Multifocal contacts can help overcome digital eye strain in presbyopia

ByOsama Said, OD

Fact checked byHeather Biele

Today’s presbyopes lead increasingly digital lifestyles, with extensive attention to screens, which research shows can cause decreased and incomplete blinking, tear film instability and lead to the development of dry eye disease.

Given the high prevalence of digital eye strain in presbyopes, those who wish to wear contact lenses may benefit from corrective options that meet their visual demands while also promoting ocular surface health.

With age comes presbyopia

Clinicians understand that presbyopia is part of the natural aging process, but many patients may be sensitive about the topic of aging. Having a sympathetic conversation with a patient about their presbyopia can put them at ease before any discussions regarding treatment.

During their first visit, I let presbyopic patients know that treatment options are not limited to reading or progressive spectacle lenses, especially with advances in multifocal soft contact lenses that can help them focus at a range of distances and allow them to reduce or eliminate their reliance on glasses. As part of this discussion, it is also worth bringing up lifestyle factors, such as digital device use, that may be contributing to patients’ ocular symptoms.

Today’s digital presbyope

Prolonged digital device use can lead to digital eye strain, characterized by dryness, tearing, pruritus, blurring, foreign body sensation and headaches. In a 2016 Vision Council report, 65% of adults in their 40s spent more than 5 hours a day on their smartphones, computers and other digital devices. Following the COVID-19 pandemic, digital device use rose steeply, increasing the prevalence of digital eye strain.

Prior to the pandemic, 65% of Americans reported digital eye strain symptoms and after, prevalence rose to between 80% and 94% (Kaur K, et al; The Vision Council). For today’s presbyope, additional screen time has compounded difficulties with refocusing and ocular fatigue and can affect the maintenance of ocular surface homeostasis.

Tasks that demand extended visual focus may decrease the rate and completeness of blinking. Blinking is essential to spreading the tear film and expressing lipid from the meibomian glands; changes in blinking dynamics can lead to tear film evaporation and to signs and symptoms of dry eye disease.

In addition, age-related changes to meibomian and lacrimal gland function can also lead to tear film instability and hyperosmolarity. Such challenges to tear film and ocular surface homeostasis can add complexity to the difficulty of managing presbyopia.

Combating digital eye strain

For patients with presbyopia who experience digital eye strain, managing the tear film and ocular surface is an essential step toward optimizing visual outcomes and minimizing symptoms. Depending on the level of symptoms and signs present, initial interventions often include behavioral changes, over-the-counter artificial tears and vision correction options that work with patients’ lifestyles.

I recommend that my presbyopic patients who have digital eye strain limit their screen time as much as possible and use hyaluronate-based, preservative-free artificial tears to help manage symptoms. To help them remember to instill the drops every few hours, I tell them to create a reminder on one of their digital devices.

Many presbyopes elect to use reading glasses or progressive addition lenses when they are first diagnosed with presbyopia. But in my experience, most of these patients return to my practice within a year or so seeking multifocal contact lenses because they have grown tired of carrying around their glasses. Given all the intrinsic and extrinsic stresses on the ocular surface, I look for lens materials with properties including high moisture content and high oxygen permeability to help minimize the impact of contact lens wear on the eye.

Multifocal contact lens technology

As technology advances, so do the designs and features of multifocal contact lenses. For example, Bausch + Lomb’s Infuse Multifocal daily disposable contact lenses have been developed with a proprietary solution of ingredients inspired by the Tear Film and Ocular Surface Society Dry Eye Workshop Study II report that includes osmoprotectants (erythritol and glycerin), electrolytes (potassium) and moisturizers (poloxamine 1107 and poloxamer 181) to help maintain ocular surface homeostasis and the integrity of tear film proteins. The silicone hydrogel material also retains 96% of its moisture for a full 16 hours, the company states.

Johnson & Johnson’s 1-Day Acuvue Moist Multifocal contact lens uses Lacreon technology, which incorporates a wetting agent into the lens and is recommended for up to 14 hours of use. CooperVision’s Biofinity Multifocal contact lens has Aquaform Technology, which underpins water molecules to the lens, hydrating the lens to twice its weight for comfort, the company states.

These multifocal contact lenses offer vision correction for presbyopes while also reducing disruptions to the ocular surface so wearers feel comfortable in their contact lenses all day, without contact lens-induced dryness.

Best treatment practices

To support both visual outcomes and comfort in presbyopic patients, managing tear film and ocular surface health is a top priority. Taking breaks from digital devices and using artificial tears may help ameliorate symptoms, even if most patients will likely still depend on electronic devices for communication, recreation and work-related tasks.

For those who wish to wear contact lenses, thinking about material properties that can influence tear film health and comfort is another step we can take toward combating digital eye strain and dryness symptoms.

References:

Al-Mohtaseb Z, et al. Clin Ophthalmol. 2021;doi:10.2147/OPTH.S321591.
Bausch + Lomb. Infused for balance. https://ecp.bauschcontactlenses.com/products/infuse-one-day/. Accessed Sep. 28, 2023.
Bron AJ, et al. Ocul Surf. 2019;15(3):438-510;doi:10.1016/j.jtos.2017.05.011.
CooperVision. Aquaform Technology. https://coopervision.com/product-technology/aquaform-technology Accessed Sep. 28, 2023.
Ding J, Sullivan DA. Exp Gerontol. 2012;doi:10.1016/j.exger.2012.03.020.
Eyes overexposed: the digital device dilemma. https://d3adjw0o5v66jd.cloudfront.net/wp-content/uploads/sites/146/2016/01/digital-strain-report.pdf. Published 2016. Accessed Nov. 29, 2023.
Galindo-Romero C, et al. Int Ophthalmol. 2023;doi:10.1007/s10792-023-02724-z.
Hirota M, et al. Optom Vis Sci. 2013;doi:10.1097/OPX.0b013e31829962ec.
Kaur K, et al. Ophthalmol Ther. 2022;doi:10.1007/s40123-022-00540-9.
1-Day Acuvue Moist Multifocal contact lenses. https://www.lens.com/contact-lenses/1-day-acuvue-moist-multifocal/. Accessed Oct. 2, 2023.
Sheppard AL, et al. BMJ Open Ophthalmol. 2018;doi:10.1136/bmjophth-2018-000146.
What is Lacreon technology? https://www.lens.com/eyestyle/technology/what-is-lacreon-technology/. Accessed Sep. 28, 2023.

For more information:

Osama Said, OD, practices at MyEyeDr. in Raleigh, North Carolina, with extensive experience in corneal refractive therapy and surgery comanagement.

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Sources/Disclosures

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Disclosures: Said reports consulting for Bausch + Lomb.

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