This article, the second of two, explores some of the top options in the multifocal contact lens category. The first article in the series, “A New Focus on Old Eyes: Cornucopia of Vision Correction Solutions Awaits Presbyopes,” was published in the February, 2018 issue of Vision Monday.

NEW YORK—As progressive addition lenses gained in popularity over the years, contact lens manufacturers followed suit with multifocal designs of their own. The task proved to be challenging, and early designs were difficult to fit and adapt to. Today’s designs are much improved, and the multifocal market has enjoyed steady growth in recent years, as manufacturers have improved the optics and materials of the lenses.

According to CooperVision, a leading contact lens manufacturer, global annual multifocal contact lens manufacturer sales are approximately $580 million, with unit sales of 480 million pairs of lenses. One-day lenses account for $220 million in annual sales; frequent replacement/reusable (monthly and two-week replacement) lenses account for $360 million in sales. Additionally, multifocal contact lens sales account for 8 percent of the global soft contact lens market. Total multifocal contact lens growth is around 11 percent, with growth being driven from sales of one-day lenses.

Yet the vast number of presbyopes points to a much larger potential market for multifocal contact lenses. According to the U.S. Census Bureau, as of 2015 there were 40 million emerging presbyopes, ages 35 to 44 years-old and 84 million current presbyopes, ages 45 years-old and older in the U.S. Projections by the Census Bureau and the American Optometric Association indicate that by 2020, there will be approximately 1,800 potential people of presbyopia age for each U.S. optometrist.

Studies conducted by Alcon, another top manufacturer, show that multifocal contact lenses can meet a wide range of presbyopic patients’ needs. Today’s presbyopes are physically and socially active, embrace technology, are image conscious and have advanced careers and disposable income, according to Alcon’s research.

One of Alcon’s notable findings is that eyecare professionals are uniquely poised to fill the patient education gap about presbyopia and multifocal contact lenses. Alcon found that although 25 percent of surveyed presbyopes mistake the first symptoms of presbyopia for temporary eye strain, approximately 40 percent of patients do not see an ECP about their emerging presbyopia symptoms, and one in five indicate a lack of awareness that remedies are available. What’s more, 56 percent of surveyed presbyopes who recently stopped wearing contact lenses are unaware of multifocal lenses.

The situation presents a significant opportunity for ECPs. More than one-third of emerging presbyopes said they would visit an ECP if they knew the ECP could help, Alcon said. However, a Gallup study showed that only 6 percent of surveyed presbyopes receive a recommendation for multifocal contact lenses from their ECP.

Yet 65 percent of surveyed presbyopes who were experiencing presbyopia symptoms when they stopped wearing contact lenses would like to wear contact lenses again, according to Alcon. The combined data suggests that many millions more pairs of multifocal contact lenses could be sold annually in the U.S. alone.

Many brands are competing for this lucrative segment of the vision correction market, and on-going research and development by manufacturers continues to produce new products on a regular basis.


ECPs Assess Multifocal Contact Lens Brands

Here’s a sampling of the latest designs from some of the top multifocal contact lens brands, along with comments from eyecare practitioners who prescribe and dispense these lenses.


ALCON
Latest Presbyopia Solution:
Dailies Total1
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What’s Behind the Design
Partnering with eyecare professionals is critical to Alcon’s success. “For more than 70 years, our approach has been to see the needs of patients through the eyes of the eyecare specialists who are treating them,” an Alcon spokesman said. “We gather insight through a number of activities, including wet labs at our state-of-the-art facilities around the world; Alcon- and investigator-initiated clinical studies; advisory boards with eyecare professionals; direct-to-patient programs where allowed; and market research.

“In addition, our R&D associates spend time observing ophthalmic surgical procedures in the OR as well as engaging with ODs in the clinic. We combine the external sources with our internal expertise and experience to develop products, including IOLs and contact lenses, that are designed to set high industry standards and deliver the best possible patient and customer experience.”

Essential Features
“The Alcon multifocal contact lens portfolio consists of three materials (delefilcon A, nelfilcon A and lotrafilcon B), two modalities (daily disposable and monthly), and a leading design that works with the natural eye function to give seamless vision—up close, far away and everywhere in between.

“The company’s multifocal portfolio offers eyecare professionals a variety of contact lens options to meet the individual lifestyle needs of patients:

- Dailies Total1 is designed to deliver the ultimate lens-wearing experience. The water gradient technology in Dailies Total1 Multifocal reduces end-of-day dryness, with water content that approaches nearly 100 percent at the outermost surface of the lens.

- Dailies AquaComfort Plus offers a fresh new lens every day and features Blink-Activated Moisture Technology for all-day comfort.

- Air Optix Aqua is designed for a monthly replacement schedule. The lenses feature SmartShield Technology for consistent comfort from day 1 to day 30.

- All three Alcon multifocal contact lens brands offer 96 percent fit success.”

PRACTITIONER’S COMMENTS
Jessica M. Crooker, MS, OD
Owner, Scituate Harbor Vision Source
Scituate, Massachusetts

“Dailies Total1 Multifocals have completely changed the way I fit my presbyopic patients with contact lenses. Presbyopes can be a difficult crowd, as they are always on the go and have many unique visual demands. The convenience of a daily lens, combined with the all-day comfort of the water gradient technology, provides my patients with an experience that is unparalleled.

“My patients marvel at how crisp and clear their vision is at all distances, and often remark how this lens has been life changing. The impact of this new and improved vision on my patients is incredible, so much so that they refer friends and colleagues to try the Dailies Total1 Multifocal lenses for themselves. My referrals since I started using this lens have skyrocketed.

“I reach for Dailies Total1 Multifocals because I know that by simply following the Alcon fit guide, I can easily fit patients with these lenses with tremendous success on my first lens selection, and seeing my patients react to their vision is priceless. As a Dailies Total1 lens wearer myself, I truly get excited when I see a patient who has struggled with other lenses finally find a lens that is perfect for them.”

​

BAUSCH + LOMB
Latest Presbyopia Solution:
Bausch + Lomb Ultra for Presbyopia
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What’s Behind the Design
“The 3-Zone Progressive Design helps provide consistently clear vision at near, intermediate and far distances,” a B+L spokesperson explained. B+L also developed innovative lens materials across both daily disposable and monthly disposable platforms.

Essential Features
- A monthly replacement silicone hydrogel lens that combines the company’s innovative MoistureSeal technology, which delivers what it describes as “exceptional” end-of-day comfort, with the 3-Zone progressive design found in Biotrue ONEday for Presbyopia daily disposable contact lenses.

- The combination of these advanced proprietary technologies provides presbyopic patients exceptional comfort and outstanding vision at near, intermediate, and distance while also providing eyecare professionals the convenience of easy and predictable lens fitting.

- Helps maintain 95 percent of lens moisture for a full 16 hours.

- Proprietary, two-phase manufacturing process retains moisture and delivers a highly wettable surface.”

PRACTITIONER’S COMMENTS
Mile Brujic, OD, FAAO
Premier Vision Group
Bowling Green, Ohio

“Providing comfortable near vision with minimal disruption to the distance vision is ultimately the Holy Grail when fitting a simultaneous vision multifocal contact lens design. The unique optical characteristics in the lens have proven beneficial from the initial experience that patients describe after placing the lens on the eye and also the positive feedback we hear when seeing them back for their follow up visit.

“The surface characteristics of the lens seem to make it uniquely engineered for the aging eye that often times requires additional moisture. This adds to the optical quality in the lens enhancing its performance when patients wear the lens in their everyday lives.”

Latest Presbyopia Solution: Biotrue ONEday for Presbyopia

What’s Behind the Design
“The 3-Zone Progressive Design helps provide consistently clear vision at near, intermediate and far distances. B+L also developed innovative lens materials across both daily disposable and monthly disposable platforms.”

Essential Features
“Biotrue ONEday for Presbyopia contact lenses combine the bio-inspired material of Biotrue ONEday contact lenses with Bausch + Lomb’s 3-Zone Progressive optical design used in PureVision2 multifocal contact lenses for presbyopia. Maintains 98 percent of its moisture for up to 16 hours.

Features high-definition optics for consistently clear vision all day. Offers convenience and comfort of a daily disposable lens.

“Biotrue ONEday for Presbyopia contact lenses are also the first daily disposable multifocal contact lens from the Biotrue ONEday family of products, which are designed to work like the eye by matching the cornea’s water content and mimicking the lipid layer by using a surfactant-enriched lens surface to retain moisture and shape.”

PRACTITIONER’S COMMENTS
Mile Brujic, OD, FAAO
Premier Vision Group
Bowling Green, Ohio

“Daily disposable lenses provide a healthy, convenient way to wear lenses. This is critically important for the presbyope. Often times, presbyopic patients are looking for alternatives to glasses to correct their vision. Patients are searching for options, not to completely replace glasses, but to be able to wear periodically. This lens provides them this option. The surface active technology in this lens helps retain high levels of moisture within the lens which provides a pleasantly moisture rich experience for most who try it. Ultimately, this means that it will provide a predictably comfortable wearing experience for our patients when contact lens vision correction is appropriate.

“The optical design in the ONEday for Presbyopia provides a remarkable wearing experience for both the early and advanced presbyopic patient. For early presbyopes, it provides remarkable near vision without compromising the distance vision. This makes it extremely easy to transition early to moderate presbyopes into the lens technology early in their presbyopic years.

“As presbyopia advances, the high add power provides exceptional near vision correction for patients. What’s unique is that this lens design has two options—a low and a high add power. This makes the fitting process remarkably simple and straightforward while providing the patient with significant advancements in optical designs to help them function optimally at both distance and near.”



COOPERVISION
Latest Presbyopia Solution:
clariti 1 day multifocal


What’s Behind the Design
“Multifocal lenses present opportunities for eye-care professionals and their patients in that they enable contact lens wearers to remain in lenses after the onset of presbyopia,” said Gary Orsborn, OD, vice president of global professional and clinical affairs, CooperVision.

“It’s an important segment of the market, and continuing to advance multifocal contact lens technology is a priority. Through our partnerships with eyecare professionals, wearers, and others, we are progressing in our understanding of what it takes to make contact lens correction of presbyopia even more successful. These insights are leading to new technologies and designs that will improve how presbyopic patients see at all distances.”

Essential Features
“Silicone hydrogel 1-day contact lenses are the fastest growing lens type, so CooperVision provides practitioners with a valuable silicone hydrogel 1-day multifocal option in clariti 1-day multifocal. The design is unique in that it has a center near portion and two intermediate zones that smoothly progress to a distance zone.

“The two intermediate zones—one for near intermediate vision and one for distance intermediate vision—are ideal for today’s presbyopes, who have digital lifestyles that require crisp vision at all distances. And clariti 1-day multifocal’s smooth progression zones design makes for a fast, easy fit. In fact, successfully fitting clariti 1 day multifocal lenses takes only five minutes longer than fitting a sphere lens.

“For eyecare professionals or patients who prefer a silicone hydrogel monthly replacement lens, CooperVision’s Biofinity multifocal lenses are designed with Balanced Progressive Technology. This design approach incorporates a dominant eye lens and a non-dominant eye lens, and allows for an individualized fitting for each wearer and each eye. This means practitioners can match each patient’s lifestyle needs, thereby maximizing fitting success.”

PRACTITIONER’S COMMENTS
Jeffrey S. Bird, RDO, ABOM
Parrelli Optical
Beverly, Massachusetts

“The limitation that has attended soft contact lens multifocals has long been insufficient add power. Lack of adequate magnification has required fitters to introduce a significant amount of plus power to the non-dominance eye. For those dedicated contact lens wearers, the coincidental negative impact on distance vision, depth perception and sight at night was an acceptable compromise.

“With clariti 1-day multifocal, the practitioner has been gifted with, what at times, can be too much add power. With this lens the emerging presbyope may need a slight over-correction of minus power to refine their distance vision.

“For the established presbyope, assuming good alignment with the line of sight, this center near design, crafted from a silicone hydrogel material, proves remarkably successful at satisfying the visual needs of today’s presbyopia patient.

“The lens provides excellent near vision in the low add. For the patient with an add power exceeding +2.00 diopters, it may be necessary to adjust the distance correction of the non-dominant eye by +0.25 or +0.50. I rarely use the high add power. The design provides exceptional intermediate visual acuities. The diameter of the near zone of the low add lens does not interfere with the distance visions for most wearers.

“The modulus of this material masks as much as 1.00 diopter of ‘with-the-rule’ astigmatism. This high oxygen permeable material maintains a close to normal corneal metabolism, delivering far fewer, late in the day, dry eye concerns so common with other designs.

“A single-use multifocal that delivers comfort, vision and patient satisfaction: why wouldn’t we all fit it?”



JOHNSON & JOHNSON VISION
Latest Presbyopia Solution:
1-Day Acuvue Moist Brand Multifocal
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What’s Behind the Design
“The development of 1-Day Acuvue Moist resulted from Johnson & Johnson’s internal research,” said Kurt Moody, OD, director of clinical new platform development, Johnson & Johnson Vision. He cited three significant findings that influenced the design of the lens:

1. Clinical research was conducted to have a better understanding of the changes that occur in pupil diameter. These results illustrated that as we age our pupils become smaller and less responsive and pupil size varies across the refractive range. This key piece of research allowed us to have the critical data needed to develop the unique optics employed in our lens.

2. A registry study was conducted to understand the safety outcomes among wearers of silicone hydrogel or hydrogel daily disposables; 1-Day Acuvue TruEye and 1-Day Acuvue Moist. This registry observed 960 years of wear. The conclusion of this work called out the low adverse event rate of 1-Day Acuvue Moist. Thus the decision to incorporate our newest presbyopic optic into the Moist material was partially based on this work.

3. Internal market research noted current presbyopic patients spent the majority of their time performing intermediate and near tasks. This research lead us to make sure our optic design delivered in these critical working distances.

Essential Features
“1-Day Acuvue Moist Brand Multifocal contact lenses incorporate advanced technology for correcting presbyopia. Each of our 183 SKUs incorporates a unique optic power profile. This unique power profile is based on the large data set we have in regard to the natural variation of pupil size across age and refractive error. The rationale of a unique power profile for each SKU was to ensure each would provide a similar ratio of distance, intermediate and near image.

“Additionally this lens was also designed with a very unique back curve; over the optic zone the lens is aspheric with an eccentricity value very close to the natural cornea. The periphery of the lens is spherical and flatter than the central zone. This unique approach was aimed to maintain the sophisticated optics as the lens wraps on the eye and so these optics are well centered over the visual axis of the eye.

“Thus the unique optical and mechanical approach of this lens makes this the most advanced technology in presbyopia correction within the Johnson & Johnson Vision contact lens portfolio.”

PRACTITIONER’S COMMENTS
Sharokh Kapadia, OD, FAAO
St. John’s Eye Associates
Jacksonville, Florida

“I’ve been practicing for 20 years, and this is the best multifocal I’ve fit in terms of clarity of vision. I started prescribing and fitting it in March, 2015. Since then, it’s been my go-to multifocal lens, without reservation.

“Fitting this lens successfully depends on doing a careful refraction and following the fitting guide right to the letter. The guide takes into account the patient’s prescription, age and pupil size, which is a key difference from other multifocals. The lens has 61 different pupil sizes for each add power. When that matches up, patients are very happy with the clarity of their vision. The science behind the lens takes the guesswork out of fitting it.

“Overall, my patients are very happy with the results. The lens works well for both emerging and mature presbyopes. I’ve had more ‘wow’ moments with this lens than any other.”