Prescribing for Presbyopia
A Look at Today’s Daily Disposable Multifocals
BY THOMAS G. QUINN, OD, MS, FAAO
We know that 80% of contact lens complications are due to dirty lenses (Ky et al, 1998). We also know that our presbyopic patients are particularly prone to contact lens surface deposits due to changes in tear physiology over time (Moss et al, 2008; Young et al, 2012). So, a daily disposable (DD) lens is a particularly compelling option for our more mature lens wearers. Fortunately, DD multifocal options have multiplied greatly in the past year.
Material Differences
Three of the five current options are made of traditional hydrogel materials. The Focus Dailies Progressives and the Dailies Aquacomfort Plus Multifocal lenses (both Alcon) are manufactured in nelfilcon A; CooperVision’s Proclear 1 Day Multifocal is manufactured in omafilcon A. Both materials demonstrate surface wettability and moisture retention (Wilcox, 2013).
Biotrue Oneday for Presbyopia (Bausch + Lomb [B+L]) is manufactured in nesofilcon A, a hydrogel material that B+L describes as a HyperGel material. One report found a “high level” of performance in a large population (Rha and Bednar, 2013).
The first silicone hydrogel DD multifocal contact lens is the Clariti 1day Multifocal, which was launched by Sauflon Pharmaceuticals; CooperVision acquired Sauflon during the summer of 2014. This lens is manufactured in somofilcon A.
Parameters and Designs
Table 1 lists the parameters of these lenses. Although all feature a center-near design, each takes a unique path from the central reading area to the more peripheral distance optics. So, don’t expect them all to behave the same in terms of visual performance.
| Focus Dailies Progressives | Dailies AquaComfort Plus Multifocal | Biotrue Oneday for Presbyopia | Proclear 1 Day Multifocal | Clariti 1day Multifocal | |
|---|---|---|---|---|---|
| Distance powers (D) | +5.00 to –6.00 | +6.00 to –10.00 | +3.00 to –6.00 (+6.00 to –9.00 in 2015) | +6.00 to –10.00 | +5.00 to –6.00 |
| Add design | Center near | Center near | Center near | Center near | Center near |
| Add powers | Single power profile | Lo, Med, Hi | Low (High in 2015) | Single power profile | Low, High |
| Material | Nelfilcon A | Nelfilcon A | Nesofilcon A | Omafilcon A | Somofilcon A |
| Material type | Hydrogel | Hydrogel | Hydrogel | Hydrogel | Silicone hydrogel |
| Comparable optics | N/A | Air Optix Aqua Multifocal | PureVision 2 for Presbyopia | N/A | N/A |
Three of the five current DD multifocals offer adds in at least two powers. Follow the manufacturers’ fitting guide when deciding which lens to select for a given spectacle add power. CLS
For references, please visit www.clspectrum.com/references and click on document #228.
Dr. Quinn is in group practice in Athens, Ohio. He is an advisor to the GP Lens Institute and an area manager for Vision Source. He is an advisor or consultant to Alcon and B+L, has received research funding from Alcon, AMO, Allergan, and B+L, and has received lecture or authorship honoraria from Alcon, B+L, CooperVision, GPLI, SynergEyes, and STAPLE program. You can reach him at tgquinn5@gmail.com.
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