Multifocal Contact Lens Myth Busting

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I opened my practices in 2021, by buying two existing locations and opening the third cold, so I now have three locations throughout the Florida panhandle. My team and I offer primary eye care services to people of all ages, beginning with pediatrics, and we treat the gamut of ocular pathology. Within our patient population is a significant amount of diabetes, glaucoma, and macular degeneration. One of my rural locations also receives referrals from our local emergency room and urgent care clinics.

When I bought my practices, my team members and I made a conscious effort to increase our contact lens business. We have been able to fulfill the need for multifocal contact lenses in our community via daily disposable and monthly options.

INTERNATIONAL DATA ON PRESBYOPIC LENS PRESCRIPTIONS SINCE 2000

In December 2024, Morgan et al published the latest data analysis of 52,580 contact lens fits (monovision and multifocal soft contact lenses) performed by practitioners in 20 countries, on presbyopic patients 45 years and older, between 2000 and 2023.¹

• Overall rates of both multifocal and monofocal prescriptions have increased over that time from 26.4% to 61.1%.
• In a sub-analysis of daily-wear soft lens fits between 2019 and 2023 (n = 13,014), the researchers found that multifocal lenses represented 51% and monovision represented 10% (22% in the United States specifically). The remaining 39% reflects nonpresbyopia lens fits, which equates to distance-only correction.

Furthermore, data from the International Contact Lens Prescribing Trends Consortium show that the prescribing of multifocal contact lenses for presbyopes has grown from approximately 25% of fitted lenses in 2005 to approximately 50% in 2020 for the US plus 17 other countries.²

1. Morgan PB, Efron N, Woods CA. International trends in prescribing multifocal and monovision soft contact lenses to correct presbyopia (2000–2023): An update. Cont Lens Anterior Eye. 2024. In press. Accessed February 6, 2025. https://www.contactlensjournal.com/action/showPdf?pii=S1367-0484%2824%2900241-8

2. Dumbleton K, Palombi J. Soft multifocal contact lenses: a review. Contact Lens Spectrum. June 1, 2022. https://www.clspectrum.com/issues/2022/june/soft-multifocal-contact-lenses-a-review/. Accessed February 6, 2025.

When I graduated from optometry school, the designs and performance of multifocal contact lenses weren’t that good. We practitioners avoided them because they took up too much clinical time, and patients complained about their visual performance and comfort. These perceptions are starting to change, since the materials and designs of multifocals have improved in recent years to include high-water-content biomaterials and optics that provide smoother transitions between viewing distances. In fact, recent research shows that prescriptions for presbyopic correction have risen significantly since 2000 around the world (see the sidebar, International Data on Presbyopic Lens Prescriptions Since 2000).

Still, are new-technology multifocal contact lenses being adopted fast enough to meet the needs of the growing number of presbyopes in our clinics? Here, we’ll consider whether old myths about multifocal contacts still hold true.

• There are approximately 2,700 multifocal contact lens candidates for each optometrist.²
• The presbyopia community is expanding: by 2035, there will be 215 million people aged 35 years or older in the US.³

Dr. Gilbert-Spear: Multifocal contact lenses are appropriate for patients of any age, as long as their corneas are healthy. Patients may not take us up on trying these lenses the first time we mention them, but that’s no reason not to keep offering them. I’ve had many patients in their 50s and 60s who haven’t worn contacts in a very long time, and after a few visits of listening to me talk about their benefits, decide they are willing to try a trial pair of multifocals. Usually, they love them. For individuals who don’t want to wear contacts every day, I recommend the daily disposable multifocal lenses, because they’re so easy and convenient. For example, I have older patients who frequently travel on the weekends, and they like the convenience of not having to remember glasses when they travel.

The general public’s awareness about multifocal contact lenses is still low, and there may be several reasons for this. For one, I suspect that many optometrists pigeonhole patients—for example, only offering multifocals to emerging presbyopes or to older people who are already wearing spherical lenses. Some practitioners think that if a patient hasn’t worn contacts in 20 years, they can’t or won’t wear them later in life. We should not automatically disqualify anyone from candidacy for a multifocal lens, even those patients who we think need a high quality of vision. In fact, I have successfully prescribed multifocal contact lenses for several military and commercial pilots in my town, and they do very well with them.

Another group of people who I’ve found are great candidates for multifocal contacts are those who dislike wearing glasses. And, once they realize the lenses let them wear non-prescription sunglasses, they’re thrilled.

Dr. Gilbert-Spear: Before better multifocal contacts became available, I had more success fitting spherical monovision or even modified monovision lenses. These days, my staff and I rarely prescribe monovision lenses. The optics of the new multifocal contact lenses are excellent, and I expect them to provide great vision for 85% of a wearer’s normal activities.

We start emerging presbyopes in multifocal contacts, and we’ve switched most presbyopes who were in monovision lenses to multifocal ones, with great success. Patients like using both eyes together; their vision works better, especially when they read digital devices. The only monovision patients I still have are people who truly do not use a computer, such as farmers, or professional truckers who drive long distances at night.

I counsel patients that they may need to use glasses over their multifocal contacts for very close-range work like sewing, or for extended-distance night driving, but otherwise I expect them to have no issues. I always set my patients’ expectations about a lens’ performance before they try it, and I’m aware of their daily habits from our conversations over time.

FOLLOW THE FIT GUIDE!

Once, I didn’t follow my own advice about adhering to the fit guide while I was fitting a female patient in her mid-60s for a multifocal contact lens. Previously, I had increased her glasses prescription from +2.50 D to +2.75 D. I was hurrying, and I thought she would probably need a medium add in the contact lens, because jumping to a low add seemed like too much. She came back to see me the following week complaining about her vision in the contacts, and then I remembered that I’d never really checked the add. The fit guide indicated a low add for this patient, and once I put her that prescription, she was very happy.

I also let patients try trial multifocal contact lenses, so they can experience the visual performance for themselves before committing to a prescription. If they decide not to purchase contacts after the fitting, we let them apply the fitting fee toward glasses or sunglasses, so they don’t lose any money for trying the contacts (this policy removes the financial barrier to trying the lenses). Usually, once patients try multifocal contact lenses, they really like them. In fact, I’ve had patients return to my office crying with joy that they don’t have to wear glasses anymore.

Dr. Gilbert-Spear: I have a very low dropout rate with multifocal contacts, which I believe is because I set my patients’ expectations about their possible limitations (close-range vision and nighttime driving, as I mentioned). As I said, we rarely hear patients complain about their vision from multifocal lenses, even those who are pilots. I don’t receive complaints about comfort, either, even from my dry eye patients, because the high-water-content materials of the new lenses feel so good on patients’ eyes.

Also, the secret to helping patients to love their contact lenses is to follow each lens’ fitting guide.

Dr. Gilbert-Spear: Veteran practitioners remember that the chair time for fitting older-technology multifocal contact lenses was significant, to the point of almost not being worth the trouble. Since adopting new multifocals, however, I’ve found that fittings can be very smooth and efficient if my staff and I prepare for them. First, having contact lens fits on the schedule is very helpful to our clinical flow, so my team and I are able to prepare for them. Second, I’ve trained my technicians to prepare patients so that when I enter the treatment room, I can talk to the patients and make any changes they need.

Third, I follow the lens’ fit guides to a tee, because they’re always right, even though they sometimes feel counterintuitive to what we’ve been taught. Having the proper measurements beforehand ensures accurate fits with the first lens. You can’t start with the add that’s in the patient’s bifocal, it’s the least plus add (see the sidebar, Follow the Fit Guide!).

Dr. Gilbert-Spear: I treat surface dryness before I put patients in contacts. If a veteran contact lens wearer develops symptoms of dry eye disease (DED), I will make sure their ocular surface is as healthy as possible before placing them back in a daily disposable lens with a high water content. I believe the daily multifocal contact lenses are healthier for eyes with any signs of DED. I’ve had no issues whatsoever with patients in this population dropping out, because these lenses are so comfortable.

1. Jone L, Efron N, Bandamwar K, et al. TFOS lifestyle: impact of contact lenses on the ocular surface. Ocul Surf. 2023;29:175-219.

2. American Optometric Association. The state of the optometric profession: 2013. Accessed October 25, 2016.
https://www.aoa.org/Documents/news/state_of_optometry.pdf.

3. US Census Bureau, Population Division. 2017 National Population Projections Tables: Detailed age and sex composition of the population, 2017-2060. Accessed September 1, 2020. https://www.census.gov/data/tables/2017/demo/popproj/2017-summary-tables.html.

4. de la Jara PL, Sulley A, Pepe P, et al. Multifocal contact lens success predictability. Cont Lens Anterior Eye. 2024;47(2):1-6. Accessed February 7, 2025.

Katie Gilbert-Spear, OD, JD, MPH
Owner, The Vision Hub, LLC, DeFuniak Springs, Fort Walton Beach, and Freeport, FL
Healthcare Attorney, Dr. Katie Gilbert Spear, PLLC
Podcast, Legal Eye on Health, legaleyeonhealth.com
kjgilbert77@gmail.com
Financial disclosure: Consultant (Alcon)