EYECARE Advances in Multifocal Contact Lens Technologies By David Schaeffer, OD, FAAO / Contributing Editor Sunday, June 18, 2023 1:58 AM RELATED CONTENT What’s New for Older Eyes Presbyopia Management In-Depth Vuity: The First Pharmacological Presbyopia Treatment It seems that nearly every year, contact lens manufacturers are trying to innovate and release new products to market, and this year is no different. Many of the products that have either recently launched or that are soon-to-launch are targeted at the growing presbyopic population. CooperVision released the MyDay Daily Disposable Multifocal in the spring of 2023.Multifocal optics are being introduced to popular modern contact lens materials and completely new multifocal optic designs have been released as well. This article will discuss the newest contact lens technologies from the major manufacturers aimed at tackling one of the more challenging fits–the presbyopic patient. CooperVision released the MyDay Daily Disposable Multifocal in the spring of 2023 that incorporates a brand new Binocular Progressive System optic design that aims to optimize vision at all distances with its unique fitting strategy. Fitting this lens is made easy by its add and power selection. What makes this lens’s fitting guide unique is that the dominant eye will always have a low add. The only adjustment ever made to the add is to the non-dominant eye. This maintains excellent distance vision while still providing near vision quality.1 CooperVision’s studies boast an 83 percent fit success rate with the first lenses tried and 98 percent success with two or fewer lenses1, which enables prescribers to be able to be efficient with fitting their presbyopic patients and reduce as much chair time as possible. The MyDay Multifocal strives to provide great comfort with its low modulus, high Dk, and high water content in a silicone hydrogel lens thanks to their Aquaform Technology. It also has the widest range of parameters in a daily disposable multifocal2–from +8.00 to -12.00 in Low, Medium and High adds–allowing practitioners to fit a majority of their patients in this lens. Johnson and Johnson's Acuvue 1-day Oasys Max Multifocal features three specific designs. Johnson and Johnson debuted the Acuvue 1-day Oasys Max Multifocal late in 2022 and included three specific designs—Pupil Optimized Design, TearStable Technology, and OptiBlue Light Filter—that make this lens special. The Pupil Optimized Design, which is also found in their 1-day Moist and Oasys Multifocal lenses, aims to provide the clearest vision at all ranges by adjusting the optics across all parameters based on the patient’s age and refraction. TearStable Technology refers to the technique used to distribute the wetting agent across the surface and throughout the lens to provide tear film stability and all-day comfort. In clinical trials, 94 percent of patients reported comfort throughout the day and 90 percent reported good end-of-day comfort.3 Lastly, the OptiBlue Light Filter is a high-energy visible light (HEVL) filter that reduces blue-violet light exposure that can come from digital devices and fluorescent lights. Acuvue 1-day Oasys Max Multifocal is the first major brand multifocal to include an HEVL filter.4 The fitting guide is the same as the 1-day Moist and 2-week Oasys Multifocals, making it simple for practitioners and allowing for a seamless upgrade to the 1-day Oasys Max MF from other Acuvue products. Parameters are available from +6.00 to -9.00 in low, mid and high adds. Bausch + Lomb will have released the Infuse One-Day Multifocal at presstime.Bausch + Lomb will have released the Infuse One-Day Multifocal at presstime. The Infuse material is revolutionary with ProBalance Techonology that was developed in response to findings from the TFOS DEWS 2 report about tear film homeostasis. Infuse lenses include electrolytes, osmoprotectants, and moisturizers that aid in maintaining tear film protein activity and ocular surface homeostasis under hyperosmotic stress, as well as a three-silicone backbone with a high Dk, low modulus and high water content.5 All of these technologies are aimed to provide all-day comfort and reduce symptoms of contact lens related dryness. To this next-generation silicone hydrogel lens, B+L incorporated the 3-Zone Progressive Design found in its Ultra for Presbyopia that is specifically designed to maximize distance, intermediate, and near vision clarity. The progressive design was optimized for seven biometric factors including pupil size, anterior chamber depth, axial length, higher-order aberrations, corneal topography and diameter, residual accommodation, and subjective refraction all within just 2 add powers across the parameter range.6 Parameters are available from +6.00 to -10.00 with Low and High adds. Alcon has plans to produce a multifocal for their Total30 line of contacts in the near future.Alcon has plans to produce a multifocal for their Total30 line of contacts in the near future. This lens is the only monthly contact of its kind in its own category of contact lens materials—Permanent Water Surface lenses. Total30 contains Alcon’s Water Gradient Technology that features a gradual transition in water content from 55 percent in the core to nearly 100 percent at the surface of the lens, which provides excellent comfort from day 1 to day 30.7 Also newly introduced in this lens is Alcon’s CELLIGENT Technology that creates a lens surface that biologically mimics the corneal surface to selectively attract small molecules like water, but repel larger ones like lipids and bacteria to prevent deposits and bacterial adhesion for a clean lens.8 Lastly, all Total30 products include an HEVL filter that blocks 34 percent of blue-violet light. Unfortunately no release date for a Total30 multifocal has been specified as of yet, but more information about the release is on the horizon. With so many new presbyopic products either on the market or soon-to-be on the market, it is a very exciting time to be an eyecare provider. Long gone are the days of dreading the presbyopic contact lens fit. There are so many tools at our disposal to combat the struggles of our aging population that we should be able to find an excellent visual solution for anyone who walks into our office. Disclosure: Dr. David Schaeffer receives financial compensation for speaking on behalf of CooperVision. References: 1. CVI data on file 2020. Prospective, double-masked, bilateral, one-week dispensing study UK with MyDay® multifocal; n=104 habitual multifocal contact lens wearers; CVI data on file 2021. Prospective, subject-masked, randomized, bilateral, two-week dispensing study at 5 US sites with MyDay® multifocal; n=58 habitual multifocal contact lens wearers. 2. CVI data on file, 2021. Based on prescription option combinations (sph and add) available across all daily disposable multifocal soft lenses from CVI, JJV, B+L and Alcon in USA May 2021 3. JJV data on file, 2022. Stand-Alone Fit Success Claims for ACUVUE 1-day OASYS MAX MULTIFOCAL Contact Lenses 4. Lasky J. VIS-TD-108916/1: HEVL/Blue Violet Blocking Contact Lens Secondary Landscape Search. 2022 5. Data on file. Bausch & Lomb Incorporated. Rochester, NY. 6. Kingston AC, Cox IG. Predicting through-focus visual acuity with the eye’s natural aberrations. Optom Vis Sci. 2013;90(10):1111-1118. 7. In vitro analysis of lehfilcon A contact lenses outermost surface softness and correlation with water content; Alcon data on file, 2021 8. Ishihara K, Fukazawa K, Sharma V, Liang S, et al. Antifouling silicone hydrogel contact lenses with a bioinspired 2-methacryloyloxyethyl phosphorylcholine polymer surface. ACS Omega. 2021;6:7058-7067