Tag: Presbyopia

The Intense Demands of Today Are Even More Troubling for the Aging Eye

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MAX MFA astigmatic presbyopes

In a world supported by technology at every corner, our lifestyles demand more from our eyes and vision. Since 2019, adults spend over 30% more time engaging with digital devices, averaging 13.5 hours of screen time a day.5 This notable increase is likely, in part, due to a shift to remote and hybrid working, which often is associated with more video teleconferencing, but many turn to using smartphones or tablets to complete day-to-day tasks or entertainment outside of a working day. A 2023 survey found that an average US household has 21 digital devices and 13 different types of devices.6 Symptoms of ocular and visual discomfort due to our digital environments are well documented, arising from altered blink patterns,7 tear film changes,8 and accommodative and convergence demands.9

End-of-day comfort and vision play key roles in overall contact lens satisfaction.10 Contact lens wearers can experience fluctuating vision throughout the day, and many patients have difficulties with the visual requirements of driving at night.11

For presbyopes, navigating the inevitable gradual decline in accommodation, coupled with the intense demands of the day brings a further visual challenge. The aging eye is also more likely to exhibit reduced tear film stability1 and increased intraocular light scattering,2,3 in addition to increased refractive astigmatism.4,12

Contact lens technologies to support success in the presbyopic patient

Amongst contact lens wearers aged over 40, 90% expect to continue to wear contact lenses.13 Despite this, almost half of patients aged over 45 drop out of contact lens wear.13 However, with 46% of presbyopic contact lens wearers fitted with a non-presbyopic fit,14 a large proportion of presbyopic contact lens wearers experience a high level of compromise, requiring the use of reading glasses over their contact lenses.14

Most spherical multifocal contact lens fitting guides recommend fitting patients with 0.75D of astigmatism or less. However, eye care professionals are likely to encounter many presbyopes with more than 0.75D of astigmatism. Data shows that prevalence of refractive astigmatism of 0.50D to 1.75D increases with age (Figure 1).4 Further, while with-the-rule (WTR) astigmatism is more prevalent in younger age, there is a gradual shift to against-the-rule (ATR) astigmatism amongst presbyopes.12

 

Figure 1: Prevalence of refractive astigmatism across age groups.4

Figure 1: Prevalence of refractive astigmatism across age groups.4

Johnson & Johnson brings innovation to market to better serve presbyopic astigmatic patients 

Up until now, daily disposable toric contact lens wearers have had to compromise as they become presbyopic.

Now, from the family of ACUVUE® OASYS MAX 1-Day comes ACUVUE® OASYS MAX 1-Day MULTIFOCAL for ASTIGMATISM, which combines innovative technologies from the ACUVUE® multifocal and toric lens designs with the performance of MAX for your presbyopic astigmatic patients.*15

This lens features an innovative 1.00D cylinder lens designed to simplify lens selection while delivering consistent results for patients with 1.00D to 1.75D cylinder to provide coverage for over 70% of presbyopic astigmatic eyes with ≥1.00D cylinder. ‡16,17

In a clinical study, average visual acuity with ACUVUE® OASYS MAX 1-Day MULTIFOCAL for ASTIGMATISM was better than 20/20 at distance and intermediate and better than 20/25+ at near for subjects with 1.00 to 1.75D cylinder. ‡17 Further, there was no clinically significant difference between patients who had 1.75D cylinder and those who had 1.00-1.50D cylinder for visual acuity, subjective comfort, subjective vision or subjective handling scores.^17 Wearers of ACUVUE® OASYS MAX 1-Day MULTIFOCAL for ASTIGMATISM confidently report clear vision reading a cell phone and using a computer.§17

Find out more about the FIRST and ONLY daily disposable multifocal toric contact lens18

Authors: Meredith Bishop OD MS FAAO, Senior Manager Global Professional Education and Development at Johnson & Johnson Vision Care, Inc. David Ruston BSc FCOptom DipCLP FAAO, Director Global Professional Education and Development at Johnson & Johnson Medical Ltd.

This Post is sponsored by Johnson & Johnson.

*Versus Dailies Total1®

‡In a clinical study of 163 subjects including 34 subjects with 1.75 D cyl in at least one eye. Average descriptive values.

^In a clinical study of 164 subjects including 34 subjects with 1.75 D cyl in at least one eye. Average descriptive values. No clinically significant difference (visual acuity:≤2.5 letters, comfort and handling:≤5 points on validated questionnaire).

  • T3B descriptive summaries: n=171

References

  1. Mostafa YMSE, Saif MYS, Saeed MA, et al. The Effect of Age and Gender on Tear Film Breakup Time. Egyptian Journal of Medical Research 2021;2(2):137–48.
  2. van den Berg TJ. Analysis of intraocular straylight, especially in relation to age. Optom Vis Sci 1995;72(2):52–9.
  3. van den Berg TJTP, Van Rijn LJR, Michael R, et al. Straylight Effects with Aging and Lens Extraction. American Journal of Ophthalmology 2007;144(3):358-363.e1.
  4. Sanfilippo PG, Yazar S, Kearns L, et al. Distribution of astigmatism as a function of age in an Australian population. Acta Ophthalmol 2015;93(5):e377–85.
  5. Eyesafe. COVID-19: Screen Time spikes to over 13 hours per day according to Eyesafe Nielsen estimates. Eyesafe March 2020.
  6. Deloitte. Balancing act: Seeking just the right amount of digital for a happy, healthy connected life. Deloitte Insights. https://www2.deloitte.com/us/en/insights/industry/telecommunications/connectivity-mobile-trends-survey/2023/connectivity-mobile-trends-survey-full-report.html. Accessed December 13, 2024.
  7. Portello JK, Rosenfield M, Chu CA. Blink rate, incomplete blinks and computer vision syndrome. Optom Vis Sci 2013;90(5):482–7.
  8. Wolffsohn JS, Lingham G, Downie LE, et al. TFOS Lifestyle: Impact of the digital environment on the ocular surface. Ocul Surf 2023;28:213–52.
  9. Watten RG, Lie I, Birketvedt O. The influence of long-term visual near-work on accommodation and vergence: a field study. Journal of human ergology 1994;23(1):27–39.
  10. Diec J, Naduvilath T, Tilia D. Subjective Ratings and Satisfaction in Contact Lens Wear. Optom Vis Sci 2018;95(3):256–63.
  11. Nicole Gruber, Urs P. Mosimann, René M. Müri & Tobias Nef (2013) Vision and Night Driving Abilities of Elderly Drivers, Traffic Injury Prevention, 14:5, 477-485, DOI: 10.1080/15389588.2012.727510.
  12. Read SA, Vincent SJ, Collins MJ. The visual and functional impacts of astigmatism and its clinical management. Ophthalmic Physiol Opt 2014;34(3):267–94.
  13. JJV Data on File 2022. A survey conducted with a total n=7356 and CL wearers n=1213 representative U.S. and U.K. consumers, ages 15-64.
  14. Morgan PB, Efron N, Papas E, et al. BCLA CLEAR Presbyopia: Management with contact lenses and spectacles. Contact Lens and Anterior Eye 2024;47(4):102158.
  15. JJV Data on File 2022. Comparative Subjective Claims for ACUVUE® OASYS MAX 1-Day lens vs Dailies Total1® and Additional Stand-Alone Claims.
    16. JJV Data on File 2024. SKU Coverage Claims for ACUVUE® OASYS MAX 1-Day and ACUVUE® OASYS MAX 1-Day MULTIFOCAL Brand Contact Lenses.
    17. JJV Data on File 2024. Subjective Standalone Claims for ACUVUE® OASYS MAX 1-Day MULTIFOCAL Contact Lenses for ASTIGMATISM.
    18. JJV Data on File 2024, First and Only Daily Disposable Multifocal Toric Contact Lens in US.

 

Important Safety Information: ACUVUE® Contact Lenses are indicated for vision correction. As with any contact lens, eye problems, including corneal ulcers, can develop. Some wearers may experience mild irritation, itching or discomfort. Lenses should not be prescribed if patients have any eye infection, or experience eye discomfort, excessive tearing, vision changes, redness or other eye problems. Consult the package insert for complete information. Complete information is also available from Johnson & Johnson Vision Care, Inc. by calling 1-800-267-5098, or by visiting www.jnjvisionpro.com/en-ca/.

The third-party trademarks used herein are the intellectual property of their respective owners.
© Johnson & Johnson and its affiliates 2025  2025PP15604

 

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ACUVUE® NEWS—A daily disposable contact lens for the presbyopic astigmat

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From the family of ACUVUE® OASYS MAX 1-Day comes ACUVUE® OASYS MAX 1‑Day MULTIFOCAL for ASTIGMATISM.

Featuring four proprietary technologies in a single lens, it delivers clear vision at all distances and in all lighting conditions, plus all-day comfort and exceptional stability.2 Plus, it’s designed for patients with up to 1.75D cyl.

PUPIL OPTIMIZED Design tailors 100% of the optical designs to pupil size variation across age and refraction.*3

BLINK STABILIZED® Design features four stability zones with vertical and horizontal symmetry so they are more resistant to gravity and realign naturally with every blink to provide clear and stable vision.4

TearStable™ Technology optimizes PVP (a tear-like wetting agent) distribution throughout the lens and at the surface, reducing evaporation nearly two times more than other leading competitors and prolonging tear-film stability.^^5-7

OptiBlue™ Light Filter provides the highest level of blue-violet light filtering.†#5,7 The combination of OptiBlue™ Filter with TearStable™ Technology in the ACUVUE® MAX 1-Day Family allows the lens to reduce light scatter.##5,6

Fit 92.3% of your presbyopic patients’ eyes with the MAX MULTIFOCAL Family8 – even those with astigmatism!

Authors: Meredith Bishop OD MS FAAO, Senior Manager Global Professional Education and Development at Johnson & Johnson Vision Care, Inc. David Ruston BSc FCOptom DipCLP FAAO, Director Global Professional Education and Development at
Johnson & Johnson Medical Ltd.

This Post is sponsored by Johnson & Johnson.

* Compared to Competitor’s design, technology optimized for both the parameter of refractive error and ADD power.

†Filtering of HEV light by contact lenses has not been demonstrated to confer any health benefit to the user, including but not limited to retinal protection, protection from cataract progression, reduced eye strain, improved contrast, improved acuity, reduced glare, improved low light vision, or improved circadian rhythm/sleep cycle. The Eye Care Professional should be consulted for more information.
^^Versus Dailies Total1®, MyDay® and Ultra® One Day, also significantly lower versus ACUVUE® OASYS 1 Day.
#Versus publicly available information for standard daily use contact lenses as of December 2023.
##Versus ACUVUE® OASYS 1-Day.

References

  1. JJV Data on File 2024, First and Only Daily Disposable Multifocal Toric Contact Lens in US.
  2. JJV Data on File 2024. Subjective Standalone Claims for ACUVUE® OASYS MAX 1-Day MULTIFOCAL Contact Lenses for ASTIGMATISM.
  3. JJV Data on File 2022. ACUVUE® PUPIL OPTIMIZED DESIGN TECHNOLOGY: JJVC contact lenses, design features, and associated benefits.
  4. JJV Data on File 2024. ACUVUE® Brand Contact Lenses for ASTIGMATISM overall fitting success, orientation position, rotational stability and vision performance.
  5. JJV Data on File 2022. TearStable™ Technology Definition.
  6. JJV Data on File 2022. Effect on Tear Film and Evaluation of Visual Artifacts of ACUVUE® OASYS MAX 1-DAY Family with TearStable™ Technology.
  7. JJV Data on File 2022. Material Properties: 1-DAY ACUVUE® MOIST, 1-DAY ACUVUE® TruEye®, ACUVUE® OASYS 1-DAY with HydraLuxe® Technology and ACUVUE® OASYS MAX 1-Day with TearStable™ Technology Brand Contact Lenses and other daily disposable contact lens brands.
  8. JJV Data on File 2024. SKU Coverage Claims for ACUVUE® OASYS MAX 1-Day and ACUVUE® OASYS MAX 1-Day MULTIFOCAL Brand Contact Lenses.

Important Safety Information: ACUVUE® Contact Lenses are indicated for vision correction. As with any contact lens, eye problems, including corneal ulcers, can develop. Some wearers may experience mild irritation, itching or discomfort. Lenses should not be prescribed if patients have any eye infection, or experience eye discomfort, excessive tearing, vision changes, redness or other eye problems. Consult the package insert for complete information. Complete information is also available from Johnson & Johnson Vision Care, Inc. by calling 1-800-267-5098 or by visiting www.jnjvisionpro.com/en ca/.

The third-party trademarks used herein are the intellectual property of their respective owners.
© Johnson & Johnson and its affiliates 2025  2025PP15771

 

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Hurry Up and Fit Them While They’re Young

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With an aging population, the opportunity to fit both current contact lens wearers and emmetropic patients with multifocal contact lenses is enormous. The benefits of doing so range from delighting patients through to increasing your revenue from higher value contact lenses and add-on sales of reading glasses. So take a moment to consider your practice: do you talk about multifocal contact lenses with every emerging presbyope or do they take a back seat until you have tried and exhausted other options such as monovision?

There are, of course, a number of positives for fitting monovision: it is quick, easy and costs no more than ‘normal’ contact lenses. However, monovision does not do so well in the long run for many patients. As the required near addition increases over time, it becomes more difficult to use the same prescription for both reading and intermediate distances. In my experience, more than half of monovision wearers have difficulty once the near add is over 2.00D. It is then that an alternative solution, such as multifocal contact lenses needs to be explored. The difficulty of this approach is that the patient already requires mid to high adds, and these are harder to adapt to.

My preference is to be proactive and fit multifocals early. In much the same way we might recommend low add varifocal spectacles to ease adaptation, fitting low add multifocal contact lenses makes initial adaptation easier for patients. It also maintains their binocular vision and provides a contact lens solution that can adapt with them over time.

Starting the Conversation Early
While no multifocal contact lens can promise to deliver perfectly clear vision 100 per cent of the time, steps can be taken to promote successful outcomes. In my experience, the most crucial step is to get communication right. Conversations about presbyopia should happen early, before its onset. I routinely talk to pre-presbyopes about what will happen to their vision in the future. It means they are not surprised when reading becomes more difficult and that they are aware of their options.

Communication is also key when it comes to setting expectations. Defining success with multifocal contact lenses helps patients frame their experience more realistically. Explain that multifocal contact lenses will work for a majority of the time and that supplementary reading glasses may occasionally be necessary for fine detail. Setting realistic expectations enables more patients to feel their contact lenses are working as well as could be expected. Scoring the relative convenience of both their spectacles and contact lenses works well too. An 8 out of 10 may not be perfect, but it’s certainly ‘good enough’ for many patients, particularly if they also score their reading glasses or varifocals at the same level. Also bear in mind that multifocal contact lenses are not the best option in every case: patients with unrealistically high expectations or specific detailed visual demands may do better with other forms of vision correction.

I follow three tips when fitting multifocal contact lenses. (1) I always use the manufacturer’s fitting guide, which will have been produced after extensive research. If the guide quotes a particular rate of fit success, it will have been achieved by following specific steps, so no matter how tempting it is to stray, I cannot recommend strongly enough that sticking to the guide should lead to the greatest fitting success. (2) I assess vision with ‘real world’ targets. I try to understand my patient’s visual environment and use that to assess how well they can see. Use real life reading material, ask patients to view their smart phone, tablet or laptop and check their vision across the street. Optimise their vision for everyday tasks. (3) Know when to stop making adjustments. As a young practitioner trying to achieve perfect vision, I would tweak multifocal prescriptions a lot, a practice that is not realistic and leads to disappointment. Use the fitting guide to make one or maybe two adjustments. Have the confidence to face your patient and say ‘this is as good as we can get it’. It is amazing how often they will accept that statement and happily choose to continue with those contact lenses. It avoids the endless pursuit of perfection and puts a sensible limit on chair time.

Increasing Choice for the Practitioner and Patient
Good choice exists for frequently replaced soft multifocals with options available in daily disposable and monthly modalities. Adding to this selection, it is worth being aware of some more recently released designs too. Available in three adds, Johnson & Johnson’s 1-DAY ACUVUE® MOIST® Multifocal is a new hydrogel daily disposable. It combines the performance of etafilcon A with an optimised aspheric centre-near design that accounts for pupil size variance due to both refractive error and age across the power range. Bausch + Lomb’s Biotrue® ONEday for Presbyopia is another new hydrogel. It delivers a centre-near, three-zone progressive design with two add powers. Less recent, but an important alternative in this category is the Clariti® 1-Day Multifocal from CooperVision, currently the only multifocal daily disposable available in a silicone hydrogel material. With many patients choosing part-time contact lens wear, increased choice in the daily disposable portfolio is welcome. Perhaps the most recent addition in the frequent replacement sector is the PureVision®2 for Presbyopia from Bausch + Lomb. Offering an updated design with a wider intermediate area and predictable, efficient fitting, it is a welcome addition to the silicone hydrogel category, alongside other options such as Alcon’s AIR OPTIX® AQUA Multifocal which offers three add powers.

In summary, fitting presbyopes with multifocal contact lenses is best done early and with good clear communication to ensure your patient’s expectations are realistic. Have confidence to be proactive with this group of patients and you will experience the professional and business rewards that follow.

This article was published originally in OPTIK Magazine, February 2016.

KAREN WALSH, MCOPTOM

Karen Walsh, BSc(Hons) PGDip MCOptom FIACLE Medical Research Fellow Phone: (519) 888-4567 ext.37548 Email: karen.walsh@uwaterloo.ca Karen graduated in Optometry from Cardiff University, Wales in 1997. She subsequently worked in the UK across all forms of clinical practice, along with supervising undergraduate contact lens clinics at Aston University, Birmingham. Following seven years of working with Brian Tompkins in his independent practice that specialized in contact lenses she joined Johnson & Johnson Vision Care as a Professional Affairs Manager for the UK & Ireland in 2007. Karen has authored clinical articles and educational training programmes on both contact lenses and UV radiation; she has lectured internationally, and has taught at the VISION CARE INSTITUTE™ of Johnson & Johnson Vision Care in both Prague and the UK. She holds a post graduate diploma in Clinical Optometry from City University, London and is a Fellow of the International Association of Contact Lens Educators. She joined the CCLR in 2015 and currently holds the post of Medical Research Fellow.

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