Contact Lenses: Presbyopia and Contacts

Happy Thursday, y’all!

After a couple of weeks off, thanks to harvest, this cool rainy day provides the perfect opportunity to hit the blog again.  Today’s topic? Presbyopia and contact lenses!

As a quick refresher, presbyopia is the lovely condition that usually begins to rear its ugly head in people over the age of 40, in which the eye is no longer able to adjust focus from distance to near, making near tasks, such as reading and computer work, more difficult.

In my full discussion on presbyopia, I provided several spectacle options – reading glasses, bifocals/trifocals, and progressives – but what about those people who prefer to wear contacts? Are they out of luck?

Thankfully, no! There are lots of options for presbyopic contact lens wearers.  Let’s check them out!


Monovision is probably one of the oldest methods for providing near and distance correction without the use of spectacles.  In this, one eye is adjusted for near, while the other (the dominant eye) remains corrected for distance.  From my experience, this is most successful when relatively little near correction is needed, as it’s easier to adapt to small differences between the eyes, rather than large differences.  Unfortunately, with age, more and more near correction is needed, until reaching a plateau at 2.50-3.00 diopters of additional power.  This prescription difference is somewhat hard to quantify verbally, but it’s essentially like seeing the 20/20 line perfectly clear in one eye, and then only being able to see the 20/125 line with the other.  Yikes!
Naturally, this difference can cause a host of problems, from glare and halos in the near eye with night driving, to issues with depth perception, to simply discomfort during every day tasks due to the sheer power difference!
Needless to say, monovision is NOT my favorite option.  Let’s see if we can’t find something better.

Soft Multifocal Contacts

Soft multifocal contacts are a newer technology that is designed to provide both distance and near correction in the same lens.  These come in daily, two week, and monthly modalities, with a variety of designs.
For those who perform more distance tasks, but still need near help, a center-distance lens may be suggested.  Conversely, for those with more of a near focus, center-near lenses are an option.  In each of these, there is a power in the center (either your distance or near prescription) that is then progressively varied in peripheral rings to provide either distance or near correction.  Additionally, a few “simultaneous” options are provided that contain alternating concentric rings of distance and near power, where the user learns to focus on the appropriate image at the appropriate time.
Out of these, the center-distance/center-near designs are my favorites, as I find they are generally the easiest for adaptation.  However, soft multifocals are not for everyone.  Due to the dual power design of the lens, vision tends to be decent at all distances, but perfect at none. Nevertheless, these lenses provide an excellent option for those desire spectacle free optical correction, and can tolerate mild imperfections.

Hard Multifocal Contacts

For those wanting clearer vision while still wearing contacts, hard multifocal contact lenses may be an option.  These lenses work essentially like a bifocal (or trifocal) lens that sits on your eye – line included, with the premise that the lens will translate, or move, as your eye does, to allow you to reach the near portion in down gaze, and stay in the distance prescription in primary/central gaze.
Admittedly, hard multifocal contacts are generally not my go to, simply because I’m less comfortable with fitting them, and often find that only those long-standing hard contact lens wearers are interested in this option.  Nevertheless, they often provide clear vision at most distances for those who can tolerate their initial discomfort!

Spectacle Over-Wear

Last but not least, let’s cover the final option for contact lens wearers – having spectacle correction too.
In this, both the contact lens and spectacle prescriptions are up to you.  Do you prefer to be glasses free when you’re driving and looking in the distance? Or are you on the computer all day and prefer to only add your glasses for distance tasks?  Or, do you prefer to switch it up, depending on the requirements of the day?
Guess what?  With spectacle over-wear, you can do it all.
While I’m not yet to the presbyopic stage, this will probably end up being my preferred method by the time that day arrives, as it is arguably one of the most cost effective options that maintains vision quality.
For those preferring contacts for distance, great!  Buy some cheap over the counter reading glasses (of varying prescriptions based on the task distance) and store them where you’re likely to need them!
Conversely, for those who are more commonly working at near, get a cheaper pair of glasses (maybe even online…) to throw on when you need crystal clear distance vision!
Win. Win.
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