.
Effective Communication With Patients
Despite advancements in lens designs and options, the adoption rate of multifocal CLs remains low, with a notable discontinuation rate of approximately 31% by year 1 in one study.14 Patients often cite poor vision and discomfort as the primary reasons for discontinued use.15 For practitioners, it is vital to effectively communicate the benefits to their patients and set realistic expectations.
During the initial visit with a presbyopic patient, I find it valuable to thoroughly explore all the available options, with a particular focus on the benefits and disadvantages of each. The extra time spent here helps to educate patients unfamiliar with multifocal CLs and dispels any misconceptions that could discourage adoption. Such an approach also fosters a strong and trusting patient-provider relationship that can support patients who may be hesitant to try new solutions for their presbyopia.
When discussing innovative, yet complex, lens technologies, it is easy to overwhelm the patient with technical details. Rather than going in-depth with advanced concepts, I like to meet patients where they are by discussing situations in which technologies can play a difference in their daily lives. Some concepts may not be common knowledge for patients, so it is important to avoid making assumptions to prevent any potential gaps in understanding.
Effective communication is particularly important to dispel and prevent misconceptions associated with multifocal CLs. Many patients who come to the clinic believe that multifocal CLs are not a good option because someone in their social circle or on the Internet has shared a negative experience. As eyecare providers, we are responsible for proactively educating patients about the technology and highlighting how multifocal CLs can be an excellent option for individuals with presbyopia. My ultimate goal is to empower all patients to make informed decisions about their preferred vision correction method.
Apart from education, practitioners should also aim to set realistic visual performance expectations during both initial and routine multifocal CL wear. It is common for patients to experience subpar visual performance when trying multifocal CLs for the first time, but it is important to emphasize that visual function will naturally improve as the brain adapts to the new optical system.
I also advise my patients that it is unlikely for them to return to perfect vision with multifocal CLs. Instead, I ask them to focus on evaluating their visual experience during major tasks, such as driving a car, reading on their smartphone, or using a computer. If a patient encounters no major visual issues during these activities, I then recommend that the patient undergo a 2-week adjustment period before fine-tuning the prescription to optimize vision.
Providing a Personalized Care Experience
With the variety of multifocal CL technologies available, it is crucial to counsel our patients on the options available to help deliver a more personalized care experience. In particular, each lens design’s unique power profile can significantly impact the final visual performance and should be a core part of patient education.16 While requiring a greater time investment from the provider, this approach leaves a lasting impact on the final care experience, as patients feel that they have received a personalized recommendation based on their preferences and needs.
Except for certain patients with excessive ocular surface issues, multifocal CLs can be an excellent visual correction option for many presbyopes. The key lies in identifying the appropriate CL to match each patient’s daily visual needs and comfort requirements. As eyecare professionals, we play a critical role in guiding patients through the journey to achieve optimal vision and overall well-being. ■
- Preston SH, Stokes A. Sources of population aging in more and less developed countries. Popul Dev Rev. 2012;38(2):221-236.
- 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. 2020;14:3439-3450.
- Administration for Community Living. 2020 Profile of Older Americans. https://acl.gov/sites/default/files/Profile%20of%20OA/2020ProfileOlderAmericans_RevisedFinal.pdf . Published 2021. Accessed August 10, 2023.
- Morgan PB, Efron N. Global contact lens prescribing 2000 to 2020. Clin Exp Optom. 2022;105(3):298-312.
- Kim E, Bakaraju RC, Ehrmann K. Power profiles of commercial multifocal soft contact lenses. Optom Vis Sci. 2017;94(2):183-196.
- Pérez-Prados R, Piñero DP, Pérez-Cambrodí RJ, Madrid-Costa D. Soft multifocal simultaneous image contact lenses: a review. Clin Exp Optom. 2017;100(2):107-127.
- Stephan Y, Sutin AR, Terracciano A. Subjective age and mortality in three longitudinal samples. Psychosom Med. 2018;80(7):659-664.
- Blöchl M, Nestler S, Weiss D. A limit of the subjective age bias: feeling younger to a certain degree, but no more, is beneficial for life satisfaction. Psychol Aging. 2021;36(3):360-372.
- Stephan Y, Sutin AR, Luchetti M, Terracciano A. Subjective age and risk of incident dementia: Evidence from the National Health and Aging Trends survey. J Psychiatr Res. 2018;100:1-4.
- Wettstein M, Spuling SM, Cengia A, Nowossadeck S. Feeling younger as a stress buffer: Subjective age moderates the effect of perceived stress on change in functional health. Psychol Aging. 2021;36(3):322-337.
- New survey: what your patients don’t know about presbyopia. Review of Optometric Business. 2019.A
- McDonald MB, Barnett M, Gaddie IB, et al. Classification of presbyopia by severity. Ophthalmol Ther. 2022;11(1):1-11.
- Dumbleton K, Palombi J. Soft multifocal contact lenses: a review. Cont Lens Spectrum. 2022;37(6):34-38,40.
- Sulley A, Young G, Hunt C, McCready S, Targett MT, Craven R. Retention rates in new contact lens wearers. Eye Cont Lens. 2018;44(Suppl 1):S273-S282.
- Rueff EM, Varghese RJ, Brack TM, Downard DE, Bailey MD. A survey of presbyopic contact lens wearers in a university setting. Optom Vis Sci. 2016;93(8):848-854.
- Novillo-Díaz E, Villa-Collar C, Narváez-Peña M, Martín JLR. Fitting success for three multifocal designs: multicentre randomised trial. Cont Lens Anterior Eye. 2018;41(3):258-262.