Presbyopia is a common age-related visual disorder that causes a progressive inability to focus on nearby objects. The exact cause of presbyopia is not fully understood, but recent research suggests that an increase in lens rigidity is the primary factor. The ciliary muscles may weaken or the lens may lose elasticity, preventing the focal point from changing. Accommodation, the ability of the eye to adjust focus, also decreases as the lens loses elasticity.
Around the fifth decade of life, accommodative amplitude declines to the point where the near point of the eye is farther away than the reading distance, and accommodation decreases to essentially 0D by the age of 60, which is when patients are considered absolute presbyopes. The Merriam-Webster dictionary defines presbyopia as “a visual condition that becomes apparent, especially in middle age, in which the loss of elasticity of the lens of the eye causes defective accommodation and an inability to focus sharply for near vision.”
Spectacles are typically considered the most convenient option for addressing the symptoms of presbyopia. Single near-vision spectacles have a single focal point that is suitable for a specific distance, requiring individuals to remove them or use a separate pair of spectacles for distance viewing. Bifocal, trifocal, or progressive addition spectacle lenses (PALs) have different optical power zones for viewing objects at various distances. It is also possible to combine multiple prescriptions into one lens for everyday use.
There are several contact lens options available for correcting presbyopia, including single-vision distance contact lens correction with reading spectacles, monovision correction, or bifocal and multifocal correction based on alternating or simultaneous image principles. The purpose of bifocal and multifocal contact lenses is to bring objects at different distances into sharp focus. Compared to spectacles, contact lenses are closer to the eye, provide a wider field of view, have less distortion, and are more consistent to use since they are not easily removed throughout the day. They serve as a platform for bifurcation and multifocality.
This study is prospective and observational, involving 38 subjects aged between 40 and 60 who met the inclusion criteria and had no ocular disease. A detailed ocular and systemic history was obtained, followed by a comprehensive slit lamp examination. Visual acuity assessments for distance and near were conducted using Snellen’s visual acuity chart and the N-notation visual acuity chart, respectively, and were converted to a log MAR value. Objective refraction was performed using either streak retinoscopy or an auto-refractometer. Subjective refraction was also conducted, including a duo chrome test and binocular balancing, followed by direct ophthalmoscopy for fundus evaluation. After the primary evaluation, iPad-based stereo acuity and contrast sensitivity tests were conducted using the subject’s existing refractive correction.
iPad-based contrast sensitivity test
The blinking square contrast sensitivity test involves showing the patient target squares at various contrast levels in different quadrants of the screen. The patient is then instructed to touch the quadrant with the target square. The test is divided into six squares, starting with a high-contrast square, and with each subsequent square, the contrast is reduced in increments of 0.3 log MAR units. The first three sequences present the same set of contrasts again, resulting in two presentations for each of the 24 contrasts. If the subject does not respond correctly to two targets in a row, the rest of that sequence is skipped, and the next sequence begins.
The contrast sensitivity is measured in log MAR units, and the score expresses the reciprocal of the threshold contrast using the Weber contrast ratio. After providing appropriate instructions to the patient, the test is performed, and the results are recorded upon completion.
iPad-based stereo acuity test
This test can be performed at multiple distances, allowing for testing of up to ten levels of stereo acuity at each distance. It uses a random dot stereogram viewable with anaglyph spectacles, and habitual refractive error correction is applied. The test has applications in visual screening programmes and the design and use of 3D displays are suggested. For depth perception evaluation, the test is performed at 40 cm with a red filter in front of the right eye and a green filter in front of the left eye.
The patient must identify the cut portion of a circle presented on the screen and match it with the side option bar. After each correct answer, the test proceeds to the next level, and the final result is displayed on the screen.
After the pre-workup and questionnaire with existing refractive correction, the patient is counselled for a multifocal soft contact lens trial, and oral consent is taken. Contact lens fitting measurements, such as keratometry readings, horizontal visible iris diameter, and pupil diameter in dim and room illumination, are taken. To fit multifocal soft contacts correctly, identifying the dominant eye is crucial, and an eye dominance test is performed. The patient’s eyes are covered with +1.50 D and +2.00 D lenses, and the subject must decide which position results in the least blur with both eyes open. This can assist in determining whether greater plus or higher add powers should be used in the non-dominant eye to enhance near vision without impairing distance vision.
Once the appropriate lenses are selected, a multifocal soft contact lens trial is given to the patient. After an adaptation period, the lens fit is evaluated, and the care and maintenance of the lenses, as well as insertion and removal, are explained to the patient. On the follow-up visit after one week, distance and near visual acuity, iPad-based contrast sensitivity, and iPad-based stereo acuity are measured.
There are several contact lens options available for correcting presbyopia, including single-vision distance contact lens correction with reading spectacles, monovision correction, or bifocal and multifocal correction based on alternating or simultaneous image principles
The paired t-test (two-tailed) was used to statistically analyse the results of the iPad-based contrast sensitivity and stereo acuity tests. The mean contrast sensitivity reading for the right eye before wearing MFCL was 1.76 ± 0.90, which increased to 1.82 ± 0.91 after wearing MFCL. Although the p-value was not statistically significant (p = 0.17), the data showed a clinically meaningful improvement in comparative contrast sensitivity. For the left eye, the mean reading of contrast sensitivity was 1.8 ± 0.91 and 1.85 ± 0.91 before and after wearing MFCL, respectively.
Comparative contrast sensitivity showed a statistically significant improvement with a p-value of 0.02. For both eyes, the mean reading of contrast sensitivity was 1.91 ± 0.95 before wearing MFCL and 1.99 ± 1.00 after wearing MFCL, respectively. Although the p-value was not statistically significant (p = 0.24), the data showed clinically significant improvement, which correlated with the present study’s high satisfaction level and improved contrast.
It is important to note that tasks such as using tools, threading needles, or operating computers all require good stereopsis and precise hand-eye coordination. The study found that wearing MFCL led to an improvement in stereopsis. The mean ± standard deviation for stereo acuity was 72.68 ± 60.91 before wearing MFCL and 69.50±31.94 after wearing MFCL. Table 2 shows that there was no statistically significant difference between pre- and post-stereopsis (P=0.462).
The study found that multifocal soft contact lenses provided significantly better stereo acuity compared to spectacles and other correction modalities. Furthermore, the results suggest that multifocal soft contact lenses offer greater comfort and satisfaction in terms of stereopsis and contrast sensitivity when compared to traditional correction options, including single vision distance, intermediate or near, bifocal, progressive spectacles, or soft contact lenses.
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7. LINKS TO OTHER SITES
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This Website is intended for residents of India only. All information on this Website is therefore intended only for the Indian market. The information contained on this Website may be altered or amended at any time without prior notification or obligation.
11. NOTICE OF CHANGE
EFFECTIVE AS OF FEBRUARY 01, 2021
The tionet.in website (“Website”) is hosted and operated by The Indian Optician (TIO); Registered in A-99 Defence Colony, New Delhi 110024, India.
The information contained on this Website may be altered or amended at any time without prior notification or obligation.
This Website should not be regarded as an infallible guide to The Indian Optician products and services, nor does it constitute an offer for the sale of any particular brand.
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INFORMATION WE COLLECT
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1. When you create The Indian Optician (TIO) account at tionet.in, we collect your Name, Email address, Password and Gender (optional). We collect these basic details so that you can access your subscriptions on multiple devices. Also, when you change your device, these details will help you sync you’re tionet account and get access to your subscriptions.
2. When you purchase a magazine/subscription on our website, we additionally collect your Address (with Pin Code) and Card details in certain scenarios. This is done to validate the transactions and we shall clear such data when validations are no longer required. Please note that we don’t store your card details and they are stored only by the payment gateway.
3. When you contact us, we collect your email address to provide services and answer your queries.
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SECURITY OF YOUR PERSONAL INFORMATION
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PERSONAL INFORMATION YOU CAN ACCESS
Company allows you to access the following information about you for the purpose of viewing, and in certain situations, updating that information: email address, name, location and marketing preferences. This list may change as the Service changes. The information you can view, update, and delete may change as the Website changes. If you have any questions about viewing or updating information, we have on file about you, please contact us at firstname.lastname@example.org or at The Indian Optician., A-99 Defence colony, New Delhi – 110024
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RETURN AND REFUNDS
If for any reason you are not completely satisfied with The Indian Optician magazine subscription, you may claim a full refund of your subscription, by contacting us within 30 days of your transaction processing date for online subscription and print subscription.
You may cancel your Subscription at any time during your subscription term. If you choose to cancel your Subscription, please note that we do not issue refunds on magazines already delivered. You may request a refund for all magazines not yet delivered, by contacting us at firstname.lastname@example.org. The amount to be refunded will be a pro rata value based on the number of magazines already issued. Money will be refunded as below:
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