What are multifocal or presbyopia contacts?

Let’s start with ‘multifocal contacts,’ ‘presbyopia contacts,’ and ‘contacts for presbyopia’ are the same thing. Sometimes there’s confusion in the naming.

Multifocal contacts are the only contacts that are designed to treat presbyopia. In other words, these lenses give you both distance and up-close vision in one lens.

How do presbyopia Contacts work?

The simple definition of how presbyopia contacts work is they have multiple prescriptions blended throughout the contact lens.

Each lens has a unique design created by contact lens scientists who blend physics of light and real-world patient studies to create the optimal blend of distance and near vision.

The most important thing to understand about multifocal contacts is they don’t have different areas of the lens you look through for distance versus near unlike glasses.

[image of glasses vs contacts]

Note: There is a rare exception to contacts not having different areas of the lens you look through and that is a specific type of “hard” contact lens, or gas permeable contact, that has a true bifocal. You look down to look through this section. I rarely see this used.

If you’d like a little more detail on exactly how these lenses are designed, there are two main designs of soft contacts lens for presbyopia:

Concentric design: Concentric multifocal contacts have multiple distinct rings (think like rings on a tree) and each ring alternates give you a distance prescription and the next gives you a reading prescription. The most common concentric design lens is Biofinity. It has choices between the center of the lens being distance of near focused, and then the rings alternate from there.

Aspheric design: Aspheric multifocal contacts have a blend of different prescriptions. Instead of multiple rings in the concentric design, it’s more of a smooth range going from distance to near vision. Most aspheric lenses start with near in the middle and get better for distance toward the outside of the lens.

So which is better concentric vs aspheric design? Reading about the two you might think aspheric is the better option, but in my experience, patients do just as well (and many times prefer) the concentric design lenses. The marketers of aspheric will say that it doesn’t cause the side effects of “ghosting” and haze of letters that aspheric designs do, but I haven’t found this in my experience prescribing the lenses.

Multiple of these rings are in your vision at one time, so your brain has to decide to focus on

How long does it take to adapt to multifocal contacts?

Adaption to multifocal contacts varies significantly but can take up to a month. Your brain has to adjust to getting two different images at one time. At first, it interprets these two images as shadows and halos on letter, but with time, most people those shadows begin to fade.

The difficult part can be determining if it’s an adaption problem or is it time to give up or make a change to the lens (see below). Your eye doctor will be used to having these conversations with patients and can give you a better idea on whether you should keep trying, or try something new (see below).

If I don’t like presbyopia contacts, what should I do?

You have multiple other contacts options for presbyopia, and I’d at least learn about your options to see if one might be for you.

But you also may not want to give up so fast.

One multifocal contact not working, doesn’t mean it’s not right for you. There are many changes your eye doctor can make to the lens:

  • Tweaking the power of the lens: distance prescriptions are straightforward, but when you combine reading, it’s often a combination of how much reading to give you. This can be a “tug of war” between distance and near. Sometimes your eye doctor just needs to fine tune right mix for you. They do this by seeing what’s working and what’s not with the lens.
  • Tweaking the fit of the lens: If you’re experiencing blurriness that changes with blinking, it might be a fit issue. Because they have multiple prescriptions in your vision, when multifocals move around, it can disrupt the fragile balance of giving you distance and near. Your eye doctor may be able to change the fit of the lens your in, or change you to a completely different lens for the fit.
  • Changing the multifocal design: There is no “one size fits all” best multifocal design. One example is smaller pupil sizes tend to do better with distance-center designs and large pupils do better with near-center designs.

Frequently asked questions about presbyopia contacts

Are there colored contacts for presbyopia?

Unfortunately, there currently are no colored contacts for presbyopia. The good news if you have other contact options to correct presbyopia, and you could consider monovision contacts or distance contacts with readers. Both of these could be done with colored contacts.

How much do multifocal contacts cost?

The cost of multifocal contact lenses for a year supplies can be anywhere from $300 to $1,200. Why the huge difference?

There are a few things that make the price difference: daily vs monthly contact, do you have astigmatism or not, and the lens design/brand. If you’re cost-conscious, you can probably work with your eye doctor to find a lens on the lower end of that range that can be a perfectly good lens. If you want the latest technology in comfort and eye health, it may be toward the upper half of that range.

In the end, are multifocal/presbyopia contacts worth it?

Multifocal contacts are where I like to start for most people. When they work, they give you the best of both worlds. You get to use both eyes to see both far and distance, you don’t need to carry reading or any glasses around with you, and they don’t have some of the depth perception issues that can come with monovision.

With that in mind, some eyes, personalities, and professions don’t work great with multifocal contacts, so you may consider another presbyopia contact option if they don’t work out for you.

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