Multifocal Contact Lens? Why? – Tips4EyeDocs Daily for 01/12/2012 No. 24

Multifocal contact lenses have been touted continuously by manufacturers as the next “holy grail” of contact lens opportunities. With fanfare and hoopla. multifocals are heavily promoted to eye care providers. Granted, the population is greying and the pool of potential patients is expanding rather than contracting.

But the shine of multifocal soft lenses has not outlasted the promises from the manufacturers. Rather than buttressing the sagging profit margins of eye care proiders, it has become a shy partner in the business of eye care. Although every lens manufacturer trumpets their lens as the best in the market, the reality is that no one brand or design has captured the market. In fact, I would venture to guess that its promise has been less than fulfilled.

What will bring back the luster of multifocal lenses? What will bring back the disillusioned doctors and the disappointed patients? First, the price of multifocals has to fall even more. With spherical contacts so much cheaper, there is little reason to gamble chair time on a product that rarely achieves 50% success rate on any random spherical presbyopic patient. With a price reduction, patients need not gamble on whether a multifocal will work full time as a replacement for spectacles.

Second, multifocal may work best in fulfilling other clinical objectives. Although myopia control has not been proven clinically, its use in children might make it a suitable alternative to penalization by atropine. Its quite possible that such a niche could be an opportunity (Walline et. al., 2011 and Llorente-Guillemot et al, 2011 and Ferrer-Blasco T, 2011), their adoption by eligible patients is still significantly less than that of a single vision spherical contact lens patient.

Lastly, both the material and the availabe parameters need to be upgraded. Because presbyopic contact lens cases are more variable than simple spheres, it is important to have a ready lens that might fit the patient. This includes toric multifocals. The lack of cylindrical correction presumes that no presbyope ever has astigmatism, a prospect that is ill-conceived.

In summary, multifocal lens success is elusive for both the doctor and the manufacturer. However, a serious initiative to improve lens material, availability of parameters and price points may improve this segment of the market.

REFERENCES

Walline JJ, Lindsley K, Vedula SS, Cotter SA, Mutti DO, Twelker JD. “Interventions to slow progression of myopia in children. “Cochrane Database Syst Rev. 2011 Dec 7;12:CD004916.

Ferrer-Blasco T, Madrid-Costa D.”Stereoacuity with balanced presbyopic contact lenses.
“. Clin Exp Optom. 2011 Jan;94(1):76-81. doi: 10.1111/j.1444-0938.2010.00530.x. Epub 2010 Oct 6.

To reference this post, use this URL http://bit.ly/yRD1Bn

About Richard Hom OD, MPA

Dr. Hom holds Doctor of Optometry and Masters in Public Administration degrees and practices family eye care and consults on public policy, health information technology and program evaluation.
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5 Responses to Multifocal Contact Lens? Why? – Tips4EyeDocs Daily for 01/12/2012 No. 24

  1. The professional myopia of optometry is that we don’t just see with the center of our eyes. Despite the obsessive focus on static images with a arc width diameter of 5 arc minutes, we don’t just see the world in 5 arc minute increments. When the patient leaves the office, the rest of the world is 180 degree in arc width. After 18 years of attempting, and failing, to adjust to progressive lenses and/or bifocal contacts, I now successfully wear tri-focals. The “obscene lines” (which every optometrist will tell you makes you look old despite the fact that at age 64 I AM old) are wonderful in helping me bracket the top and bottom of my monitor.
    However, the real delight even beyond the cognition I now have that i never had with my progressives, is that not only have I been able to document that progressives (and likely my attempted bi-focal contacts) only let me “see” 20% of my monitor without having to move my eyes so that the focus was on the non-astigmatic (non-dyslexic) areas. Even the newer, enhanced progressives only let me “see” 50% of my monitor without distortion.
    The explanation as to my difficulty in adjusting to progressives versus the success of my school-teacher wife (and many others) has to do with “convergence type” rather than occupation. People with a tendency for high convergence stress (inability to read text for periods longer than about 30 minutes without visual stress) tend to also have a higher need for clear peripheral vision. Graduate students with low convergence stress tend to be humanities majors. Graduate students with high convergence stress tend to be science majors. (This is from data of Dr. Chris Chase of Western University. It may not be the beginning of the Eugenics of Vision with hunters versus gatherers, but it could explain why “engineers can’t wear progressives” which is an observation made by numerous opticians.
    The discovery of additional limits with the Snellen test are on our http://www.dyop.org webpage in that the 150 year old 5 arc minute concept of the optotype is likely just as valid as the Egyptian use of 3 as the value of Pi 3000 years ago.

  2. Jamie says:

    That was totally irrelevant Allan.

    I can’t figure out how the contact lens companies ever thought bifocal soft contact lenses would work….no matter how much the reps smile at you trying to promote them. I guess if everyone smiles about it then there must be some sort of magic that makes them work.

  3. Dr. Richard Hom,
    Thank you for clearly pointing out the difficulty that we encounter with the current market selection of bifocal/multifocal soft contact lenses.

    Multifocal soft contact lenses can work much better if the add segment is in registration with the true visual axis ( Reference US Patent # 6,896,368 ). I am the inventor of this patent and may be contacted at tkbaugh@hotmail.com (but you know that.)

    Dr. Thomas Baugh
    Denison, Texas

  4. colored eye contacts says:

    I want to try the bifocal contact lenses, but each time that I read I become more afraid. But today when I read Dr. Baugh’s comment, I think I will go ahead and try them.

  5. I love reading an article that can make people think. Also, many thanks for allowing me to comment!

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