Clinical Report: Multifocal Contact Lenses in Pre-Presbyopic Myopia Control
Overview
Multifocal soft contact lenses (MFSCLs) show promise in slowing myopia progression in pre-presbyopic patients, who retain accommodation and have larger pupils. Visual performance varies with pupil size, contrast, and lens design, impacting distance and near vision differently.
Background
MFSCLs are increasingly used for myopia control, with growing evidence supporting their efficacy. Unlike presbyopes, pre-presbyopes maintain accommodative ability and have larger pupils, which influences how simultaneous images from multiple focal zones affect vision. Understanding these effects is critical for optimizing lens design and patient satisfaction. Studies have explored accommodation behavior, visual acuity changes, and quality of life impacts in this younger population.
Data Highlights
| Study | Parameter | Finding |
|---|---|---|
| Altoaimi et al, 2018 | Accommodation with MFSCLs | Near lens power used at all distances; transition zone drives accommodation for close objects |
| Dolce et al, 2025 | Visual acuity vs pupil size | ~2 lines worse acuity under low contrast with 6-mm vs 3-mm pupil |
| Durmaz Engin et al, 2025 | Visual performance & QoL | Distance acuity decreased vs SVLs; near acuity and reading speed improved; higher satisfaction with SVLs for distance and glare |
| Huang et al, 2025 | Glare impact on shape discrimination | Similar thresholds with multifocal lenses and spectacles; glare worsens performance |
Key Findings
- Pre-presbyopes retain accommodation and have larger pupils, affecting MFSCL performance.
- Accommodation during MFSCL wear involves use of near power and transition zones, influencing myopic defocus.
- Visual acuity decreases slightly with center-distance MFSCLs, especially with larger pupils and low contrast stimuli.
- Pupil-optimized MFSCL designs improve near vision and reading metrics but may reduce distance acuity compared to single-vision lenses.
- Patient satisfaction favors single-vision lenses for distance vision and glare, while MFSCLs score higher for near tasks.
- Glare effects on visual tasks are comparable between multifocal lenses and spectacles in children.
Clinical Implications
Eye care practitioners should consider the unique accommodative and pupil characteristics of pre-presbyopic patients when fitting MFSCLs for myopia control. Counseling patients on potential trade-offs between distance and near vision, as well as the impact of lighting and pupil size, can improve acceptance. Selecting pupil-optimized lens designs may enhance near visual function while managing distance acuity compromises.
Conclusion
MFSCLs offer a valuable option for myopia control in pre-presbyopes, but their optical effects differ from single-vision lenses due to accommodation and pupil dynamics. Tailored lens selection and patient education are essential to maximize benefits and satisfaction.
Related Resources & Content
- Janarthanan et al, 2024 -- Exploring the impact of optical corrections on visual functions in myopia control
- Aissati et al, 2024 -- Visual quality and accommodation with novel optical designs for myopia control
- Altoaimi et al, 2018 -- Accommodative behavior of young eyes wearing multifocal contact lenses
- Dolce et al, 2025 -- The effect of pupil size on visual performance with center-distance soft multifocal contact lenses
- Durmaz Engin et al, 2025 -- Visual performance and quality of life in myopic adolescents with pupil-optimised multifocal versus single-vision contact lenses
- Huang et al, 2025 -- Impact of multifocal soft contact lenses on the shape discrimination threshold under glare in myopic children
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