Optical and visual quality with physical and visually simulated presbyopic multifocal contact lenses

Abstract

Purpose : Evaluate through-focus (TF) visual and optical quality in patients with multifocal contact lenses (M-CLs) and with the corresponding simulated multifocal patterns using an adaptive optics (AO) visual simulator.

Methods : TF optical and visual quality with a center-near aspheric M-CL (Add:Low,+1.25D;Mid,+1.75D;High,+2.50D) were evaluated. A custom-developed AO visual simulator was used to measure ocular aberrations (Hartmann-Shack,ImagineEyes) and to simulate the multifocal patterns (SimVis,tunable lens working on temporal multiplexing mode). On bench TF optical quality of SimVis-simulated M-CLs (SimVis-L) was obtained from double-pass (DP) images & images of an E-stimulus using artificial eyes. Ten subjects (-3.44±0.85D; 52.3±5.21yrs) were fit with M-CL. Visual acuity (VA)&DP retinal images were measured TF in a 4-D range with the M-CL on eye, and SimVis-L.TF optical quality was also calculated from the measured aberrations.Control measurements were performed with monofocal correction. Depth-of-focus (DOF) was estimated for each condition from the width of the TF optical performance curves. The similarity of TF optical & visual performance between real M-CL&SimVis-L was assessed by the RMS (root mean square) TF difference.TF difference.Quantitative anterior segment 3-D OCT measurements were performed with/without the M-CL.

Results : OCT-based corneal elevation maps indicate minimal wrapping of the CL on eye.DOF increased with add power (E-stimuli: L2.0D<M2.4D<H3.1D; DP:L1.6D<M2.1D<H2.7D).Average VA far/near was 0/+0.3 (M-CL), 0/+0.4 (SimVis-L) & -0.1/+0.7 (Monofocal). VA remained >+0.2 in a range >3.0D with M-CL/SimVis-L, and <2D for the monofocal lens.TF DP&VA curves with M-CLs and SimVis-L on patients showed no significant differences (mixed model analysis p=0.504), with low RMS TF differences (L:0.10±0.01,M:0.07±0.02, H:0.10±0.02). While TF performance with both M-CL&SimVis-L was primarily driven by the multifocal pattern, the patient’s aberrations also played a role in visual performance with the M-CL.The predicted change in VS from monofocal to multifocal optics is positively correlated with native RMS wavefront error (r=0.713).

Conclusions : M-CLs theoretically and effectively expand DOF. SimVis-L captured the through-focus visual performance of the M-CL in most of the patients. Visual simulators may permit patients to experience vision with multifocal lenses prior to testing them on-eye.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.