This article was originally published in a sponsored newsletter.

The prevalence of presbyopia is increasing. In 2015, approximately 1.8 billion people had presbyopia and the prevalence is expected to be nearly 2.1 billion people in 2030.¹ When optical correction for presbyopia is absent, it can significantly affect the quality of life in myriad ways including difficulty reading (incapability to read fine print, digital eye strain, and/or headache), diplopia, demand for additional lighting, epiphora, and additional tasks, such as threading a needle or seeing finite aspects of close objects.² The majority (94%) of individuals who have uncorrected presbyopia with significant near vision disabilities live in developing countries.³

Over the last decade, there have been a multitude of scleral multifocal designs for regular and irregular corneas. For greater success, it is pertinent to follow the manufacturer’s recommendations and fitting guide. Every proprietary lens design is unique and requires different approaches for troubleshooting.

A recent pilot study compared visual quality, contrast sensitivity, stereopsis, subjective vision, and comfort between multifocal and monofocal scleral lens (SL) designs.⁴ An experimental, cross over, short-term study was conducted in 19 presbyopic patients (51.9 ± 3.8 years) who had regular corneas.

Eyes were fitted bilaterally with monofocal and multifocal SL designs following the manufacturer’s fitting guide. The multifocal lenses had an aspheric power profile and a center-near design. The lenses are offered in two near optic zone diameters based on eye dominance. For dominant power profile lenses, the center-near optic zone diameter is smaller than the non-dominant center-near optic. The lens design was based on sensory dominance, add power, and the fitting guidelines (non-dominant design on both eyes, nondominant design on the sensory dominant eye, dominant design on the sensory dominant eye, or dominant design on both eyes).

The study evaluated and quantified subjective vision and comfort, low- and high-contrast visual acuity (VA) at 4m and 40cm under photopic and mesopic conditions, contrast sensitivity function, stereopsis, and defocus curves. With the multifocal lens design, distance VA demonstrated dramatically lower values under mesopic conditions for low- and high-contrast tests (p < 0.05), and on low-contrast test under photopic lighting environments (p < 0.001). With multifocal designs, there was a statistically significant betterment for intermediate and near vision in the defocus curve under photopic and mesopic lighting environments (p < 0.05). The mean add power of the lenses was 1.72D ± 0.38D. Stereopsis and contrast sensitivity for high spatial frequencies was worse with multifocal designs (both p < 0.05). In this study, multifocal SLs demonstrated improved vision at near and intermediate and distances without impacting distance vision compared with monofocal designs for a high-contrast test under photopic conditions.

Reference(s):

1. Katz JA, Karpecki PM, Dorca A, et al. Presbyopia - A Review of Current Treatment Options and Emerging Therapies. Clin Ophthalmol. 2021 May 24;15:2167-2178.
2. Mancil G, Bailey I, Brookman K. Optometric clinical practice guideline care of the patient with presbyopia. Reference guide for clinicians. Am Optometric Assoc. 2014 Sep;92:497-500.
3. Goertz AD, Stewart WC, Burns WR, Stewart JA, Nelson LA. Review of the impact of presbyopia on quality of life in the developing and developed world. Acta Ophthalmol. 2014 Sep;92:497-500..
4. Privado-Aroco A, Valdes-Soria G, Romaguera M, Serramito M, Carracedo G. Visual Quality Assessment and Comparison of Monofocal and Multifocal Scleral Lens Designs: A Pilot Study. Eye Contact Lens. 2024 Jan 1;50:35-40.

Melissa Barnett, OD, FAAO, FSLS is the Director of Optometry at the University of California, Davis, specializing in anterior segment disease and specialty contact lenses. She is the past president of the Scleral Lens Education Society and is past chair of American Optometric Association Contact Lens and Cornea Section. She is an advisor to and/or has received honoraria or travel expenses from AccuLens, Alcon, Allergan, Bausch + Lomb, Bruder, Contamac, CooperVision, Johnson & Johnson Vision, Ocusoft, ScienceBased Health, Tarsus, and Visus Therapeutics.