MyDay® multifocal - fast fitting success with a novel multifocal contact lens

An estimated 1.9 billion people worldwide were impacted by presbyopia in 2020, and with the aging population this number will continue to increase further over the next few years.  [1] Current contact lens (CL) prescribing trends from 2020 reflect the different approaches eye care professionals (ECPs) take when fitting presbyopes with soft CLs.[2]  Globally, around half of patients over 45 years of age were fitted with multifocal contact lenses (MFCLs) and 10% with monovision,[2] meaning approximately a third were fitted with single vision lenses plus readers.

Once a presbyope has been fit with CLs, regular follow-up visits are critical to ensure success. A recent review on reasons for CL drop out highlighted that new wearers of single vision lenses may discontinue due to issues with lens handling and discomfort, while those fit in torics and MFCLs struggle more with poor vision.[3] It should also be recognized that aging is a significant risk factor for dryness symptoms which affect more women than men,[4] and these signs and symptoms need to be monitored and managed appropriately. To manage visual needs, attention needs to be paid to distance, intermediate and near vision with today’s digital lifestyle having increased visual demands at all distances.

What is needed to make a multifocal lens successful?

Fitting an optimal MFCL will look different for each presbyope in practice, with decisions on lens type, material and replacement schedule influenced by lens wear history, ocular physiology, lifestyle and expectations. Concerns often raised by ECPs previously have been that MFCLs should cover a wide prescription range and be easy to fit to help minimize chair time. [5] Today’s soft MFCLs are available in a range of lens designs, with centre near or distance optics, although with differences between manufacturers and lens brands, this variation combined with patient factors has meant ECPs can find MFCL fit success difficult to predict [6] This level of uncertainty and unpredictability may be one of the reasons only 14% of new lens fits globally were with MFCLs in 2020.[2]  A simple to fit, predictably comfortable MFCL lens that delivers good vision at all distances would boost ECP confidence in fitting and help to reduce lapsing by meeting patient needs.

Daily disposable MFCLs offer the best flexibility in wear schedules. These not only eliminate the need for lens cases, care regimens and the associated lens handling, but they are also associated with reduced risks of ocular complications.  [7, 8] Daily disposable CL wear fits a flexible lifestyle and is particularly popular with part-time wearers, who wear their lenses 1-3 times per week, compared to just 20% of frequent replacement lens wearers who wear only part-time.[9]

This article introduces an innovation in MFCLs which has been designed to meet the needs of ECPs and their presbyopic patients and summarises key results from two recent clinical studies.

Introducing MyDay® daily disposable multifocal

CooperVision has recently added MyDay^® multifocal to the daily disposable family which has already proved successful in single vision spherical and toric designs. This uses Aquaform® Technology with the stenfilcon A silicone hydrogel material; this binds water throughout the lens material to help retain moisture (Table 1). This expansion with an option for presbyopes means there is now a MyDay lens for all stages of life.  MyDay® multifocal covers a wide range of distance spherical powers (+8.00 to -12.00DS), with 0.25D steps in most powers for prescribing accuracy, along with three add powers.  For presbyopes with astigmatism of up to 0.75DC, the range covers 99.8% of prescriptions[10]

Table 1: MyDay® multifocal specifications

The CooperVision® Binocular Progressive System™ is an innovative design that helps presbyopes achieve their vision needs with its unique 3-add system. The Binocular Progressive System allows the multifocal designs to work in tandem, with a simple fitting process and easy progression for presbyopes as the near vision requirement increases (Figure 1). The LOW and MEDIUM Add lenses have an aspheric centre‐near design with a wide distance area and optical progression into the central reading area, and cover spectacle adds from +0.75 to +1.25D for the LOW add, and from +1.50 to +1.75D for the MEDIUM add. The HIGH add lens, which is used with later stage presbyopes, has been designed with a single‐powered, spherical centre‐near zone and spherical dual intermediate power zones to address intermediate and near vision needs (Figure 1).

Lens fitting – simple and successful

Ease of fit saves time for patients on repeat visits, and it is particularly important to busy ECPs who would like a MFCL to work well first time. The Binocular Progressive System fitting guide for MyDay multifocal 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. 

Start with an up-to-date refraction, ensure the presbyope is not over-minused, and determine ocular dominance using the +1.00 blur method. 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 (Figure 2). After asking patients to experience the lenses in a “real world” environment, vision assessment at all distances should be binocular under normal room illumination.

For vision enhancement, the distance prescription needs to be adjusted either to the dominant eye for distance improvement, or non-dominant for near vision (±0.25D) using a hand-held lens or flipper.  Always keep in mind that the initial near add selection (LOW, MEDIUM or HIGH) will remain unchanged. 

OptiExpert – for additional fitting support

Following the fitting guide allows a simple and straight forward fitting process , with its use helping achieve a high level of fit success with two pairs or fewer.[11]  There is also 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.[12] Simply enter the up-to-date 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 could be used by optometric assistants to start the first conversation about MFCL options before the patient sits in the chair, and trial lenses can be prepared in advance. This means other practice personnel can be involved in the contact lens patient education and management process and may help reduce chair time.

References

1.              Fricke, T.R., et al., Global Prevalence of Presbyopia and Vision Impairment from Uncorrected Presbyopia: Systematic Review, Meta-analysis, and Modelling. Ophthalmology, 2018. 125(10): p. 1492-1499.

2.              Morgan, P., et al., International Contact Lens Prescribing in 2020. Contact Lens Spectrum, 2021(January): p. 35-38.

3.              Pucker, A.D. and A.A. Tichenor, A Review of Contact Lens Dropout. Clin Optom (Auckl), 2020. 12: p. 85-94.

4.              de Paiva, C.S., Effects of Aging in Dry Eye. Int Ophthalmol Clin, 2017. 57(2): p. 47-64.

5.              Thite, N., et al., Barriers, motivators and enablers for dispensing multifocal contact lenses in Mumbai, India. J Optom, 2015. 8(1): p. 56-61.

6.              Perez-Prados, R., et al., Soft multifocal simultaneous image contact lenses: a review. Clin Exp Optom, 2017. 100(2): p. 107-127.

7.              Steele, K.R. and L. Szczotka-Flynn, Epidemiology of contact lens-induced infiltrates: an updated review. Clin Exp Optom, 2017. 100(5): p. 473-481.

8.              Sulley, A. and K. Dumbleton, Silicone hydrogel daily disposable benefits: The evidence. Cont Lens Anterior Eye, 2020. 43(3): p. 298-307.

9.              Morgan, P.B. and N. Efron, Quarter of a century of contact lens prescribing trends in the United Kingdom (1996 - 2020). Cont Lens Anterior Eye, 2021: p. 101446.

10.            CVI data on file 2021; Rx coverage database n=72,937; 42 to 70 years

11.            CVI data on file 2020. Prospective, double-masked, bilateral, one-week dispensing study UK with MyDay® multifocal; n=104 habitual multifocal contact lens wearers; CVI data on file 2021. Prospective, subject-masked, randomized, bilateral, two-week dispensing study at 5 US sites with MyDay® multifocal; n=58 habitual multifocal contact lens wearers