Since their introduction nearly a century ago, multifocal contact lenses have undergone significant evolution in both design and performance. Early iterations were limited by manufacturing constraints and a lack of biometric customization, leading to suboptimal visual outcomes, visual disturbances, and patient dissatisfaction.
These early drawbacks contributed to higher discontinuation rates among presbyopes, despite the clear need for a lens that could deliver functional vision across all distances.1-3 Over the past several decades, however, advancements in optical design, lens materials, and computer-driven modeling have transformed the landscape of presbyopic correction.
Modern multifocals no longer rely solely on simplistic add-power adjustments, but instead incorporate sophisticated approaches that address pupil size, higher-order aberrations, and other biometric factors to optimize visual performance.1-3
Today’s multifocal contact lenses leverage simultaneous-image designs—such as center-near, center-distance, and concentric-zone configurations—to provide functional vision across distance, intermediate, and near ranges.
Using wavefront-sensing technology, lens manufacturers can now generate detailed power profiles that map thousands of measurements across the optic zone, offering insight into how design variations influence on-eye performance.1-3 This precision has enabled the development of advanced designs like Johnson & Johnson Vision’s pupil-optimized lenses, which integrate multiple biometric variables to improve wearer satisfaction.
The result is a new generation of multifocal contact lenses that deliver superior comfort, reduced visual disturbances, and enhanced visual outcomes—making them a reliable option for presbyopic patients seeking spectacle independence.1-3
We spoke with Susan Gromacki, OD, MS, FAAO, FSLS—an internationally-recognized clinician, lecturer, and author on the topics of the cornea and contact lenses—to gain prescribing pearls for multifocal contact lenses.
For which patients are multifocal lenses a great option?
Multifocal contact lenses are an excellent option for presbyopes who:
- Desire to see at all distances without glasses
- Want binocular vision (as opposed to monovision)
- Require excellent vision at intermediate distances (e.g., working at a computer)
Though multifocal lenses are viable for a broad range of individuals, there are a few factors to consider. Aside from the general contraindication for contact lens use, such as dry eye, giant papillary conjunctivitis (GPC), and the inability to comply with recommended wear and care, the level of astigmatism should also influence prescribing.
High astigmatism can limit options and, when combined with multifocal optics, can result in lower acuity than that which the patient desires.
Does the patient's level of presbyopia come into play? How about their level of astigmatism?
Yes, as both add power and astigmatism increase, it becomes more difficult to correct the patient's vision optimally. But with our latest technologies, it can be done.
Do other factors, such as ocular surface health and pupil size, influence prescribing?
Absolutely. Many soft lens multifocal optics are predicated on pupil size. If a patient's pupil is too large or too small for the design, it will be difficult for the patient to access the optics of the lens.
Good ocular surface health is important for success as well. Remember, these patients are older, so they have decreased tear quality and quantity as compared with younger patients.
Which materials and design features do you feel are most important?
We have tremendously innovative new materials, including those with excellent embedded wetting agents, some with a water gradient that is high at the lens surface, some with excellent Dk/L (oxygen transmissibility), and others with a blue light filter to help diminish the glare and haloes that older people may experience.
Customized center near zones, for both age and refractive error, can also help maximize success with soft multifocal contact lenses.
When educating patients, how do you set up realistic expectations?
It is important to set realistic expectations in order to succeed with multifocal contact lenses. One extreme would be to dissuade patients altogether; in this case, the patient does not receive the opportunity to do what they came to the doctor for—to wear contact lenses.
On the flip side, to overpromise and underdeliver will not result in success, either. Educate the patient (in layman's terms) about how the lenses work and what they should expect. Additionally, if the doctor is presbyopic and wears multifocal contact lenses, s/he can share their experiences—that adds credibility.
Do you have any other prescribing pearls?
Thoroughly get to know one to two lens designs per category (center-near, center-distance, aspheric, alternating, etc., including gas permeable multifocals) and how to troubleshoot them for greatest success. Match the patient's refractive error (including astigmatism), ocular health, and lifestyle to the particular lens brand that works best for them.
In conclusion
As the prevalence of presbyopia continues to grow, multifocal contact lenses represent an increasingly powerful tool in the optometrist’s armamentarium.
With advances in design, materials, and biometric customization, today’s lenses can deliver the kind of visual performance and comfort that was once out of reach. Success, however, hinges on careful patient selection, realistic expectation setting, and familiarity with a few well-chosen lens designs.
By leveraging the latest technologies and following evidence-based fitting strategies, practitioners can maximize outcomes, reduce chair time, and offer presbyopic patients the freedom from spectacles they desire—solidifying multifocal contact lenses as a reliable and rewarding option in everyday practice.
