Jennifer Sha

Short-Term Visual Performance of Novel Extended Depth-of-Focus Contact Lenses.

Purpose To compare the objective and subjective visual performance of a novel contact lens which extends depth of focus by deliberate manipulation of higher-order spherical aberrations and a commercially available zonal-refractive multifocal lens. Methods A prospective, cross-over, randomized, single-masked, short-term clinical trial comprising 41 presbyopes (age 45 to 70 years) wearing novel Extended Depth of Focus lenses (EDOF) and ACUVUE OAYS for Presbyopia (AOP). Each design was assessed on different days with a minimum overnight wash-out. Objective measures comprised high-contrast visual acuity (HCVA, logMAR) at 6 m, 70 cm, 50 cm, and 40 cm; low-contrast visual acuity (LCVA, logMAR) and contrast sensitivity (log units) at 6 m; and stereopsis (seconds of arc) at 40 cm. HCVA at 70 cm, 50 cm, and 40 cm were measured as “comfortable acuity” rather than conventional resolution acuity. Subjective performance was assessed on a 1–10 numeric rating scale for clarity of vision and ghosting at distance, intermediate and near, overall vision satisfaction, ocular comfort, and lens purchase. Statistical analysis included repeated measures ANOVA and paired t tests. Results HCVA, clarity of vision, and ghosting with EDOF were significantly better than AOP (p < 0.01); however, differences were dependent on testing distances and add groups. Post hoc analysis showed EDOF was significantly better than AOP for HCVA at 70 cm (0.11 ± 0.11 vs. 0.21 ± 0.16, p < 0.001), 50 cm (0.26 ± 0.17 vs. 0.36 ± 0.18, p = 0.003), 40 cm (0.42 ± 0.17 vs. 0.52 ± 0.21, p = 0.001), and LCVA at 6 m (0.22 ± 0.08 vs. 0.27 ± 0.12, p = 0.024). EDOF was significantly better than AOP for clarity of vision at distance (7.7 ± 1.6 vs. 6.8 ± 2.3, p = 0.029), intermediate (8.8 ± 1.4 vs. 7.0 ± 2.2, p < 0.001), and near (7.4 ± 2.4 vs. 5.2 ± 2.7, p < 0.001), ghosting at distance (9.1 ± 1.2 vs. 8.1 ± 2.5, p = 0.005), and overall vision satisfaction (7.6 ± 1.6 vs. 6.0 ± 2.6, p < 0.001). More participants chose to purchase EDOF compared to AOP (61 vs. 39%) and significantly more chose to only-purchase EDOF compared to only-purchase AOP (27 vs. 5%, p = 0.022). Conclusions When compared with AOP, EDOF lenses provide better intermediate and near vision performance in presbyopic participants without compromising distance vision.

Impact of Spherical Aberration Terms on Multifocal Contact Lens Performance

PURPOSE To investigate the impact of the primary (PSA) and secondary (SSA) spherical aberration terms on visual performance (VP) in presbyopes, as measured using multifocal (MFCL) soft contact lenses on eye. METHODS Seventeen presbyopes (age: 55.1 ± 6.9 years) wore seven commercial lenses (four center-near (MFCL N), one center-distance (MFCL D), one bifocal, and one single vision control). Unaided and with each lens on eye, the PSA and SSA terms were obtained with an aberrometer, the BHVI-EyeMapper (low illumination, natural and 4 mm pupil diameter). High- and low-contrast distance visual acuity, contrast sensitivity, high-contrast visual acuities at near, and range of clear vision were measured. In addition, subjective VP variables included clarity of vision at distance and near, ghosting, and overall vision satisfaction. Pearsons correlation was used to determine the association between the PSA and SSA terms and the VP variables. RESULTS PSA (natural pupil) was more negative (P < .05) with the MFCL N (mean PSA = -0.053 ± 0.080 μm) and bifocal (PSA = +0.005 ± 0.067 μm) lenses and more positive with the MFCL D lens (PSA = +0.208 ± 0.160 μm) than the control (+0.067 ± 0.072 μm). SSA (natural pupil) was significantly more positive for the MFCL N lenses (mean SSA = +0.025 ± 0.029 μm) compared to the control (SSA = -0.001 ± 0.017 μm). PSA and SSA terms were significantly (P < .05) correlated with 78% and 56% of VP variables, respectively, but the correlation coefficients were weak, ranging between |0.210| and |0.334|. Although distance variables showed improved VP with more positive PSA or negative SSA, most near variables showed improved VP with more negative PSA. Range of clear focus was greater for more negative PSA terms. CONCLUSIONS The amount and direction of PSA and SSA terms, as measured with different MFCLs on eye, can affect VP at different distances. Results of this study may provide useful information when designing new or optimize existing MFCLs for improved VP at specific distances.

Short-term visual performance of soft multifocal contact lenses for presbyopia.

PURPOSE To compare visual acuity (VA), contrast sensitivity, stereopsis, and subjective visual performance of Acuvue® Oasys® for Presbyopia (AOP), Air Optix® Aqua Multifocal (AOMF), and Air Optix® Aqua Single Vision (AOSV) lenses in patients with presbyopia. METHODS A single-blinded crossover trial was conducted. Twenty patients with mild presbyopia (add ≤+1.25 D) and 22 with moderate/severe presbyopia (add ≥+1.50 D) who wore lenses bilaterally for 1 h, with a minimum overnight washout period between the use of each lens. Measurements included high- and low-contrast visual acuity (HCVA and LCVA, respectively) at a distance, contrast sensitivity (CS) at a distance, HCVA at intermediate (70 cm) and near (50 cm & 40 cm) distances, stereopsis, and subjective questionnaires regarding vision clarity, ghosting, overall vision satisfaction, and comfort. The test variables were compared among the lens types using repeated-measures ANOVA. RESULTS Distance variables (HCVA, LCVA, and CS) were significantly worse with multifocal lens than with AOSV lens (p≤0.008), except for AOMF lens in the mild presbyopia group in which no significant difference was observed (p>0.05). Multifocal lenses had significantly greater HCVA at 40 cm than AOSV lens (p≤0.026). AOMF lens had greater intermediate HCVA than AOP lens (p<0.03). AOP lens demonstrated greater improvements in stereopsis than AOMF and AOSV lens in the moderate/severe presbyopia group (p≤0.03). Few significant differences in subjective variables were observed, with no significant difference in the overall vision satisfaction observed between lens types (p>0.05). The proportions of patients willing to buy AOSV, AOMF, and AOP lenses were 20%, 40%, and 50%, respectively, in the mild presbyopia group and 14%, 32%, and 23%, respectively, in the moderate/severe presbyopia group; however, these differences were not statistically significant (p≥0.159). CONCLUSIONS Further development of multifocal lenses is required before significant advantages of multifocal lenses over single vision lens are observed in patients with presbyopia.

Extended depth of focus contact lenses vs. two commercial multifocals: Part 2. Visual performance after 1 week of lens wear

Purpose To compare the visual performance of prototype contact lenses designed via deliberate manipulation of higher-order spherical aberrations to extend-depth-of-focus with two commercial multifocals, after 1 week of lens wear. Methods In a prospective, participant-masked, cross-over, randomized, 1-week dispensing clinical-trial, 43 presbyopes [age: 42–63 years] each wore AIROPTIX Aqua multifocal (AOMF), ACUVUE OASYS for presbyopia (AOP) and extended-depth-of-focus prototypes (EDOF) appropriate to their add requirements. Measurements comprised high-contrast-visual-acuity (HCVA) at 6 m, 70 cm, 50 cm and 40 cm; low-contrast-visual-acuity (LCVA) and contrast-sensitivity (CS) at 6 m and stereopsis at 40 cm. A self-administered questionnaire on a numeric-rating-scale (1–10) assessed subjective visual performance comprising clarity-of-vision and lack-of-ghosting at various distances during day/night-viewing conditions and overall-vision-satisfaction. Results EDOF was significantly better than AOMF and AOP for HCVA averaged across distances (p ≤ 0.038); significantly worse than AOMF for LCVA (p = 0.021) and significantly worse than AOMF for CS in medium and high add-groups (p = 0.006). None of these differences were clinically significant (≤2 letters). EDOF was significantly better than AOMF and AOP for mean stereoacuity (36 and 13 seconds-of-arc, respectively: p ≤ 0.05). For clarity-of-vision, EDOF was significantly better than AOP at all distances and AOMF at intermediate and near (p ≤ 0.028). For lack-of-ghosting averaged across distances, EDOF was significantly better than AOP (p < 0.001) but not AOMF (p = 0.186). EDOF was significantly better than AOMF and AOP for overall-vision-satisfaction (p ≤ 0.024). Conclusions EDOF provides better intermediate and near vision performance than either AOMF or AOP with no difference for distance vision after 1 week of lens wear.

Visual performance of myopia control soft contact lenses in non-presbyopic myopes

Purpose To compare the visual performance of soft contact lenses reported to reduce myopia progression. Methods In a double-blind, randomized, crossover trial, 30 non-presbyopic myopes wore MiSight™, center-distance Proclear® Multifocal (+2.00 D add), and two prototype lenses for 1 week each. High- and low-contrast visual acuities at 6 m, and 70 and 40 cm; stereopsis at 40 cm; accommodative facility at 33 cm; and horizontal phoria at 3 m and 33 cm were measured after 1 week. Subjective performance was assessed on a numeric rating scale for vision clarity, lack of ghosting, vision stability, haloes, overall vision satisfaction, and ocular comfort. Frequency of eye-strain symptoms and willingness to purchase lenses were also reported with categorical responses. Participants reported wearing times (total and visually acceptable). Linear mixed models and chi-square tests were employed in analysis with level of significance set at 5%. Theoretical optical performance of all lenses was assessed with schematic myopic model eyes (−1.00, −3.00, and −6.00 D) by comparing the slope of the edge spread function (ESF), an indicator for optical performance/resolution and the blur patch size of the line spread function, an indicator for contrast, between the lenses. Results Proclear Multifocal and MiSight provided the best distance acuities. However, the prototype lenses were rated significantly higher for many subjective variables, and there were no subjective variables where commercial lenses were rated significantly higher than the prototypes. Theoretical optical performance showed steeper slopes of the ESF and greater blur patch sizes of the LSP with commercial lenses, supporting the clinical findings of better visual acuities but reduced subjective performance. Participants wore prototypes longer and reported their vision acceptable for longer each day compared to MiSight. Both prototypes had the highest willingness-to-purchase rate. Conclusions The prototypes were better tolerated by myopes compared to the commercial soft contact lenses currently used for slowing myopia progression.

Effects of relative negative spherical aberration in single vision contact lens visual performance

Objective The study aimed to compare the visual performance of contact lenses with and without negative spherical aberration (SA) over 5 days of wear. Methods At baseline, 32 myopic participants (aged 18–33 years) were fitted in a randomized order with two lenses (test lens with minimal or no SA and 1-Day Acuvue Moist designed with negative SA) for 5 days (minimum 6 hours wear/day). Participants returned for a follow-up visit. This consisted of on-axis SA measurements; high- and low-contrast visual acuities at 6 m; high-contrast acuities at 70 and 40 cm; low-illumination, low-contrast acuity at 6 m; stereopsis at 40 cm; horizontal phorias at 3 m and 33 cm; and ±2.00 D monocular accommodative facility at 33 cm. Participants also rated (1–10 scale) vision quality (clarity and lack of ghosting for distance, intermediate, near, driving vision and vision stability during day- and night-time), overall vision satisfaction, ocular comfort, and willingness to purchase (yes/no response). Results 1-Day Acuvue Moist induced significantly (p<0.05) more negative SA at distance (Δ=0.078 μm) and near (Δ=0.064 μm) compared to the test lens, for a 6 mm pupil. There were no significant differences (p>0.05) in acuity, binocular vision, and all subjective metrics except vision stability between lenses where the test lens was rated to provide more stable vision (p<0.05). Conclusion Contrary to expectations, incorporating negative SA in single vision soft contact lenses did not improve visual performance in non-presbyopic adult myopes.