New OD's Guide to Multifocal Contact Lenses

Something terrible happens to the human being around age 40.  They just can't see like they used to.  Even people with perfect, 20/20 vision previously suffer the side effects of this change with near and reading vision called presbopia.  Glasses are always a solution, but for those people wanting more flexibility (albeit, usually a sacrifice on visual quality) contact lenses can be a successful alternative.

Multifocal contact lenses are the newest technology on the market, and the performance of these lenses has greatly improved over the past 5 years.  Typically these lenses use rings of distance and near power throughout the lens to account for vision at multiple distances.  That means that at any one time, your brain is processing both a distance and a reading image when you wear multifocal contact lenses. As a result, neither image may be perfectly clear.  Sometimes you even get a "ghosting" or haloed effect.  Vision tends to improve as your brain has time to adjust to the lenses, but after a few days, you will be getting your maximum effect.  Unfortunately, that may not be 20/20 in every person.  With all lenses, lighting will improve near vision.  That means if you want to read a book, you need to give yourself good lighting.  Don't expect the lenses to perform well in low lighting, even with simple tasks like using your phone!  You may need to wear reading glasses on top of the contact lenses for maximum reading vision!

There are plenty of brands on the market, but here is what I use most often:

Biofinitymultifocal.eu

1) Biofinity Multifocal

-monthly disposable

-comes in dominant and non-dominant 

I love this lens.  This is my go-to soft multifocal lens, and I find that in about 80% of patients it provides great vision.  Comfort is nearly never an issue.  In new wearers I tend to fit dominate lenses on both eyes to maximize distance vision.  You may want to veer on the side of more minus when selecting distance power.  Have a patient with -0.25 cyl?  Bump them to the stronger distance power.  If near vision isn't strong enough, you can try increasing the add on the non-dominant eye, or changing to a Non-D lens for an even greater near boost.  I split adds all the time, with the higher add on the non-dominant, and am having great success.  I always check vision binocularly when I do this, because pushing add on the non-dominant eye is going to hurt the distance vision out of that lens.  Just remember, this lens performs best with both eyes open, and isn't going to work well with each eye alone.  

2) Air Optix Multifocal

-monthly disposable

-comes in low, medium, and high add

This is the highest selling multifocal lens on the market, and is still a great option.  Unfortunately, distance vision isn't that great with the high add lens, but in the lower adds it works very well!

3) Proclear and Purevision Multifocal

-monthly disposable

-I don't fit either of these lenses routinely since they are older technology.  If your patient has a hard time handling lenses (like most first time contact lens wearers), Purevision Multifocal is nice and thick. It works particularly well in men with large fingers that are 50 and trying to wear contact lenses for the first time.

4) C-Vue Multifocals

-2 week disposable

-comes in high and low add

This is an old material lens, so I don't love the breathability, but something about the design works well for patients that just aren't seeing out of the new-age monthlies.  I typically only fit the 8.5 Base Curve  because you want this lens to fit close to the cornea to maximize vision.  

5) Oasys Presbyopia

-2 Week disposable

I honestly never fit this lens.  I don't especially love the optics. Comfort, like all Acuvue lenses, is great.  Vision--don't expect 20/20.

6) Proclear 1-Day Multifocal

-Daily disposable for ultra comfort

-only 1 add

Fitting this lens is a little peculiar.  Typically I find I am pushing a lot of plus to improve distance and reading vision.  I've only fit a few patients, but when comfort is the most important criteria in selecting a lens, this is a great option!

7) Proclear EP

-2 week disposable

This is a "baby add" for emerging presbyopes (thus the EP).  It's great for late 30's early 40's.  If your patient needs more than +1.25 add, it's not going to give great near vision.