Features

Novel multifocal CLs for presbyopia

The advantages of MyDay multifocal, fitting tips and study results on patient satisfaction

itting the optimal multifocal contact lens (MFCL) may look different for every presbyope who walks into your practice, because the decision for lens type, material and replacement schedule can vary depending on lens wear history, ocular physiology, lifestyle and expectations. Today’s soft MFCLs are available in a range of lens designs, with centre near or distance optics, to deliver good vision performance for different stages of presbyopia, while supporting ocular health and comfort.1,2

CooperVision has recently introduced MyDay multifocal to the daily disposable family, which has already proved successful in single vision spherical and toric designs. This expansion with an option for presbyopes means there is now a MyDay lens for all stages of life. The lens material, stenfilcon A, uses Aquaform Technology, which provides a unique balance of high oxygen transmissibility (Dk/t =100 x 10-9 @ -3.00DS), high water content (54%) and optimum modulus for comfortable wear.3 This is particularly beneficial to presbyopic MFCL wearers who more commonly suffer with dryness and discomfort.4 MyDay multifocal is offered in a wide prescription range from sphere +8.00 to -12.00DS, with 0.25DS steps in the majority of sphere powers for accuracy of prescribing, and three different near add powers, and allows for coverage of 71% of presbyopic eyes as determined in a cohort of 53,000 presbyopic clinic patients.5 MyDay and MyDay toric have been shown to cover 96% of prescriptions for pre-presbyopic patients;6 and there is then a total coverage of 83% of eyes achieved with the MyDay daily disposable brand family.7

In a clinical study reported in Optician, the performance of MyDay multifocal was compared to habitual MFCLs and Dailies Total1 Multifocal (DT1MF, Alcon).8 Overall comfort with MyDay multifocal was preferred over DT1MF and while all lens types performed well for distance vision, Snellen visual acuity (VA) was better with MyDay multifocal compared to the other lenses for intermediate and near vision. These findings were confirmed by the participants’ responses when they indicated their preference for MyDay multifocal over DT1MF for overall vision clarity at intermediate distance and with digital device use, in addition to comfort. The comfort and visual performances demonstrated that MyDay multifocal satisfied the needs of presbyopes.

Ease of fit saves the patient time on repeat visits, but it is particularly important to a busy eye care professional (ECP) who needs a MFCL to work well first time. MyDay multifocal was shown to be easy to fit with the first lens pair fitted providing the final prescription for 83% of participants and the remainder required just one more fitting attempt. The MyDay multifocal fitting guide was used in the study, which describes in a few simple steps how to reach the optimal lens prescription and is described in more detail below.


Lens fitting

CooperVision’s Binocular Progressive System is an innovative design and fitting system and it helps presbyopes achieve their vision needs using its unique 3-add system (figure 1).


Figure 1 CooperVision Binocular Progressive System

The fitting guide was developed through a series of clinical trials and validated in a randomised, controlled, clinical study, and is crucial to provide a fast and successful fit, so it is strongly recommended to follow the steps described to increase success and help minimise chair time.

Just like all contact lens fitting, the starting point is an up-to-date refraction, and for presbyopes it is important to maximise the plus power (and not over-minus). The guide always directs the LOW add to the dominant eye, while the non-dominant eye receives either LOW, MEDIUM or HIGH add based on the near addition determined in the subjective refraction (figure 2). After asking the patient to experience the lenses in a ‘real world’ environment, vision assessment at different distances should be binocular under normal room illumination. The steps in the MyDay multifocal fitting guide are summarised in table 1.


Figure 2 Initial lens selection and optimisation for MyDay multifocal lens fitting


Table 1 MyDay multifocal fitting guide

If the vision is not acceptable, the distance prescription will be adjusted as required. Always keep in mind that the initial near add selection of the MyDay multifocal (LOW, MEDIUM or HIGH) must remain unchanged. For potential optimisations:

  • To improve distance vision: with both eyes open offer ±0.25DS to the dominant eye using a hand-held lens or ±0.25DS flipper (no phoropter); if distance vision improves, after checking that near vision is maintained, switch to the revised contact lens sphere power.
  • To improve near vision: with both eyes open offer ±0.25D to the non-dominant eye and if this improves near vision, and distance vision is maintained, the sphere power of the lens

    • can be adjusted.


    OptiExpert

    Following the fitting guide allows a simple and straight forward fitting process. The guide has proved to lead to a confirmed fit success with two pairs or fewer.8 However, there is another tool that supports CooperVision soft lens fitting even before the first lens is placed on eye. The OptiExpert app has been developed to help with the initial lens selection for all CooperVision soft lens products including MyDay multifocal (figure 3).9 Simply enter the up-to-date spectacle subjective refraction and vertex distance in the OptiExpert fitting app and it will suggest the prescription for all lens options available for this specific patient. This tool can be used by optometric assistants to start the first conversation about MFCL options before the patient sits in the chair and the initial trial fitting lenses can be prepared in advance. This offers a great way to get other practice personnel proactively involved in the contact lens patient education and management process and help reduce chair time.


    Figure 3 OptiExpert app


    Clinical study results

    Since there are a variety of MFCL options available on the market, it is important to understand how their performance compares. As well as the study referred to earlier,8 another recent randomised, controlled one-week clinical study in the UK determined the vision acceptability and overall performance of MyDay multifocal when compared to the widely used daily disposable hydrogel lens, 1 Day Acuvue Moist Multifocal (1DAMMF, Johnson & Johnson Vision). This study included a population-representative group of 104 emergent, established and advanced presbyopes with low (+0.75 to +1.25DS), medium (+1.50 to +1.75DS) and high (+2.00 to +2.25DS) reading additions.

    All participants were habitual MFCL wearers ranging from 42 to 71 years of age, with a mean age of 54 years. Most of these presbyopic participants were myopic (mean -1.90DS, range +3.00 to -5.75DS) and the astigmatism of all participants was no more than -0.75DC (mean -0.36DC). During the one-week lens wear phases, both investigators and participants were masked to lens type to avoid any brand bias. Clinical assessments and subjective performance ratings were collected to capture the wear experience with each lens type.

    Fitting success: Both lens types were fitted according to their respective product fitting guide and there was no difference between MyDay multifocal and 1DAMMF in the number of contact lens pairs necessary to arrive at the final prescription. The percentage of patients fitted with two pairs or fewer was 97% with MyDay multifocal and 95% with 1DAMMF. In addition, both lens types provided very good fit characteristics during the clinical study, including centration and dynamic fit, with all fits clinically acceptable and the majority being optimal, with no differences in fit compared to the comparator lens.

    Vision performance: During the study, MyDay multifocal was shown to provide good overall binocular Snellen VA (6/6-1), which was similar to that found with 1DAMMF. Distance VA was also clinically similar (within one line) to the wearers’ sphero-cylindrical spectacle prescription. A paper recently presented at the BCLA conference also highlighted that MyDay multifocal achieved a high level of vision performance (both VA and vision satisfaction) across the 3-add range.10

    Patient satisfaction: After one week of wear, participants were asked to rate each lens type based on their performance using a 0-100 visual analogue (VAS) scale, where 100 was the best possible score (figure 4). Both lenses scored very well (averaged around 80) for distance, intermediate and near vision performance, overall performance and comfort. Interestingly, while there were no statistically significant differences between the two MFCLs for these performance ratings, when subjects were asked at the end of the study about overall preference, 62% preferred MyDay multifocal while only 38% preferred 1DAMMF (p = 0.001). The majority of participants (56%) across all presbyopia stages also indicated that they would definitely or probably purchase the MyDay multifocal after the study.


    Figure 4 Participants’ satisfaction ratings completed after one week of multifocal lens wear using a 0-100 VAS (where 100=best) with MyDay multifocal and 1 Day Acuvue Moist Multifocal


    Whether vision with a MFCL satisfies the patient’s needs can typically not be determined in the practice alone, instead the patient needs to wear these lenses for a few days to find out how they truly work in their everyday life. To capture the performance of MyDay multifocal during typical activities, a number of scenarios were described to the participants at the end of the wear period, and they were asked to indicate whether they agreed or disagreed (table 2). High levels of satisfaction were achieved overall for the various activities and there were no differences found between the three near addition groups.




    Conclusion

    This and the previous article have introduced the latest innovation from CooperVision; MyDay multifocal helps to meet the needs of ECPs and presbyopes with its simple, yet highly effective, fitting approach and its performance compared to widely used, daily disposable MFCLs.

    The performance of MyDay multifocal from clinical studies across six sites in the USA and UK and 162 subjects demonstrates that the lens satisfies vision demands equally for distance, intermediate and near tasks and during all types of activities. This efficient fit process and high fit success rate with two pairs or fewer, and the opportunity for staff to be involved in the OptiExpert review of MFCL fitting opportunities, along with clear vision and comfort performance of the lens, means this lens offers considerable advantages to the busy practice.

    Offering good comfort, good vision across all distances, a broad power range, and daily disposability to aid flexible wear schedules, MyDay multifocal helps address the needs of ECPs and presbyopes, and highlights MyDay multifocal as a valuable addition to the MyDay daily disposable lens family.

    The final article in this series will report on the results from a large, global, observational in-market assessment with the new multifocal contact lens with feedback from ECPs and wearers.


    • Percy Lazon de la Jara is Director of Research Programmes at CooperVision where Gary Orsborn is Global Head, Post-Market Clinical Studies and Anna Sulley is Director of Global Medical Affairs.


    References

    1. Perez-Prados, R, et al. Soft multifocal simultaneous image contact lenses: a review. Clinical & Experimental Optometry, 2017. 100(2): p. 107-127.
    2. Richdale, K, et al. CLEAR - Contact lens optics. Contact Lens & Anterior Eye, 2021. 44(2): p. 220-239.
    3. Woods, J, et al. Comparison of silicone hydrogel versus hydrogel daily disposables in an astigmatic population. Contact Lens & Anterior Eye, 2018. 41(Supplement 1): p. 93.
    4. de Paiva, CS. Effects of Aging in Dry Eye. International Ophthalmology Clinic, 2017. 57(2): p. 47-64.
    5. CVI data on file 2021; Rx coverage database n=102,816 eyes; 42 to 70 years..
    6. CVI data on file 2021; Rx coverage database n=101,130 eyes; 14 to 41 years
    7. CVI data on file 2021; Rx coverage database n=203,946 eyes; 14 to 41 years for MyDay sphere and MyDay toric; 42 to 70 years for MyDay multifocal
    8. Lazon de la Jara et al. MyDay multifocal - the introduction of an innovative solution for presbyopia. Optician, 05.11.2021, pp28-32
    9. CooperVision. OptiExpert https://coopervision.com/practitioner/tools-and-calculators/optiexpert/optiexpert-web#/calculator. Accessed 20.04.2021
    10. Guillon M et al. Influence of near addition power on the accetpance and performance of progressive contact lenses. BCLA 2021 conference, paper presentation