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Contact Lens Spectrum

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Research Review: Pre-Presbyopes and Multifocal Contact Lenses

As evidence supporting the use of multifocal soft contact lenses in slowing myopia progression continues to grow, the performance of these types of lenses in non-presbyopic patients has spurred further study.

By: Alex Hui, OD, PhD, FAAO
Contact Lens Spectrum January 1, 2026 Vol 41, Issue January-February 2026 Page(s): 8

Clinical Scorecard: Research Review: Pre-Presbyopes and Multifocal Contact Lenses

At a Glance

CategoryDetail
ConditionMyopia progression and visual performance in pre-presbyopic patients
Key MechanismsUse of multifocal soft contact lenses (MFSCLs) providing simultaneous images at multiple distances, affecting accommodation and pupil-dependent visual acuity
Target PopulationPre-presbyopic and non-presbyopic myopic patients, including children and adolescents
Care SettingOptometry and vision care clinics fitting contact lenses for myopia control

Key Highlights

  • Pre-presbyopes retain accommodation and have larger pupils, influencing MFSCL performance differently than presbyopes.
  • Visual acuity with MFSCLs decreases under larger pupil sizes and low-contrast conditions compared to single-vision lenses.
  • Pupil-optimized MFSCL designs improve near vision and reading performance but may reduce distance vision satisfaction.

Guideline-Based Recommendations

Diagnosis

  • Assess accommodative ability and pupil size in pre-presbyopic patients before fitting MFSCLs.

Management

  • Consider pupil-optimized multifocal lens designs tailored to patient age and prescription.
  • Inform patients about potential trade-offs between distance and near vision quality with MFSCLs.

Monitoring & Follow-up

  • Monitor visual acuity under varying pupil sizes and contrast conditions.
  • Evaluate patient satisfaction for distance, near vision, and glare sensitivity during follow-up.

Risks

  • Potential decrease in distance visual acuity and increased visual acuity deterioration under low contrast and large pupil conditions.
  • Possible reduced patient satisfaction for distance vision and glare compared to single-vision lenses.

Patient & Prescribing Data

Myopic pre-presbyopic children, adolescents, and young adults

MFSCLs can slow myopia progression and improve near vision tasks but may cause slight reductions in distance acuity and overall satisfaction compared to single-vision lenses.

Clinical Best Practices

  • Evaluate pupil size and accommodative response when selecting MFSCL designs for younger patients.
  • Use pupil-optimized lens designs to balance distance and near visual performance.
  • Educate patients on expected visual changes and manage expectations regarding distance vision and glare.
  • Regularly assess visual acuity under different lighting and contrast conditions to optimize lens fit and performance.

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