Contact Lenses For Presbyopia

Published on
December 4, 2023
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Spectacles aren't the only option for both distance and near vision! If you're over 45 years of age and typically wear reading glasses, progressive or bifocal spectacles, that doesn't mean you can't wear a pair of contact lenses to provide the same level of vision.

Contact lenses are perfect for when you want to be able to do the things you enjoy in life without the hassle of having to wear a frame on your face. There are two primary options for presbyopic contact lens wear: multifocal contact lenses and monovision (or blended) contact lenses. Soft disposable contact lenses or rigid gas permeable lenses are both available in these options. During your consultation, your optometrist will advise which is best for you.

Soft contact lens on an index finger prior to insertion. Contact lens case underneath.
Figure 1. Soft lens placed on a finger, prior to insertion.

Multifocal contact lenses

With these lenses, your eyes are focused for both distance and near vision at the same time. Your brain figures out which image it needs to concentrate on and ignores the other. The clarity of your vision will never be as sharp as with your spectacles due to slight ghosting’ of images, but the majority of patients find these lenses allow them to perform most visual tasks in their life with about the same visual quality. Patients tend to prefer these lenses over monovision lenses because they offer better ‘real-world’ vision, despite the loss of clarity.1

Monovision contact lenses

With monovision, one of your eyes is corrected for distance and the other is corrected for near vision. This means your eyes won’t work together as naturally; however, the quality and clarity of the vision at specific distances (e.g. at 6 metres in the distance and at reading distance) tends to be superior compared to multifocals.2 Monovision also allows significant astigmatism to be corrected better than multifocals. Inpatients with good distance vision, you may just need a lens in one eye to improve your vision for near or distance tasks.

3 contact lenses sitting on fingers, scleral, soft and RGP
Figure 2. A variety of different lens types. Scleral, soft and corneal rigid.

Deciding on the right lens type

Most often, multifocal and monovision contact lenses are soft contact lenses. Multifocals are typically only available in a monthly modality but do exist in a daily modality for occasional use. Since monovision lenses are essentially just two differently powered standard spherical lenses, they are available across more modalities, and for this same reason tend to be cheaper than multifocal contact lenses. See this article for more information on the features of soft lenses.

As well as soft contact lenses, orthokeratology or ‘ortho-k’ lenses (overnight corneal reshaping lenses) can also be designed to give distance and near vision in a manner similar to monovision. Due to the nature of how ortho-k lenses reshape the cornea, they have more of a multi-focal effect than standard soft lenses. Like monovision, if you normally see well in the distance, you may just need a single ortho-k lens worn overnight in one eye to give you better vision for near tasks throughout the day.

References

1) Richdale, K., Mitchell, G. L., &Zadnik, K. (2006). Comparison of Multifocal and Monovision Soft Contact Lens Corrections in Patients With Low-Astigmatic Presbyopia. Optometry and Vision Science, 83(5), 266–273.

2) Woods, J., Woods, C., & Fonn, D.(2015). Visual Performance of a Multifocal Contact Lens versus Monovision in Established Presbyopes. Optometry and Vision Science, 92(2), 175–182.

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