Cathleen Fedtke, Klaus Ehrmann, Varghese Thomas, Ravi C Bakaraju

The aim of this study was to assess the association between decentration of several commercial multifocal soft contact lenses (MFCLs) and various objective and subjective visual performance variables in presbyopic and non-presbyopic participants. All presbyopic (age >40 years, near add ≥+1.25 D) and non-presbyopic (age ≥18 years, no near add requirements, spherical equivalent ≤-0.50 D) participants were each fitted bilaterally with six and two MFCLs (test lens), respectively, and with one single vision lens (control lens). Lens decentration, ie, the x- and y-differences between the contact lens and pupil centers, was objectively determined. Third-order aberrations were measured and compared. Visual performance (high- and low-contrast acuities and several subjective variables) was analyzed for any associations (Pearson's correlation, r) with MFCL decentration. A total of 17 presbyopic (55.1±6.9 years) and eight non-presbyopic (31.0±3.3 years) participants completed the study. All lenses displayed a temporal-inferior decentration (x=-0.36±0.29 mm, y=-0.28±0.28 mm, mean ± SD). Compared to the control, a significant inferior decentration was found for the Proclear® MFCL Near lens in both groups (ypresbyopic =-0.26 mm, ynon-presbyopic =-0.70 mm) and for the Proclear® MFCL Distance lens in the non-presbyopic group (ynon-presbyopic =-0.69 mm). In both groups, lens-induced vertical coma (C(3, -1)) was, by at least tenfold, significantly more positive for the Proclear® MFCL Distance lens and significantly more negative for the Proclear® MFCL Near lens. In the presbyopic group, the correlation of total MFCL decentration with vision variables was weak (r<|0.191|). Conversely, a moderate but significant correlation with total MFCL decentration was found in the non-presbyopic group for most of the vision variables, indicating a decrease in vision as decentration increased. Certain MFCLs decentered more than others; the same lens designs also induced significant amounts of third-order aberrations. An association between MFCL decentration and seven out of nine vision variables was found in the non-presbyopic group, ie, the group where lenses were most decentered, which had larger pupils and lower levels of inherent third-order aberrations.