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.

On average, myopia progresses by 0.50D every single year in a growing child.  That means if your child is a -1.00D myope at age 6, they will be wearing a -6.00D by age 16!  Myopia is a condition that results from the curvature of the eye and the length of the eyeball.  Often, as we go through normal growth and puberty changes, that length can increase, inducing more myopia.  Eventually, these changes will slow down, and normally stop progressing by our 20s.  But in this critical time period, a prescription can develop that permanently changes that individual's lifestyle forever.

How do we prevent myopia progression?

That's a question scientists still don't have complete answers to.  Today's best research suggests that 3 options are giving the best results in slowing myopic progression:

1) Atropine 

      -this involves daily insertion of a potent dilating drop, and having to wear bifocals to read

2) Corneal Reshaping with specialty hard contact lenses

3) Soft multifocal contact lenses

      -the premise is the cause reduced near strain and peripheral blur, giving a negative feedback signal to the eye's myopia development process 

None of these options are easy.  Atropine is an eye drop that causes the pupil to dilate and the accommodative muscles in the eye to lose the ability to focus.  As a side effect, the child will need to wear bifocals in order to see to read.  They may experience headaches, and will complain of intense burning when the drop goes in.  Great for kids, right?

Corneal reshaping is performed by wearing rigid (hard) contact lenses overnight, almost like a retainer that molds the eye into a different shape.  Believe it or not, it's not as uncomfortable as it sounds.

The third option involves soft contact lenses, which is another extra addition to the child's daily routine, for cleaning and caring for these lenses.

Even with these techniques, myopia will likely still progress.  Studies have shown that the rate of progression with these options can be reduced anywhere from 30-50% however, which can make a real difference in your child's final prescription.  If you are interested in any of these options, talk to your doctor to see if your child would be a candidate!