Contact Lens Options for Presbyopia

Around the age of 40, we all start to lose the ability to focus on objects at close distances. Of course,
reading glasses is the first option people think of to help but a lot of my patients just don’t want to deal
with the hassle of glasses. Contacts could be a great option for you if you fall into this category. The first
thing to understand is that to correct your reading vision, we put things into focus at close range, which
makes things at a distance blurry. To really understand this, throw on a pair of readers and try to look
far away. Things will be really blurry! So, how do we correct near vision with contacts without making
the distance blurry?

There are three ways of fitting contacts to help with reading:

  • Multifocal Contact Lenses or Bifocal Contact Lenses
  • Monovision Contact Lenses
  • Distance Contacts with occasional reading glasses

Multifocal Contact Lenses

Multifocal lenses have multiple prescriptions within the lens (one prescription for distance, and one for
reading). The most common design for these lenses is concentric rings of varying powers for different
viewing distances. They also call these type of lenses “simultaneous vision lenses” because your eyes are focusing through the distance and near powers at the same time. This requires your brain to learn how to adjust so that your eyes know how to chose which strength to use when looking at different objects. Another version of this is aspheric lenses which basically blends the powers together so that there is a gradual change from distance to near.

Advantages to Bifocal Contact Lenses:

  • If all goes well, no glasses are needed!
  • Depth perception still intact (as compared to monovision, more on this in a minute).
  • You can see both distance and near with each eye which is important doing certain things like
    changing lanes in a car

Disadvantages to Bifocal Contact Lenses:

  • They can make glare worse.
  • Vision is typically not as clear as just correcting distance or reading only.
  • Cost- these are more expensive than single vision contacts.

Overall, this can be a great option depending on lifestyle and refractive error.

Monovision Contact Lenses

With monovision contact lenses, you take traditional single vision lenses and correct one eye to see at
near and one eye to see at distance (or no contact in the “distance” eye at all if you already see well far
away). We do have to check and see which eye is the dominant eye because this is the eye that we
correct for distance.

Advantages to Monovision Contacts:

  • No glasses needed for most tasks. You may still need readers occasionally for very small print.
  • Glare is not as bad as with multifocal lenses
  • Much more cost effective, especially if you only need one lens to read.

Disadvantages to Monovision Contacts:

  • You will lose some depth perception since your eyes are working separately.
  • Blurry vision on one side of vision.
  • Harder to correct later stages of presbyopia.

This is a really great option for a lot of patients. I do tell my patients that not everyone’s brain is
wired to see this way so the only way to know for sure is to test it out with a pair of trials lenses first.

Distance Contacts + Reading Glasses

I will say, a lot of my patients don’t like the idea of this because their whole reason for staying in
contacts is so that they don’t have to deal with glasses at all. But this is a great option for people
who spend a lot of time doing one specific thing like running or playing sports and only need to read
occasionally.

Advantages to Distance Contacts:

This by far gives the best distance vision because both eyes are solely focused on seeing far
away.

  • Not as expensive as multifocal lenses. You can just buy inexpensive over-the-counter readers.

Disadvantages to Distance Contacts:

  • You will need to keep up with a pair of reading glasses.

If you have to change focus from distance to near a lot, you will have to take your glasses off
and on quite a bit.

All of these options come with pros and cons, but I am confidant that there is an option for everyone!
We can even blend some of these by having a distance contact in one eye and a multifocal in the other
or having two different powered multifocals in each eye. It may take some time to achieve the right
combination that works, but as long as you are patient, we can make it work.

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Dr. Thirion

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