AS EVIDENCE supporting the use of multifocal soft contact lenses (MFSCLs) in slowing myopia progression continues to grow, the performance of these types of lenses in non-presbyopic patients has spurred further study (Janarthanan et al, 2024). In contrast to the presbyopic population, pre-presbyopes retain their accommodative ability while also having larger pupil sizes (Aissati et al, 2024). There is a need to find out how the visual systems of younger patients are impacted when presented with simultaneous images from multiple viewing distances when wearing MFSCLs (Altoaimi et al, 2018).
One study of presbyopic adults investigated the levels of accommodation used when multiple images were presented by MFSCLs across the pupil. The study examined 8 adults wearing either center-near or center-distance MFSCLs while viewing objects farther away and closer than the far point created by the add power. At all distances, participants used some near lens power to aid in accommodating. When viewing objects closer than the add power far point, accommodation was driven by the refractive power in the transition zone rather than the full add zone, resulting in myopic defocus for either the pupil or the pupil margin zones (Altoaimi et al, 2018). It was noted that the transition zone in both lens designs spanned the majority of the pupil.
The impact of pupil size in non-presbyopic adults wearing MFSCLs has also been investigated with high-contrast and low-contrast stimuli. Under high-contrast, small-pupil conditions, usage of a center-distance MFSCL resulted in a decrease in visual acuity of only a few letters compared to single-vision lenses (SVLs) (Dolce et al, 2025). Visual acuity further deteriorated with larger pupils and lower contrast, with approximately 2 lines of worse acuity under low-contrast stimuli with a 6-mm pupil compared to a 3-mm pupil (Dolce et al, 2025).
Some MFSCL designs are reported to have pupil-optimized design, in which the optics of the MFCLs are based on not only the prescription, but also the age of the patient (Durmaz Engin et al, 2025). With these lenses, measurable decreases in distance visual acuity when compared to SVLs are found; however, there are improvements in near visual acuity, maximum reading speed, and reading acuity (Durmaz Engin et al, 2025).
Interestingly, when measuring quality of life using a questionnaire, participants reported greater satisfaction with SVLs for distance vision, glare, and overall satisfaction compared to MFSCLs, which only had higher rated satisfaction for near vision tasks (Durmaz Engin et al, 2025).
Investigations into the effects of glare when wearing MFSCLs do not seem to suggest that they are any worse than other forms of correction for certain tasks. The shape discrimination thresholds in 8- to 13-year-old participants are similar whether wearing aspheric, continuous progressive lenses or spectacles, and both were worsened under glare conditions (Huang et al, 2025).
As more young patients are fitted with MFSCLs, eyecare practitioners should be reminded of the potential impact that they may have on the vision of wearers, both positive and negative, so that acceptance of this can be maximized for purposes such as myopia control.
References
1. Janarthanan SD, Samiyullah K, Madheswaran G, Ballae Ganeshrao S, Watt K. Exploring the impact of optical corrections on visual functions in myopia control-a scoping review. Int Ophthalmol. 2024;44(1):47. doi: 10.1007/s10792-024-02937-w
2. Aissati S, Zou T, Goswami S, Zheleznyak S, Marcos S. Visual quality and accommodation with novel optical designs for myopia control. Transl Vis Sci Technol. 2024;13(12):6. doi: 10.1167/tvst.13.12.6
3. Altoaimi BH, Almutairi MS, Kollbaum PS, Bradley A. Accommodative behavior of young eyes wearing multifocal contact lenses. Optom Vis Sci. 2018;95(5):416-427. doi: 10.1097/OPX.0000000000001214
4. Dolce JC, Nti AN, Berntsen DA. The effect of pupil size on visual performance with center-distance soft multifocal contact lenses. Optom Vis Sci. 2025;102(7):421-426. doi: 10.1097/OPX.0000000000002271
5. Durmaz Engin C, Yapıcı B, Köksaldı S, Vupa Çilengiroğlu O. Visual performance and quality of life in myopic adolescents with pupil-optimised multifocal versus single-vision contact lenses. Clin Exp Optom. 2025;108(7):792-799. doi: 10.1080/08164622.2024.2432449
6. Huang C, Li X, Liu J, et al. Impact of multifocal soft contact lenses on the shape discrimination threshold under glare in myopic children. Front Med (Lausanne). 2025;12:1635583. doi: 10.3389/fmed.2025.1635583