Early symptomatic presbyopes--what correction modality works best?

Centre for Contact Lens Research, School of Optometry, University of Waterloo, Waterloo, Ontario, Canada.
Eye & contact lens (Impact Factor: 1.68). 09/2009; 35(5):221-6. DOI: 10.1097/ICL.0b013e3181b5003b
Source: PubMed

ABSTRACT To compare the performance of a low-addition silicone hydrogel multifocal soft lens with other soft lens correction options in a group of habitual soft lens wearers of distance correction who are symptomatic of early presbyopia.
This clinical study was designed as a prospective, double-masked, randomized, crossover, dispensing trial consisting of four 1-week phases, one for each of the correction modalities: a low-addition silicone hydrogel multifocal soft lens, monovision, habitual correction, and optimized distance visual correction. The prescriptions of all modalities were finalized at a single fitting visit, and the lenses were worn according to a randomized schedule. All lenses were made from lotrafilcon B material. A series of objective vision tests were conducted: high- and low-contrast LogMAR under high- and low-room lighting conditions, stereopsis, and critical print size. A number of other data collection methods used were novel: some data were collected under controlled laboratory-based conditions and others under "real-world" conditions, some of which were completed on a BlackBerry hand-held communication device.
All participants were able to be fit with all four correction modalities. Objective vision tests showed no statistical difference between the lens modalities except in the case of low-contrast near LogMAR acuity under low-lighting levels where monovision (+0.29 +/- 0.10) performed better than the multifocal (+0.33 +/- 0.11, P=0.027) and the habitual (+0.37 +/- 0.12, P<0.001) modalities. Subjective ratings indicated a statistically better performance provided by the multifocal correction compared with monovision, particularly for the vision associated with driving tasks such as driving during the daytime (93.3 +/- 8.8 vs. 84.2 +/- 23.7, P=0.05), at nighttime (88.8 +/- 11.7 vs. 74.9 +/- 23.6, P=0.001), any associated haloes or glare (92.0 +/- 10.6 vs. 78.0 +/- 22.8, P=0.003), and observing road signs (90.1 +/- 11.8 vs. 79.4 +/- 20.2, P=0.027). Preference for the multifocal compared with monovision was also reported when watching television (95.0 +/- 6.4 vs. 82.6 +/- 20.1, P=0.001) and when changing focus from distance to near (87.0 +/- 13.4 vs. 66.1 +/- 32.2, P<0.001).
For this group of early presbyopes, the AIR OPTIX AQUA MULTIFOCAL--Low Add provided a successful option for visual correction, which was supported by the results of subjective ratings, many of which were made during or immediately after performing such activities as reading, using a computer, watching television, and driving. These results suggest that making a prediction of "success or not" based on consulting room acuity tests alone is probably unwise.

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    ABSTRACT: Objective: To assess and compare the effects of four simultaneous-image multifocal contact lenses (SIMCLs), and those with distant-vision-only contact lenses on visual performance in early presbyopes, under dim conditions, including the effects of induced glare. Methods: In this double-masked crossover study design, 28 presbyopic subjects aged 40 to 46 years were included. All participants were fitted with the four different SIMCLs (Air Optix Aqua Multifocal [AOAM; Alcon], PureVision Multifocal [PM; Bausch & Lomb], Acuvue Oasys for Presbyopia [AOP; Johnson & Johnson Vision], and Biofinity Multifocal [BM; CooperVision]) and with monofocal contact lenses (Air Optix Aqua, Alcon). After 1 month of daily contact lens wearing, each subject's binocular distance visual acuity (BDVA) and binocular distance contrast sensitivity (BDCS) were measured using the Functional Visual Analyzer (Stereo Optical Co., Inc.) under mesopic conditions (3 candela [cd]/m(2)) both with no glare and under the 2 levels of induced glare: 1.0 lux (glare 1) and 28 lux (glare 2). Results: Among the SIMCLs, in terms of BDVA, AOAM and PM outperformed BM and AOP. All contact lenses performed better at level without glare, followed by Glare 1, and with the worst results obtained under glare 2. Binocular distance contrast sensitivity revealed statistically significant differences for 12 cycles per degree (cpd). Among the SIMCLs, post hoc multiple comparison testing revealed that AOAM and PM provided the best BDCS at the three luminance levels. In both cases, BDVA and BDCS at 12 cpd, monofocal contact lenses outperformed all SIMCL ones at all lighting conditions. Conclusions: Air Optix Aqua Multifocal and PM provided better visual performance than BM and AOP for distance vision with low addition and under dim conditions, but they all provide worse performance than monofocal contact lenses.
    Eye & Contact Lens Science & Clinical Practice 09/2014; 41(1). DOI:10.1097/ICL.0000000000000060 · 1.68 Impact Factor
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    ABSTRACT: Purpose: To assess and compare the effects of contact lens-based artificial pupil design and contralateral balanced multifocal contact lens combination (CBMCLC) on visual performance. Methods: This randomized crossover study conducted at the University of Valencia, Spain included 38 presbyopic patients using an artificial pupil contact lens in the nondominant eye and a CBMCLC. After a month of lens wear, the binocular distance visual acuity (BDVA), binocular near visual acuity (BNVA), defocus curve, binocular distance, and near contrast sensitivity and near stereoacuity (NSA) were measured under photopic conditions (85 cd/m(2)). Moreover, BDVA and binocular distance contrast sensitivity were examined under mesopic conditions (5 cd/m(2)). Results: Visual acuity at an intermediate distance and near vision was better with the CBMCLC than with the artificial pupil (p<0.05). Statistically significant differences were found in contrast sensitivity between the two types of correction for distance (under mesopic conditions) and for near vision, with the CBMCLC exhibiting better results in both cases (p<0.05). The mean NSA values obtained for the artificial pupil contact lens were significantly worse than those for the CBMCLC (p=0.001). Conclusion: The CBMCLC provided greater visual performance in terms of intermediate and near vision compared with the artificial pupil contact lens.
    Arquivos Brasileiros de Oftalmologia 04/2014; 77(2):76-80. DOI:10.5935/0004-2749.20140019 · 0.44 Impact Factor
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    ABSTRACT: To compare subjective and objective visual performance of the Air Optix Aqua Multifocal lens to monovision in a group of subjects requiring a medium level of reading-addition power. Fifty participants with reading additions between 1.25 and 2.00 diopters (inclusive) were randomized into a prospective, crossover clinical trial. They wore monovision and multifocals for 2 weeks in a randomized order. High- and low-contrast logMAR (logarithm of the minimum angle of resolution) acuity and stereopsis were measured at the beginning and end of each period. During each phase, participants performed specific tasks followed by subjective rating surveys and also completed satisfaction rating surveys on days 3, 7, and 12; all were transferred in real time using BlackBerry smartphones. A general rating survey was completed at the dispensing and 2-week visits. Forty-nine participants completed the study (mean age, 52 years). Distance and near high- and low-contrast acuities were significantly better (p < 0.05) with monovision at all visits. High-contrast intermediate acuity was only better (p < 0.05) with multifocals after 2 weeks. Stereopsis was equivalent after 2 weeks, but better (p < 0.05) with multifocals at dispensing. Subjective ratings were generally equivalent between modalities although there was a trend for multifocals to be rated higher for focus changing and driving, whereas monovision tended to be rated higher for near tasks. For both corrections, the satisfaction survey showed no significant change between days 3, 7, and 12, and the general survey showed that comfort was maintained but subjective vision ratings decreased significantly over the 2 weeks. Twenty-five participants (51%) preferred multifocals, 18 (37%) preferred monovision, and the remaining 6 (12%) declared both unacceptable. In this cohort, distance and near acuities were better with monovision, whereas the subjective ratings tended to favor the Air Optix Aqua Multifocal, with the exception of near performance. Preference was statistically similar between both corrections, with a trend toward preferring the multifocal.
    Optometry and vision science: official publication of the American Academy of Optometry 12/2014; DOI:10.1097/OPX.0000000000000476 · 1.53 Impact Factor


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Jun 3, 2014