The multifocal contact lens market continues to expand and grow. In recent years we have seen the addition of new daily disposable brands and the expansion of astigmatic multifocal options.
For most presbyopic contact lens wearers, there is a multifocal option that, at least theoretically, could work well for their visual and lifestyle needs.
Overview of multifocal lenses in the US
Despite this expansion in technology and resources, multifocals tend to be under-prescribed for our presbyopic contact lens wearers—especially in the United States. In Contact Lens Spectrum’s annual review of international prescribing trends, Morgan et al. reported in 2022, among all reporting countries, multifocals and monovision modalities were prescribed for 18% and 3% of soft contact lens wearers, respectively.1
When only presbyopic contact lens wearers were considered, these averages adjusted to 53% and 7%, respectively. Considered together, this means that, across the globe, about 60% of presbyopic contact lens wearers are wearing a modality that addresses both their distance and near visual needs. While these prescribing rates have almost doubled in the last 20 years, there is still room for improvement.1
“Interestingly, the averages reported for the United States were notable compared to international averages.”
The US reported 13% multifocal and 14% monovision for soft lens wearers.1 While the multifocal percentage isn’t markedly different than the international average of 18%, the reported 14% monovision fits is the highest reported by any other country—with most countries averaging about 3% monovision fits. When contrasted to most other countries, the United States is fitting more than four times as many patients in monovision.
Why is monovision so popular in the US?
Why does monovision still have such an influence on how eyecare providers (ECPs) in the United States choose and fit contact lenses? The answer to this question is complex and multifaceted. Monovision can feel like the most satisfying option, objectively, in the exam room. Immediately upon applying lenses, monovision allows a patient to read the lowest line on the distance and near chart with minimal adaptation period.
While most practitioners are aware of some of the disadvantages associated with monovision (reduced depth perception, no range of clear vision, etc.), the ease and efficiency of fitting a monovision modality are likely appealing when considering some of the presumed disadvantages associated with multifocal designs (glare, reduced quality of vision at all distances, adaptation time, etc.).
Additionally, some prescription types (high ametropia, astigmatism, etc.) have been limited by parameter availability for multifocal options.
Clinical studies comparing monovision and multifocals
While a monovision fit can feel satisfying to the eyecare provider when the patient easily reads the vision chart, evidence suggests that patients subjectively prefer multifocal options.
In a clinical trial that compared multifocals to monovision, Woods et al. reported that, while objective distance and near acuity measurements were better with monovision, the participants subjectively preferred the visual experience with multifocals.2
Similarly, Gupta et al. reported that distance and near acuity were the only measures where monovision outperformed multifocals.3 Multifocals provided better stereoacuity, a range of clear near vision, and minimal difference in contrast sensitivity.3
Monovision can seem efficient on the initial fitting day, but multifocal designs perform better than monovision over time.
Additional clinical studies on multifocal contact lenses
When comparing monovision and multifocals over a 15-day period, Fernandes et al. reported that monovision performed worse than the multifocal in light distortions.4 This finding is particularly notable because glare and halos are commonly noted as a presumed disadvantage of multifocal optics.
In another study by this same group, they noted that for the multifocal, near vision improved in the dominant eye (the eye preferred to see distance images), and distance vision improved in the non-dominant eye (the eye preferred to see near images).5
The evidence cited above collectively suggests that multifocals offer the best overall visual experience for presbyopic contact lens wearers.
Takeaways on using multifocals
Globally, the use of multifocal contact lenses for presbyopic wearers is expanding and increasing. ECPs in the United States only need to be convinced that these technologies outperform monovision once the patient leaves the exam room and enters the real world.
The only way they can convince themselves is to fit multifocals proactively—especially on patients they may have previously thought were not candidates for multifocal contact lenses.
Final thoughts on multifocals
The multifocals available in today’s market bring some of the best comfort and technologically advanced optics designs ever available for presbyopic wearers. All brands are supported by fitting guides that make initial lens selection less confusing and troubleshooting less confounding.
Using a fitting guide resource alone will ensure that new fitters have a smooth entry into multifocal fittings. Looking toward trends in 2023, let’s raise the bar together to see more multifocal and less monovision fits throughout the United States.
