Multifocal contact lenses recommended for patients nearing middle age
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Investigators encouraged early multifocal lens intervention for patients nearing age 40 years despite finding no significant difference in comfort between multifocal and single lens wear, according to a study published in Ophthalmic and Physiological Optics.
“Research examining how aspheric multifocal contact lenses affect accommodation reports mixed conclusions,” Erin Rueff, OD, PhD, FAAO, of the Southern California College of Optometry, and colleagues wrote. “Due to this difficulty in accommodative measurement, assessing symptoms of visual discomfort may be an optimal way to determine if visual fatigue is alleviated by a multifocal contact lens.”
The randomized, participant-masked, crossover clinical trial included 84 subjects between 30 and 40 years old who reported discomfort wearing soft contact lenses.
Rueff and colleagues fitted participants with single vision and multifocal contact lenses to wear for 2 weeks each, then measured for contact lens discomfort symptom severity using the Contact Lens Dry Eye Questionaire-8 (CLDEQ-8) and the Convergence Insufficiency Symptom Survey (CISS).
Study data showed an interaction between lens type and age group, with participants in the under 35 age group preferring the single lens for immediate distance (P = .003) and overall vision (P = .002). Symptom scores for all participants improved with the single vision (CLDEQ-8 P < .001; CISS P < .001) and the multifocal lens (CLDEQ-8 P < .001; CISS P < .001). However, there was no significant difference in surveys scores between the single vision and multifocal lens.
“These results suggest that wearers approaching 40 years with symptoms of contact lens discomfort may benefit from a multifocal contact lens earlier than typical clinical practice,” Rueff and colleagues wrote. “These findings directly impact clinical care and encourage eye care providers to consider multifocal contact lens correction in uncomfortable contact lens wearers.”
Perspective
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Celia Gong, OD, MS, FAAO, FSLS
If you fit contact lenses, you know that contact lens dropout from discomfort is common, particularly with older individuals. The etiology of discomfort is often attributed to dry eye, even when the signs of dry eye do not match the patient’s symptoms. The authors bring to light a source of contact lens discomfort that I have not strongly considered before: visual discomfort. This can be in the form of accommodative or vergence fatigue, which the authors hypothesized may be relieved by multifocal contact lenses in myopic pre-presbyopes between 30 to 40 years old.
The results did not support the use of multifocal lenses in younger pre-presbyopes (younger than 35 years old), but it was interesting that older pre-presbyopes (35 to 40 years old) did not report a preference between single vision or multifocal lenses.
When I encounter patients with contact lens discomfort, I would switch modalities or brands before recommending multifocal lenses, because the conclusions do not strongly support fitting multifocal lenses in pre-presbyopes. However, I would now start to consider multifocal lenses as an option when troubleshooting uncomfortable contact lens wearers. A more thorough assessment of binocular vision in a future study may be useful in predicting whether an uncomfortable, emerging presbyopic contact lens wearer can benefit from multifocal lenses.
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Rueff E, et al. Ophthalmic Physiol Opt. 2021;doi:10.1111/opo.12761.
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