Subjective and objective assessment of soft bifocal contact lens performance

Subjective and objective techniques were used to assess the on-eye performance of soft bifocal contact lenses. In the subjective technique a young observer whose accommodation had been paralyzed with a cycloplegic agent was fitted with the contact lens type under investigation and aligned with a Maxwellian view Badal optometer using a bite-bar. Visual acuity was measured as a function of both target vergence (0.00 to -4.00 D) and pupil size (1 to 5 mm). Aspheric, concentric, and diffractive soft bifocal contact lens designs were investigated. Diffractive and concentric bifocal designs with +2.00 D near additions showed "twin peaks" of visual acuity with one peak at 0.00 D target vergence (equivalent to distance viewing) and the second at -2.00 D target vergence (equivalent to a target at 50 cm). Some aspheric designs produced a relatively constant visual acuity across this vergence range, whereas others gave poor acuity at near. Visual acuity with the Echelon diffractive lens was relatively unaffected by pupil size, confirming theoretical predictions. Visual acuity with concentric designs was also relatively free of pupil size effects. In the objective technique, the variation in surface power across the lens was assessed using video-keratography. This technique provided an elegant means of visualizing the power profile of the lens. The location of the zones of increased power and the magnitude of power variations allowed an accurate prediction of the visual performance measured subjectively. Temporal displacement of lenses may explain the occasions where visual performance did not vary with pupil size.