AAO 2018-2019

“Contact Lenses for Presbyopia

”

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• Presbyopia aects virtually everyone older than 40
years. Thus, as contact lens wearers age, their
accommodation needs must be considered.

• Three options are available :

1. Using reading glasses with contact lens
2. Monovision
3. Bifocal contact lens
▹ USING READING
GLASSES OVER
CONTACT LENSES

Advantages :

• Simple
• Inexpensive
• Effective
 ▹ MONOVISION
• the dominant eye, for distance (For driving
and other critical functions, overcorrection
with glasses may be necessary)
• the non dominant eye, for near
• Many patients are satised. A temporary trial
of monovision contact lenses is often useful
Eye Dominance Test

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 ▹ USING
BIFOCAL
CONTACT
LENSES
2 types of bifocal lenses:
• Alternating Vision Lenses
• Simultaneous Vision Lenses
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Alternating vision bifocal contact lenses are similar in
function to bifocal spectacles in that there are separate areas for
distance and near, and the retina receives a focused image from
only 1 object plane at a time

For alternating vision contact lenses, the position on the eye is

critical and must change as the patient switches from distance to
near viewing.
The lower eyelid controls the lens position, so that as a
person looks down, the lens stays up, and the eye’s
visual axis moves into the reading portion of the lens.
The need for this “translation” of the lens in downgaze
makes RGP lenses work well for these designs.
2 types of Alternating vision bifocal contact
lenses :
• Segmented contact lenses have 2 areas, top
and bottom, like bifocal spectacles, whereas
concentric contact lenses have 2 rings, 1 for far and
1 for near.

• Concentric (annular) contact lenses

Alternating Vision Bifocal Contact
Lenses

Segmented contact lenses

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Simultaneous vision bifocal contact lenses
provide the retina with light from both distance and near points in
space at the same time, requiring the patient’s brain to ignore the
reduction in contrast Usually, either the distance or near vision is
compromised; the compromise is greater for higher adds.
 Simultaneous Vision Bifocal Contact Lenses

These lenses have various optical designs. One type is aspheric, or multifocal, as are intraocular
lenses. Aspheric surfaces change in power from the center to the periphery: minus lenses decrease in
power from the center to the periphery, whereas plus lenses increas
 Simultaneous Vision Bifocal Contact Lenses

Another type of simultaneous vision lens is diractive . It has concentric grooves on the back surfaces,
such that the light rays are split into 2 focal packages: near and far. The diractive surfaces reduce
incoming light by 20% or more, thereby reducing vision in dim lighting. These lenses are less sensitive
to pupil size, but they must be well centered for best vision.
• No single style works for all patients, and most require highly
motivated patients and tters for success. Despite the availability
of contact lenses for presbyopia, monovision is still the most
common approach. A trial of monovision contact lenses may be
benecial when considering a permanent correction such as
laser refractive surgery or lens implant surgery.
THANK YOU