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Research Review:
Pupil Size and Multifocal Lens Performance

Even among individuals performing the same visual task, such as using a computer or reading a book, there is considerable variation in pupil size.

By: Alex Hui, OD, PhD, FAAO
Contact Lens Spectrum September 1, 2026 Vol 41, Issue September-October 2026 Page(s): 7

Clinical Report: Pupil Size and Multifocal Lens Performance

Overview

This review examines the impact of pupil size on the performance of multifocal contact lenses (MFCLs), noting that variations in pupil size can influence visual acuity and contrast sensitivity. High-contrast acuity is comparable across different pupil sizes, while low-contrast performance shows a decline, particularly with larger pupils.

Background

Understanding the relationship between pupil size and multifocal lens performance is crucial for optimizing visual outcomes in presbyopic patients. Variability in pupil size can alter the effective refractive power of MFCLs, impacting the distribution of vision across distance, intermediate, and near tasks.

Data Highlights

No numerical data available in the source material.

Key Findings

  • Variation in pupil size affects the performance of multifocal contact lenses (MFCLs) due to changes in the refractive power profile.
  • High-contrast distance visual acuity with MFCLs is comparable to single vision lenses across pupil sizes from 3 mm to 6 mm.
  • Low-contrast visual acuity shows a significant decrease of up to 2 lines between 3-mm and 6-mm pupils when using MFCLs, as reported in some studies.
  • Contrast sensitivity function (CSF) is impacted by pupil size, with a decrease in CSF area under larger pupil conditions.
  • Visual satisfaction with MFCLs correlates with pupillary dynamics.
  • Manipulation of pupil size through tints can enlarge pupils but may not improve distance visual acuity if light transmission is reduced.

Clinical Implications

Clinicians should consider pupil size when fitting multifocal contact lenses, as it can influence visual performance.

Conclusion

Pupil size is a factor in the performance of multifocal contact lenses, affecting visual acuity.

Related Resources & Content

  1. Cardona G, López S, J Optom, 2016 -- Pupil diameter, working distance and illumination during habitual tasks.
  2. Papadatou E, et al, Int J Ophthalmol, 2017 -- Objective assessment of the effect of pupil size upon the power distribution of multifocal contact lenses.
  3. Dolce JC, et al, Optom Vis Sci, 2025 -- The effect of pupil size on visual performance with center-distance soft multifocal contact lenses.
  4. Phatak NR, et al, Clin Optom (Auckl), 2025 -- Vision performance of a 3-zone progressive™ design kalifilcon a silicone hydrogel multifocal contact lens is not influenced by pupil size.
  5. Martinez-Plaza J, et al, 2026 -- Study on multifocal contact lenses and pupil size.
  6. Contact Lens Spectrum — PRESCRIBING FOR PRESBYOPIA
  7. Contact Lens Spectrum — Research Review: Pre-Presbyopes and Multifocal Contact Lenses
  8. contact lens spectrum — Research Review: Pre-Presbyopes and Multifocal Contact Lenses
  9. contact lens spectrum — Prescribing for Presbyopia: <br>Pupils, Aberrations, and Miotic Impact</br>
  10. Prescribing for Presbyopia
  11. Research Review: Pre-Presbyopes and Multifocal Contact Lenses
  12. International consensuses and guidelines on multifocal intraocular lenses (IOLs) by the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) - ScienceDirect
  13. Impact of ocular aberrations and pupil diameter on vision with four daily multifocal contact lenses - PubMed