Jiyoon Chung

Visual performance of single vision and multifocal contact lenses in non-presbyopic myopic eyes

PURPOSE To assess visual performance of single vision and multifocal soft contact lenses. METHODS At baseline, forty-four myopic participants (aged 18-35 years) were fitted bilaterally with a control lens (AirOptix Aqua). At the four follow-up visits, a total of 16 study lenses (5 single vision, 11 multifocal lenses) were fitted contralaterally. After 1h of lens wear, participants rated (scale 1-10) vision clarity (distance, intermediate and near), magnitude of ghosting at distance, comfort during head movement, and overall comfort. Distance high contrast visual acuity (HCVA), central refraction and higher order aberrations, and contact lens centration were measured. RESULTS For single vision lenses, vision ratings were not significantly different to the control (p>0.005). The control outperformed Acuvue Oasys, Clariti Monthly and Night and Day in HCVA (mean VA: -0.10 ± 0.07 logMAR, p<0.005). Most refraction and higher order aberration measures were not different between lenses. The Night and Day lens showed greatest differences compared to the control, i.e., C[4, 0] was more positive (p<0.005) at distance (Δ=0.019 μm) and near (Δ=0.028 μm). For multifocal lenses, the majority of vision ratings (84%) were better with the control (p<0.005). HCVA was better with the control (p<0.005). Proclear Multifocal lenses showed greatest differences for M, C[3, -1] and C[4, 0] at distance and near, and were inferiorly de-centered (p<0.005). CONCLUSION Design differences between single vision lenses had a small impact on visual performance. Lenses featuring multifocality decreased visual performance, in particular when power variations across the optic zone were large and/or the lens was significantly de-centered.

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.

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.

Short-Term Adaptation of Accommodative Responses in Myopes Fitted With Multifocal Contact Lenses.

Objectives: To investigate whether adaptation of accommodative responses occurred in non-presbyopic myopes fitted with four multifocal contact lens (MFCL) designs. Methods: Prospective, subject-masked clinical investigation comprising 40 experienced myopic lens wearers (18–25 years) fitted bilaterally with single-vision (SV) control lens (Air Optix Aqua [Alcon, Fort Worth, TX]) and randomized to two of four test MFCL (Proclear MFCL [Distance and Near] [CooperVision, Pleasanton, CA], Air Optix Aqua MFCL, Purevision MFCL [Bausch & Lomb, Rochester, NY]). Lenses were dispensed on a daily wear basis and worn for a minimum of 8 (maximum 14) days over three assessment visits, with a 1-week wash out between stages. Paraxial curvature matched spherical equivalent (M) was measured with lenses on eye using the BHVI-EyeMapper with an internal movable fixation target positioned at target vergences of +1.00 diopter (D) (fogging) and −2.00 to −5.00 in 1.00 D steps (accommodative stimuli). Accommodative facility was assessed by several flips of ±2.00 D/min (cycles/min) at 33 cm and horizontal phoria with a Howell phoria card at distance (3 m) and near (33 cm). Results: For center-distance MFCL (Proclear D), the spherical equivalent (M) at all near vergences became significantly more negative at the follow-up visits compared with the dispensing visit (P<0.029). For all center-near MFCLs and SV lens, M remained invariant during the adaptation period, however (P≥0.267). At distance, M became significantly less minus with Air Optix Aqua MFCL over time (P=0.049). Accommodative facility increased over the three assessment visits for participants wearing Air Optix Aqua SV, Air Optix Aqua MFCL, and PureVision MFCL (P=0.003). Distance and near horizontal phoria remained stable over the three assessment visits for all lens types (P≥0.181). Conclusions: Adaptation differences were not consistently found for static accommodative measures gauged by M, as measured with lenses on eye, and phoria but were found in dynamic measures (facility), perhaps indicating some learning effects. Accommodative adaptation seems unlikely to occur with long-term MFCL in non-presbyopes.