New OD's Guide to Multifocal Contact Lenses

7:30 PM

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:
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.

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  1. I recently suffered a near and reading vision recently it's really annoying that's why I went to contact lens columbia sc to have some eye checkup and they provide me some contact lens so that I can see clearly.

  2. I wear contact lenses and I don't even know how I would handle multifocal contact lenses. I still have vision problems so I probably just need to get my contacts updated. But still, multifocal lenses would be annoying.

    1. They are definitely not successful for everyone! Sometimes it works better to wear distance contact lenses in both eyes and wear reading glasses for near vision over top. Some people succeed wearing a distance lens in 1 eye, and a reading lens in the other (called monovision). For people who want both eyes to see both distance and near, and want to limit their use of reading glasses, multifocal contact lenses provide an option for success.

    2. I wore Night & Day single vision lenses for years without any problems, so my Optometrist fitted me with Air Optix Multifocals when I developed presbyopia. However, I had problems off and on with eye irritation, even after switching to Clear Care for disinfection and Unisol for rinsing. I asked to try Biofinity Multifocals, but my Optometrist concluded that this was not a good lens for me because my near and distance vision were not as good as with AO. I went back a couple more times and shared your experience in fitting these lenses and pushed for more minus (I have a -.50 cyl) and a higher add. It worked! Biofinity are so much more comfortable than AO. No more itchy, irritated eyes! Thank you!

  3. I recently got multifocal contact lenses after wearing glasses for 10 years and I am so glad I did. I really love wearing contacts now and don't know why I didn't get them sooner!

  4. I graduated from monovision to mulifocal lenses a couple of years ago, first of all trying Air Optix and then Biofinity multifocal, after some minor comfort problems with the Biofinity lenses I settled on Proclear 1 day.
    The advantages I find with multifocals compared to monovision are the restoration of binocular vision, albeit with a slight loss of contrast but this may be due to the fact that I have mild astigmatism in both eyes (OD -0.50, OS -0.75).
    As has been mentioned plenty of light is the key to success with multifocal lenses also a bit of perseverance and a good optometrist (which I have)

    1. Great to hear another success story with these lenses! While no technology is perfect, talking about how much success you have had with multifocal lenses can really help encourage others to want to try the lenses for themselves. Please keep sharing your experiences and maybe other readers will seek an optometrist to help find the right lenses for them too.

  5. Looks like you could benefit from some "proof readers".