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Presbyopia correction with contact lenses

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Dr Judith Flanagan
Dip Ed PhD ELS
Scientific writer and manager of academic education, Brien Holden Vision Institute

 

Presbyopia is an inevitable part of ageing, becoming noticeable around the age of 40 years, and characterised by a loss of accommodation and a concomitant diminished ability to focus at near.

In the United States alone, more than 40 per cent of the population is aged over 45 years.

This target group grew by over 45 per cent from 2000 to 20101 and in the next few years the number of presbyopes is expected to exceed 135 million.2

As the population of the developed world continues to age, the need for presbyopia vision correction is exploding with a six per cent increase since 2010 in the target population (now estimated at 560 million people 45 years and older) and with a further five per cent increase predicted by 2020.3

Usually by the age of 52, there is no objective accommodation remaining.4-6 Globally, an estimated two billion people have presbyopia7 and with an ageing global population, this is set to increase exponentially. Although this age group makes up almost 45 per cent of the population, it represents only 22 per cent of the contact lens market.8-12

In 1874 Benjamin Franklin developed the first version of bifocal spectacles by combining half lenses from his different spectacles so that he could see ‘near and far’.13 In addressing his presbyopia, he was following a tradition starting around 5000 BC when transparent semiprecious stones were used to help with reading.13 From Franklin’s bifocals to today’s progressive lenses, using lenses to give clear focus for presbyopes has never been completely satisfactory due to limits in the direction and distances for which clear vision can be maintained.

Strategies for presbyopia correction

At the onset of presbyopia, monovision correction is acceptable as low reading correction is usually all that is needed.14,15,16 As accommodation diminishes further, the increased disparity between eyes that is required for monovision correction leads to decreased binocular acuity,17 stereoacuity14-18 and contrast sensitivity, which can all contribute to increased risk of accidents in the elderly.19 

Various strategies for presbyopia correction have been trialed over the years with three systems of correction most often prescribed: spectacle lenses only, contact lenses only, and spectacle/contact lens combinations. Refractive surgery can also be used but is less common.

For those wishing to remain in contact lenses as they age, earlier reports suggested that monovision lenses were the correction often advocated by practitioners,20,21 in part due to practitioner bias related to the perception that multifocals are harder to fit, require more chair time, and the understanding that ‘consulting room’ preferences of wearers might not translate to ‘real world’ efficacy.22

 

421 Presbyopia Correction Figure 1

Contact Lens Optical Quality Analyser image of Brien Holden Vision EDOF lens in -3.00 D distance power

 

Popularity of multifocal modality

However, in 2011 Efron, Morgan and Woods reported from their survey of prescribing habits in 38 countries that the majority (63 per cent) of presbyopes were fitted with non-presbyopic lenses, while 29 per cent wore multifocals and only eight per cent used monovision correction.23 From 2005 to 2009, about one-third of presbyopic contact lens wearers were prescribed multifocals23 and this proportion increased between 2010 and 2014 to almost half, representing about 12.5 per cent of all soft contact lens fittings.23 The increasing popularity of the multifocal modality is also represented in statistics showing that between 2000 and 2009 in Australia, the multifocal designs offered increased from six to 21.23

Presbyopia correction can become more challenging in the presence of additional attendant ocular aberrations. Contemporary simultaneous image-design multifocal contact lens designs are suboptimal because in attempting to correct refractive errors they compromise the quality of vision at both distance and near,24,25 introducing a degree of ghosting and/or distortion,26 which can sometimes result in unsatisfactory quality of vision with decreased contrast sensitivity.27 Fluctuating vision can also arise due to change of pupil size.24 Thus there is need for contact lenses that can address presbyopia without inducing distortions of vision.

EDOF lenses

Fourier optics simulations suggest that interactions of higher order spherical aberration terms with Zernike defocus can improve depth of focus.2 Modelling the wavefront aberration profiles for eyes permits the manufacture of lenses that can provide images that are focused on the retina over all focal lengths.

The Brien Holden Vision Institute has developed an extended depth of focus (EDOF) lens for presbyopia that deliberately manipulates higher order aberrations of the ocular wavefront to optimise retinal vision quality over near, intermediate and far distances. This depth of acuity is achieved by treating aberrations and desired visual outcomes as variable parameters in a non-linear optimisation routine that can be manipulated to determine the best metrics for ‘compromise free’ vision through focus over a selected range of distances.

Conclusion

In the quest to supply satisfactory options in contact lens wear for the ageing population, novel lenses were designed that deliberately manipulate higher-order spherical aberrations to optimise retinal image quality. Novel EDOF lenses that are relatively independent of patients’ natural aberrations offer acceptable intermediate and near vision performance without compromising distance vision performance in low, medium and high presbyopes, and offer great opportunity for successful presbyopic vision correction for the burgeoning consumer market.

In April 2015, Brien Holden Vision Pty Ltd announced that the US Food and Drug Administration had granted clearance for the company’s EDOF contact lenses, a world-first for the correction of presbyopia.

 

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  3. United States Census Bureau. 2013.
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