Visual Performance of Center-Distance Multifocal Contact Lenses Fit Using a Myopia Control Paradigm

Purpose: Multifocal contact lenses (MFCLs) are increasingly being prescribed for non-presbyopic patients (e.g., myopia control, digital eye strain, etc.). It is important to understand how these contact lenses affect visual performance. MFCLs and single vision contact lenses (SVCLs) were evaluated under several illuminations and contrast levels. Methods: Twenty-five non-presbyopic adults with -1.00 D astigmatism or less and spherical equivalent refraction (SER) between -0.75 DS and -6.00 DS at the corneal plane were enrolled and fitted binocularly in three contact lens designs using a myopia control paradigm. Two lenses were center-distance MFCLs (Biofinity “D” +2.50 add, NaturalVue Multifocal) and one was a spherical SVCL (Biofinity). Subjects were masked to the lens type. High-(HC) and low-contrast (LC) logMAR visual acuity (VA) was measured at distance in photopic, mesopic, and mesopic with glare lighting. Photopic high-contrast acuity and reading speed were measured at near. Data were analyzed using repeated-measures analyses of variance (RM-ANOVA) with adjusted post-hoc t-tests, when appropriate. Results: The mean (± SD) age and SER were 24.1 ± 1.5 years and OD: –3.38 ± 1.53 DS (range –1.00 to –5.00 DS), OS –3.29 ± 1.66 DS (range –0.75 to –5.75 DS), respectively. HC and LCVA depended on lighting and lens type (lens x contrast x lighting interaction; P = .015). HC was always better than low (all P < .05). The acuity loss in photopic HCVA between SVCLs and MFCLs was statistically significant, approximately 1.5 to 2 letters (P = .017). Mesopic, HCVA with MFCLs was 4 to 5 letters worse than SVCLs (P < .001). All lenses performed better in photopic lighting (all P < .001). Photopic, LCVA with both MFCLs was 5-6 letters worse than SVCLs. For mesopic LCVA without glare, loss was just over 2 lines for MFCLs compared to SVCLs. Reductions in LCVA between photopic and mesopic lighting differed by lens types (SVCL versus MFCLs; P < .0001). In mesopic lighting, the addition of glare reduced VA by about 3 letters (0.065 logMAR; P < .00001); VA reduction did not depend on lens design (SVCL vs MFCLs; P = .17). Reading performance in words per minute (WPM) was worse with MFCLs (Biofinity MFCL 144 ± 22 WPM, NaturalVue multifocal 144 ± 28 WPM) than with SVCLs (156 ±23 WPM; P = .019) regardless of letter size (P = .13). No difference in visual acuity between the MFCLs was detected (all P > 0.05). Conclusion: Compared to the SVCL, both MFCL designs resulted in reductions in distance VA under photopic low-contrast and mesopic, high- and low-contrast conditions. Additional reductions in VA were observed with glare, but these reductions did not differ between lens designs. High-contrast VA does not fully describe the effect of MFCL optics on visual acuity. Additional work is needed to better ascertain visual performance with multifocal lens designs.