Arming yourself with the right information can make multi-focal contact lenses a breeze. Brush up on the best in the industry with this guide.
It’s 4:45 PM at the end of a long day and in your mind you’re halfway out the door — until you see the chief complaint on your next chart. “55-year-old with decreased vision in their monovision contacts.” You picture your hands shaking as you hold loose lenses in front of an increasingly unimpressed patient. Sure, they can read the 20/20 line, but it’s a blurry 20/20 . . . Suddenly the end of the day doesn’t seem so near.
While I chose to pick on monovision wearers — they’re an easy target — all presbyopic contact lens wearers should be included in the discussion on multifocal contact lenses. By offering improved depth perception compared to monovision and eliminating the inconvenience of reading glasses over single-vision lenses, the advantages of multifocal contacts lenses are easy for the patient to recognize. In fact, more and more frequently, I find that patients are the first ones to broach the subject.
Don’t let them be. By being the one to present new technologies and anticipating their visual needs, we build patient confidence in our skills and in the lenses that we prescribe. That being said, it's difficult to recommend anything without a working knowledge of the product. What follows is a brief review of multifocal lens designs and the most popular lenses currently on the market.
Lens Designs
Often I hear doctors describe multifocal contacts to their patients as “kind of like progressives." And I get it. It’s familiar to the patient, easy to explain, and close to the truth. As practitioners, though, we should know the design used in a given multifocal lens, if for no other reason than to avoid repeating similar designs after a failed trial.
Translating designs are common in RGP lenses and work by moving a near correction in front of the pupil when the patient shifts gaze.1 Most soft contacts use simultaneous vision designs — termed such because multiple vision corrections are viewed at the same time. It is this viewing of multiple prescriptions at once which causes the mild visual compromise associated with multifocal lenses.
Of the lenses produced by the four major manufacturers (Johnson & Johnson, Alcon, Bausch & Lomb, and CooperVision) nearly all use some variation of a center-near, aspheric design. Acuvue® Oasys for Presbyopia, which utilizes a center-distance design combined with alternating, aspheric, concentric rings, is one of the few exceptions. Regardless of lens design, initial selection will begin by selecting a replacement schedule — monthly, biweekly, or daily.
Monthly Replacement
Like many of you, I prescribe monthly-replacement lenses due to improved patient compliance over biweekly options and a lower price point than daily disposables. Alcon, Bausch & Lomb, and CooperVision offer multifocal lenses in this category.
Alcon:
The Air Optix® Aqua Multifocal is Alcon’s flagship monthly multifocal. Featuring a center-near, bi-aspheric design and low, medium, and high add powers, this multifocal is a logical transition for patients already wearing Air Optix® monthly lenses. Expect to see Alcon rollout the Air Optix® “plus Hydraglyde” Multifocal — promising increased comfort and reduced protein deposition — in the coming months.2
Air Optix® Aqua Multifocal
Dk/t (at-3.00D) | 138 |
---|---|
Base Curve | 8.6 |
Diameter | 14.2 |
Add Powers | Low, Medium, High |
Powers Available (0.25D steps) | +6.00 to -10.00D |
Design | Center-near, bi-aspheric |
Initial Lens Selection (Up to +1.25) | Low Add OU |
Initial Lens Selection (+1.50 to +2.00) | Medium Add OU |
Initial Lens Selection (+2.25 to +2.50) | High Add OU |
Bausch & Lomb
Ultra for Presbyopia is Bausch & Lomb’s premier monthly multifocal, largely supplanting both generations of the PureVision multifocal. The PureVision2 for Presbyopia shares a similar design with the Ultra for Presbyopia — center-near with a “3-Zone Progressive” to provide clear vision at far, intermediate, and near distances. The original PureVision Multifocal shares a center-near, front aspheric design with Bausch & Lomb’s biweekly Soflens Multifocal.
Ultra for Presbyopia
Dk/t (at-3.00D) | 163 |
---|---|
Base Curve | 8.5 |
Diameter | 14.2 |
Add Powers | Low, High |
Powers Available (0.25D steps including plano) | +6.00 to -10.00D |
Design | Center-near, "3-Zone Progressive" |
Initial Lens Selection (+0.75 to +1.50D) | Low Add OU |
Initial Lens Selection (+1.75 to +2.50D) | High Add OU |
PureVision for Multifocal
Dk/t (at-3.00D) | 101 |
---|---|
Base Curve | 8.6 |
Diameter | 14.0 |
Add Powers | Low, High |
Powers Available (0.25D steps) | +6.00 to -10.00D |
Design | Center-near, front surface aspheric |
Initial Lens Selection (Up to +1.25) | Low Add OU |
Initial Lens Selection (+1.50 to +1.75) | High Add OU with -0.25D/-0.50D over the distance power |
Initial Lens Selection (+2.25 to +2.50) | High Add OU |
PureVision 2 for Presbyopia
Dk/t (at-3.00D) | 130 |
---|---|
Base Curve | 8.6 |
Diameter | 14.0 |
Add Powers | Low, High |
Powers Available (0.25D steps) | +6.00 to -10.00D |
Design | Center-near, aspheric, "3-Zone Progressive" |
Initial Lens Selection (+0.75 to +1.50D) | Low Add OU |
Initial Lens Selection (+1.75 to +2.50D) | High Add OU |
CooperVision:
CooperVision bucks the trend of center-near lenses, if only slightly, by introducing separate designs for the dominant and non-dominant eye. In both the Biofinity Multifocal and the Proclear Multifocal, a center-distance lens is placed over the dominant eye* and a center-near lens is placed over the non-dominant eye. The Proclear Multifocal is also available in toric powers, unlike any of the other lenses presented here. While not a traditional multifocal, CooperVision also produces Biofinity Energys, which uses “Digital Zone Optics” to relieve accommodative stress associated with digital device use.
*The dominant eye is the eye which reports greater blur when alternating +1.50 or +2.00D lens between the best-corrected eyes.
Biofinity Multifocal
Dk/t (at-3.00D) | 142 |
---|---|
Base Curve | 8.6 |
Diameter | 14.0 |
Add Powers (D and N) | +1.00, +1.50, +2.00, +2.50 |
Powers Available (-0.50 steps after -6.50D) | -10.00D to +6.00D |
Design | Center-near non-dominant, center-distance dominant |
Initial Lens Selection (+1.00) | +1.00D OU |
Initial Lens Selection (+1.50) | +1.50D OU |
Initial Lens Selection (+2.00) | +2.00D (dominant eye) and +2.00N (non-dominant eye) |
Initial Lens Selection (+2.50) | +2.50D (dominant eye) and +2.50N (non-dominant eye) |
Proclear Multifocal (including XR)
Dk/t (at-3.00D) | 21.3 |
---|---|
Base Curve | 8.7 (XR only: 8.4) |
Diameter | 14.4 |
Add Powers (D and N) | (XR only: +3.00, 3.50D, +4.00) |
Powers Available (-0.50 steps after +/-6.50D) | -8.00D to +6.00D (XR only: -20.00D to +20.00D) |
Design | Center-near non-dominant, center-distance dominant |
Initial Lens Selection (+1.00) | +1.00D (dominant eye) and +1.00N (non-dominant eye) |
Initial Lens Selection (+1.50) | +1.50D (dominant eye) and +1.50N (non-dominant eye) |
Initial Lens Selection (+2.00) | +2.00D (dominant eye) and +2.00N (non-dominant eye) |
Initial Lens Selection (+2.50) | +2.50D (dominant eye) and +2.50N (non-dominant eye) |
Note: Round down if add power is between available adds. XR follows the same fitting guidelines.
Proclear Multifocal Toric
Dk/t (at-3.00D) | 21.3 |
---|---|
Base Curve | 8.4, 8.8 |
Diameter | 14.4 |
Add Powers (D and N) | +1.00, +1.50, +2.00, +2.50, +3.00, +3.50, +4.00 |
Powers Available (-0.50 steps after +/-6.50D SPH) | SPH: +20.00D to -20.00D CYL: -0.75 to -5.75 (0.50D steps) Axis: 5° steps full |
Design | Center-near non-dominant, center-distance dominant |
Initial Lens Selection (+1.00) | +1.00D (dominant eye) and +1.00N (non-dominant eye) |
Initial Lens Selection (+1.50) | +1.50D (dominant eye) and +1.50N (non-dominant eye) |
Initial Lens Selection (+2.00) | +2.00D (dominant eye) and +2.00N (non-dominant eye) |
Initial Lens Selection (+2.50) | +2.50D (dominant eye) and +2.50N (non-dominant eye) |
Initial Lens Selection (++) | Etc. |
Note: Round down if add power is between available adds
Biofinity Energys
Dk/t (at-3.00D) | 160 |
---|---|
Base Curve | 8.6 |
Diameter | 14.0 |
Add Powers | N/A |
Powers Available (-0.50 steps after +/-6.50D) | +8.00 to -12.00D |
Design | Front-surface aspheric, "Digital Zone Optics" |
Initial Lens Selection | Vertex distance corrected, spherical equivalent spectacle Rx |
Biweekly Replacement
While biweekly lenses suffer a stigma of patient overwear, in some cases they represent the best option for transitioning patients into a multifocal lens (e.g. Acuvue® Oasys loyalists). Acuvue® and Bausch & Lomb both offer biweekly multifocal options.
Acuvue® (Johnson & Johnson):
Acuvue® Oasys for Presbyopia offers a unique, center-distance design with concentric, aspheric rings providing correction at intermediate and near distances — they call this “Stereo Precision Technology." Between the comfort provided by Hydraclear Plus and the familiarity of the brand, Acuvue® Oasys for Presbyopia can be a gentle transition for presbyopic patients looking to move into a multifocal lens.
Acuvue® Oasys for Presbyopia
Dk/t (at-3.00D) | 147 |
---|---|
Base Curve | 8.4 |
Diameter | 14.3 |
Add Powers | Low, Medium, High |
Powers Available (0.25D steps) | +6.00 to -9.00D |
Design | Center-distance, multi-zonal, aspheric, concentric rings |
Initial Lens Selection (+0.75D to +1.25D) | Low Add OU |
Initial Lens Selection (+1.50D to +1.75D) | Medium Add OU |
Initial Lens Selection (+2.00D to +2.50D) | High Add OU |
Bausch & Lomb:
The less said about the Soflens Multifocal, the better. With an abysmal Dk and the dated “NatraSight” design found in the original PureVision Multifocal, your patient will be better off in one of B&L’s monthly designs. If biweekly wear is a must, consider Acuvue® Oasys for Presbyopia.
Soflens Multifocal
Dk/t (at-3.00D) | 8.4 |
---|---|
Base Curve | 8.5, 8.8 |
Diameter | 14.5 |
Add Powers | Low, High |
Powers Available (0.25D steps) | +6.00 to -7.00D |
Design | Center-near, front surface aspheric |
Initial Lens Selection (+0.75 to 1.50D) | Low Add OU |
Initial Lens Selection (+1.75 to +2.50D) | High Add OU |
Daily Replacement
Dailies, increasingly popular with active, young patients should not be overlooked when prescribing for presbyopic patients. Older patients will also appreciate the health benefits and convenience of this modality and are often more prepared to pay the higher price tag. All 4 major brands now produce daily disposable multifocal lenses.
Acuvue® (Johnson & Johnson):
While Johnson & Johnson’s 1-Day Acuvue® Moist Multifocal doesn’t offer an impressive Dk compared to some dailies, the addition of Lacreon technology provides improved patient comfort via an embedded wettability agent. The 1-Day Acuvue® Moist Multifocal is the only lens optimized for presbyopic pupil sizes and utilizes a center-near aspheric design to achieve clear vision at all distances. All of that, in addition to UV blocking materials, makes this lens a contender for any daily replacement multifocal wearer.
1-Day Acuvue® Moist Multifocal
Dk/t (at-3.00D) | 28 |
---|---|
Base Curve | 8.4 |
Diameter | 14.3 |
Add Powers | Low, Medium, High |
Powers Available (0.25D steps) | +6.00 to -9.00D |
Design | Center-near, aspheric, "pupil optimized" |
Initial Lens Selection (+0.75D to +1.25D) | Low Add OU |
Initial Lens Selection (+1.50D to +1.75D) | Medium Add OU |
Initial Lens Selection (+2.00D to +2.50D) | Medium Add (dominant eye), High Add (non-dominant eye) |
Alcon:
Alcon offers two daily replacement multifocal options — the Dailies AquaComfort Plus Multifocal and the Dailies Total 1 Multifocal. The AquaComfort Plus Multifocal is business as usual for Alcon, with the bi-aspheric, center-near design of the Air Optix® Aqua Multifocal, combined with the materials of Dailies AquaComfort Plus.
The Dailies Total 1 Multifocal doesn’t branch out from Alcon’s Precision Profile multifocal design, but its comfort and breathability are unparalleled compared to any lens on the market. Presbyopes with a history of dry eye or complaints of discomfort in their current lenses are prime candidates for the Dailies Total 1 Multifocal.
Dailies AquaComfort Plus Multifocal
Dk/t (at-3.00D) | 26 |
---|---|
Base Curve | 8.7 |
Diameter | 14.0 |
Add Powers | Low, Medium, High |
Powers Available (0.25D steps) | +6.00 to -10.00D |
Design | Center-near, bi-aspheric |
Initial Lens Selection (Up to +1.25) | Low Add OU |
Initial Lens Selection (+1.50 to +2.00) | Medium Add OU |
Initial Lens Selection (+2.25 to +2.50) | High Add OU |
Dailies Total 1 Multifocal
Dk/t (at-3.00D) | 156 |
---|---|
Base Curve | 8.5 |
Diameter | 14.1 |
Add Powers | Low, Medium, High |
Powers Available (0.25D steps) | +6.00 to -10.00D |
Design | Center-near, bi-aspheric |
Initial Lens Selection (Up to +1.25) | Low Add OU |
Initial Lens Selection (+1.50 to +2.00) | Medium Add OU |
Initial Lens Selection (+2.25 to +2.50) | High Add OU |
Bausch & Lomb:
The BioTrue OneDay for Presbyopia is Bausch & Lomb’s only daily replacement multifocal. Marketed as part of the BioTrue OneDay line, B&L delivers a strong showing for comfort and ocular health with a 78% water content and a very respectable Dk/t, while maintaining the proven “3-Zone Progressive” optics of the Ultra for Presbyopia.
As a modern hydrogel lens, the BioTrue OneDay for Presbyopia is well-positioned for patients who are unsuccessful in silicone hydrogel lenses or are struggling with the comfort of older hydrogel materials.
BioTrue OneDay for Presbyopia
Dk/t (at-3.00D) | 42 |
---|---|
Base Curve | 8.6 |
Diameter | 14.2 |
Add Powers | Low, High |
Powers Available (0.25D steps) | +6.00 to -9.00D |
Design | Center-near, "3-Zone Progressive" |
Initial Lens Selection (+0.75D to +1.50D) | Low Add OU |
Initial Lens Selection (+1.75D to +2.50D) | High Add OU |
CooperVision:
In a change of form from their monthly lenses, CooperVision opted for fresh, center-near, aspheric designs for their daily replacement multifocals. The Proclear 1 Day Multifocal offers no traditional add powers and instead rely on the provider to prescribe a near boost in the non-dominant eye. Sounds like monovision, right? Yes and no.
Unlike traditional monovision, the Proclear 1 Day Multifocal is able to maintain binocular vision while providing clear vision at distance, intermediately, and near. The Clariti 1 Day Multifocal offers excellent breathability (it’s one of the only silicone hydrogel daily lenses reviewed here) and clear vision at all ranges thanks to its center-near spherical design. Hindered only by its complicated fitting guide, the Clariti 1 Day Multifocal should be close at hand when prescribing for patients who require the health benefits of silicone hydrogel at a fraction of the cost of Dailies Total 1.
Clariti 1 Day Multifocal
Dk/t (at-3.00D) | 86 |
---|---|
Base Curve | 8.6 |
Diameter | 14.0 |
Add Powers | Low, High |
Powers Available (0.25D steps) | +6.00 to -10.00D |
Design | Center-near, aspheric |
Initial Lens Selection for Myopes/Emmetropes (+0.75 to +1.75D) | Spherical Equivalent (SE) Low Add OU |
Initial Lens Selection for Myopes/Emmetropes (+2.00 to +2.25D) | SE Low Add (dominant), SE+0.50D Low Add (non-dominant) |
Initial Lens Selection for Myopes/Emmetropes (+2.50D and up) | SE+0.25D Low Add (dominant), SE+0.25D High Add (non-dominant) |
Initial Lens Selection for Hyperopes (+0.75 to +1.75D) | SE Low Add (dominant), SE+0.25D Low Add (non-dominant) |
Initial Lens Selection for Hyperopes (+2.00 to +2.25D) | SE+0.25 Low Add OU |
Initial Lens Selection for Hyperopes (+2.50D and up) | SE+0.25D Low Add (dominant), SE+0.25D High Add (non-dominant) |
Proclear 1 Day Multifocal
Dk/t (at-3.00D) | 28 |
---|---|
Base Curve | 8.7 |
Diameter | 14.2 |
Add Powers | "Near Boost" |
Powers Available (0.25D steps) | +6.00 to -10.00D |
Design | Center-near, aspheric |
Initial Lens Selection (Up to +1.00D) | No Near Boost recommended |
Initial Lens Selection (+1.25 to +1.75D) | +0.75D added to non-dominant eye Rx |
Initial Lens Selection (+2.00 to +2.50D) | +0.75D to +1.00D added to non-dominant eye Rx |
Bottom Line
There are a number of multifocal options available for soft contact wearers struggling to adjust to presbyopia. By being the one to present them, you can ensure that your patients are making informed decisions about their vision, rather than settling for what they think is available — this leads to happier patients with increased trust in their doctors.
I know what some of you are thinking, “That’s great and all, but multifocal fittings take forever.” And it’s true. Fitting a multifocal lens is going to take longer than other soft lenses. It can be easy to lose track of time trying to over-refract an unsatisfied multifocal wearer, but it doesn’t have to be that way.
Ignore your instincts to tackle a problem head-on and instead consult the lens’ fitting guides linked in this article. These companies have spent a lot of time and a lot of money figuring out the best path to a successful fitting. Don’t be too prideful to take the advice that they’ve written out for you. By managing patient expectations and then following the fitting guide provided by the manufacturer, multifocal fittings can be a simple, systematic process like any other part of your practice.