Impact of ocular aberrations and pupil diameter on vision with four daily multifocal contact lenses

Understanding which ocular optical factors are clearly influencing the visual performance achieved with MFCLs is essential for conducting a more optimised procedure when fitting this type of lenses.

To assess and compare the induction of ocular higher-order aberrations by four daily multifocal contact lenses and evaluate the influence of pupil diameter on their performance.

A randomised, crossover study evaluated four contact lenses in 20 presbyopic participants. Subjective refraction, distance/intermediate/near visual acuity and patient-reported visual satisfaction, and pupil diameter under four lighting conditions were assessed. Pupillary dynamic were calculated as the difference between mesopic and photopic pupil sizes. Primary coma, trefoil, spherical aberration, and higher-order aberration (HOA) root mean square were analysed.

A significant negative induction of primary spherical aberration was found with all lenses (p ≤ 0.04); being greater with MyDay than Moist in both eyes and with Total1 than Moist in non-dominant eyes (p ≤ 0.02). Coma and HOA increased significantly with all lenses (p ≤ 0.03), except for the Moist lens in dominant eyes; being greater with Total1 than Moist in dominant eyes (p ≤ 0.049). Odd aberrations showed inverse correlations with intermediate/near visual acuity and patient satisfaction (rho≤-0.58, p ≤ 0.04). Greater pupillary dynamic variation was significantly associated with better intermediate/near visual acuity for MyDay and Biotrue MCLs in dominant eyes (rho≤-0.59, p ≤ 0.04).

Centre-near multifocal contact lenses induce negative primary spherical aberration. Interestingly, greater coma aberration correlates with improved visual acuity and patient satisfaction at intermediate and near distances. Additionally, larger pupillary dynamic variation may enhance visual acuity and satisfaction in certain presbyopic contact lens wearers.