Multifocal Studies Support a First-Line Approach
Next-generation multifocal soft contact lenses outperform monovision lenses in the real world, and doctors like these easy-to-fit lenses.
Contributing authors: Victoria Dzurinko, OD, FAAO, Thomas G. Quinn, OD, MS, FAAO, Jill Woods, BSc(Hons), MCOptom
Doctors who fit Air Optix Aqua Multifocal contact lenses are impressed with the lenses. More than 95% of those surveyed agreed that the lenses are easy to fit, and most agreed that they're easier to fit than monovision. An impressive 96.8% would recommend the lenses to presbyopic patients.1 Air Optix Aqua Multifocal contact lenses have become a first-line choice for presbyopic contact lens patients.
CLINICAL STUDY: LENS PERFORMANCE
A recent clinical study enrolled 25 soft contact lens wearers, all of whom had distance vision correction and symptoms of early presbyopia (≤1.00D add).2 In four 1-week phases, patients all wore four different correction modalities, all made from lotrafilcon B: a low-ADD silicone hydrogel multifocal contact lens (Air Optix Aqua Multifocal), monovision, habitual correction, and optimized distance vision correction. For all modalities, patients were fit in one visit. Their correction modalities were randomized.
Each week, researchers performed objective vision tests in the clinic, including high- and low-contrast LogMAR in high and low light, stereopsis, and critical print size. To gauge real-world performance, researchers had patients use Blackberry devices to answer questions about their vision outside the office.
THE REAL-WORLD ADVANTAGE OF MULTIFOCALS
In the exam room, all the modalities fared about the same. The only standout number was the superiority of monovision in low-contrast, low-light near LogMAR, where it scored higher than multifocal lenses (0.29 ± 0.10 and 0.33 ± 0.11, p 0.027, respectively). However, responses to 16 real-world subjective questions showed a significant difference between the modalities, and monovision scored lowest while multifocal contact lenses scored highest.
For example, multifocals significantly outperformed monovision in several important real-world situations. Patients rated their satisfaction with their general vision, as well as their vision while driving and watching television (Figure 1).
|Figure 1. Patient Satisfaction Ratings2|
|Satisfied with distance vision||92.2%||79.6%|
|Satisfied with intermediate vision at 4 feet||93.8%||82.0%|
|Satisfied with changing focus from distance to near||87.0%||66.1%|
|Satisfied with daytime driving||93.3%||84.2%|
|Satisfied with nighttime driving||88.8%||74.9%|
|Satisfied with nighttime driving haloes or glare||92.0%||78.0%|
|Satisfied with observing road signs||90.1%||79.4%|
|Overall satisfaction with vision for watching television||95.0%||82.6%|
|Satisfied with TV clarity of picture||95.2%||84.7%|
|Satisfied with clarity for reading detail on TV||92.6%||78.8%|
|Ratings by emerging presbyopes on a scale of 0 to 100, with 100 being excellent satisfaction. All p values are p ≤ 0.05|
Air Optix Aqua Multifocal contact lenses clearly outperformed monovision in distance and intermediate vision, changing focus, watching television and night driving (Figure 2). There was no significant difference in vision for computer use. Other studies point to similar patient preference for multifocal lenses.3,4
|Figure 2. Air Optix Aqua Multifocal contact lenses outperform monovision2|
|Ratings by emerging presbyopes on a scale of 0 to 100, with 100 being excellent satisfaction|
While monovision performed somewhat better than multifocal lenses in the exam room — possibly explaining why they have been a first choice in the past — multifocals have the advantage for practical tasks in the real world. As a result, researchers found that multifocals were the best option for this group of presbyopes.
PRE-MARKET EVALUATION: EASY FITTINGS
During a pre-market evaluation1 of Air Optix Aqua Multifocal contact lenses, complimentary trial lens sets were sent to about 350 doctors. Doctors were instructed to follow fitting guidelines supplied with the trial sets and report their experiences fitting 10 patients.
Reports from 2,455 patients (1,985 current contact lens wearers, 452 non-contact lens wearers, and 18 not specified) were received. Criteria used to determine ease of fitting included the number of trial lenses needed to fit patients, how many office visits the fitting required, and how doctors rated a list of key statements.
The reported overall success rate of the pre-market evaluators was 76%. The majority of patients fit in the pre-market evaluation were moderate to advanced presbyopes. In fact, more than 60% of the patients fit required at least a +2.00 spectacle add at near. Further, there was very consistent fitting success across the entire presbyopic power spectrum (Figure 3).
|Figure 3. Success Rates5||Spectacle Add|
|0.75 to 1.00||1.25 to 1.50||1.75 to 2.00||2.25 to 2.50|
The doctors said that they needed an average of 2.4 visits and fewer than 4 lenses per patient to successfully fit the Air Optix Aqua Multifocal lenses. Some 70.6% agreed that they were able to fit most patients on the first try.
In response to a series of statements about fitting Air Optix Aqua Multifocal lenses, this is how doctors answered:
|• 95.5% agreed these lenses are easy to fit|
• 81.5% agreed these lenses are easier to fit than other multifocal soft contact lenses
• 65.6% agreed these lenses are easier to fit than monovision
• 79.7% agreed these lenses have a higher success rate than other multifocal soft contact lenses
In addition to these results, 89.6% of doctors indicated Air Optix Aqua Multifocal lenses would be preferred in their practice. Some 96.8% of them will recommend the lenses to their patients, and 96.0% will recommend them to colleagues.
80.6% of the practitioners listed Air Optix Aqua Multifocal as their most preferred multifocal contact lens.
FIRST-LINE CHOICE FOR PRESBYOPIA
Study results for both real-world vision quality and ease of fit are exceptional. Patients fit with Air Optix Aqua Multifocal contact lenses were more satisfied (p≤0.05) than patients fit with monovision for intermediate and distance vision, as well as refocusing from distance to near. Emerging presbyopes rate their vision better with Air Optix Aqua Multifocal contact lenses than monovision for realworld activities like day and night driving and viewing television (Figure 2).
Doctors who fit Air Optix Aqua Multifocal contact lenses are equally impressed. More than 95% agreed these lenses are easy to fit, and most agreed that they're easier to fit than monovision. An impressive 96.8% of them would recommend the lenses to their presbyopic patients. Air Optix Aqua Multifocal contact lenses have become a first-line choice for presbyopic contact lens patients. CLS
|1. Rappon J, Bergenske P- Air Optix Multifocal Contact Lenses in Practice. Contact Lens Spectrum, March 2010. Available at http://www.clspectrum.com/article.aspx?article=103980; last accessed Dec 13 2011.|
2. Woods J, Woods CA, Fonn D. Early symptomatic presbyopes — What correction works best? Eye Contact Lens 2009;35:221-226.
3. Situ P, Du Toit R, Fonn D, Simpson T. Successful monovision contact lens wearers refitted with bifocal contact lenses. Eye Contact Lens 2003;29:181-184.
4. Jackson JM. Better designs improve success with soft toric multifocals. Contact Lens Spectrum August 2007. Available at: http://www.clspectrum.com/printarticle.aspx?article=100762; last accessed Nov. 28, 2011.
5. Bergenske P, Rappon J. Influence of required spectacle ADD on success with a multifocal contact lens. Contact Lens Anterior Eye 2010;33:278-279.