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ISSN : 1229-6457(Print)
ISSN : 2466-040X(Online)
The Korean Journal of Vision Science Vol.21 No.2 pp.201-208
DOI : https://doi.org/10.17337/JMBI.2019.21.2.201

Effect of Undercorrection on Visual Functioning Using Spectacle Lens and Multifocal Contact Lens in Young Adults

Inn-Jee Park1)*, Byoung-Sun Chu2)*
1)Dept. of Optometry, Kaya University, Professor, Gimhae
2)Dept. of Optometry and Vision Science, Daegu Catholic University, Professor, Daegu

* Address reprint requests to Byoung-Sun Chu Dept. of Optometry and Vision Science, Daegu Catholic University, Daegu TEL: +82-53-850-2553, E-mail: bschu@cu.ac.kr
May 13, 2019 June 19, 2019 June 25, 2019

Abstract

Purpose :

To investigate the effect of using multifocal soft contact lens on visual functioning compared to other vision correction methods, such as no correction, undercorrection with +1.00 D spectacle lens


Methods :

Seventeen individuals were recruited to participate in this study. The age range of the 17 participants (mean age of 23.6±2.1 years) who have less than sphere refractive error within the range of ±1.00 D with less than -0.75 D of astigmatism. Repeated measurements were performed using three different correction options; no correction (NC), correction using multifocal contact lenses (CM) with a plano power for distance and addition up to +1.00 D and undercorrection using +1.00 D spectacle lens (UL). Distance visual acuity with high contrast (100%) and low contrast (10%) vision chart, and distance contrast sensitivity, and near visual acuity were measured.


Results :

The type of vision correction had a significant effect on distance visual acuity measured with the high and low contrast vision chart (p<0.01). There was no significant difference in near visual acuity among the correction types (p=0.34), the type of vision correction worn had a significant effect on distance contrast vision chart (p=0.01).


Conclusion :

Multifocal contact lens did not alter the best corrected visual acuity and contrast sensitivity and maintain good overall visual functioning that are comparable to no correction. Therefore, using this center near multifocal contact lens in young adults can provide the high quality visual acuity for distance and near and relieve the accommodative burdens on near tasks.


Multifocal soft contact lens , Undercorrection , Visual functioning

안경렌즈와 멀티포컬 콘택트렌즈를 이용한 저교정이 시기능에 미치는 영향

박 인지1)*, 추 병선2)*
1)가야대학교 안경광학과, 교수, 김해
2)대구가톨릭대학교 안경광학과, 교수, 대구

    Ⅰ. Introduction

    Undercorrection is wearing single vision lenses with certain degrees less (i.e. +0.50 D) than a necessary amount prescription to correct refractive errors. It is well known that there are various reasons for the undercorrection, such as relieving accommodative burden on prolonged near tasks,1-3) myopia control,4-11) prescribing for vergence disorders and accommodative dysfunctions,12-14) or alleviating symptoms of binocular vision problems.15) Undercorrection with plus lenses and multifocal contact lens can be effective in relieving accommodative responses, in controlling myopic progression, and helping to reduce number of issues with binocular vision problems. And there are few ways to simulating undercorrection, such as using center near multifocal soft contact lenses, or using full correction with additional lenses. Additionally, multifocal contact lens has been applied for the different purposes such as myopia control and vergence disorder.

    The use of multifocal contact lenses has been increased for correcting presbyopia.16) Especially, in a recent report showed that the use of multifocal soft contact lenses increased by 12.3%.17) Recently, many contact lens manufacturers produce different types of multifocal contact lenses and especially the center near design multifocal soft contact lenses has been prescribed world widely. The center near design multifocal soft contact lens can provide the great visual quality in vision performance.18) Also, it is assumed that the low addition (i.e. +1.00 D) in center near design multifocal lens would relax the accommodation system of the lens wearers, which can help to decrease the symptoms of prolonged near work or binocular dysfunctions such as near esophoria.19)

    However, when multifocal contact lens is used for non-presbyopic subjects, it is not clear how the visual functioning can be affected. Therefore, it is necessary to investigate the effect of using multifocal contact lens with addition up to +1.00 D on visual functioning compared to other vision correction methods, such as no correction, undercorrection with +1.00 D spectacle lens.

    Ⅱ. Subjects and Methods

    1. Participants

    Seventeen individuals who have VA of more than 0.00logMAR without any vision correction were recruited to participate in this study. The age range of the 17 participants for whom complete data were collected was between 20 and 27 years (mean age of 23.6±2.1 years, Male: 3, Female: 14). Their spherical equivalent for right eye was – 0.35±0.45 D (range of +2.00 D ~ -0.50 D), and for left eye was –0.31±0.56 D (range of +0.50 D ~ -0.75 D). Since there is no correction for the astigmatism in multifocal contact lenses, all the recruited participants have less than -0.75 D astigmatism to minimize the effect of uncorrected astigmatism. Thus, spherical equivalent was used and uncorrected spherical equivalent amount is within -0.50 D. All participants were screened for their suitability to participate in the study by clinical examination and informed consent was obtained. Inclusion criteria were (1) being able to wear contact lenses, (2) no ocular pathology such as cataract, glaucoma or age-related maculopathy which might influence visual function, (3) best sphere refractive error within the range of ±1.00 D with less than -0.75 D of astigmatism, (4) aided binocular VA better than 6/6(0.0 logMAR), (5) having normal binocular visual function.

    2. Informed consent and ethical approval procedures

    Informed consent was obtained from all participants, and the research protocol was approved by the Daegu Catholic University, Institutional Review Board (CU-IRB 2017-0060).

    3. Vision correction and fitting methods

    Repeated measurements were performed using three different correction options; No correction (NC), correction using multifocal contact lenses (CM) with a simultaneous design with plano power for distance and addition up to +1.00 D for near and undercorrection using +1.00 D spectacle lens (UL) to match with multifocal contact lenses prescription. The reason for choosing the multifocal contact lenses with addition up to +1.00 D was that it is one of the options for early presbyopes with minimum visual compromise. In addition, +1.00 D undercorrection is chosen to be comparable with chosen multifocal contact lenses.

    4. Visual performance measurements

    This study evaluated the visual functioning of the three correction methods under laboratory conditions. The battery of vision test included distance visual acuity with high contrast (100%, ETDRS Original Series Chart 1, Good-Lite, USA) and low contrast (10%, ETDRS Low Contrast LEA NUMBERS® Charts, Good-Lite, USA) vision chart and contrast sensitivity (The MARS Letter Contrast Sensitivity Test, The Mars Perceptrix Corporation, USA) measured at 3 m distance (3.3 cycle per degree). Also, the near visual acuity (Sloan ETDRS format Near Vision Chart, Precision Vision, USA) at 40 cm was measured. All assessment of visual function was conducted binocularly under high (77 cd/m2) room illumination conditions. The order of wearing correction options was randomized. During the contact lens assessments, 15 minutes of settling time was allowed before the measure.

    5. Statistical analysis

    For statistical analysis, SPSS software (IBM SPSS Statistics 19, USA) was used. The normality of the collected data distributions was confirmed. The visual measures were analyzed using repeated measurements of ANOVAs for each correction type (NC, UL and CM) as the within-subjects variable. Where Mauchly’s test was significant and sphericity could not be assumed, the Greenhouse Geisser correction was used. Also post-hoc multiple comparisons (Tukey or Tamhane T2 tests) could be used for assessment of significant differences across visual conditions. For comparison between two conditions such as right eye and left eye, paired-t test was performed.

    Ⅲ. Results

    The mean data for the visual functioning for each correction type (no correction, undercorrection with +1.00 D spectacle lens, and multifocal contact lenses) is summarized in table 1.

    The type of vision correction had a significant effect on distance visual acuity measured with the high contrast vision chart (F(1.365, 21.846)=15.489, p<0.01). Pairwise comparisons revealed that distance visual acuity with NC was higher than with UL (p=0.02). However, there was no difference found between NC and CM (p=0.48). In addition, visual acuity with CM was higher than with UL (p<0.01) (Fig. 1).

    The type of vision correction had a significant effect on distance visual acuity measured with the low contrast vision chart (F(1.147, 18.357)=27.201, p<0.01). Pairwise comparisons revealed that distance visual acuity with NC was higher than with UL (p<0.01). However, there was no difference found between NC and CM (p=0.07). Additionally, visual acuity with CM was higher than with UL (p=0.01) (Fig. 2).

    There was no significant difference in near visual acuity among the correction types (F(2, 32)=1.123, p=0.34) (Fig. 3). The type of vision correction worn had a significant effect on distance contrast vision chart (F(1.196, 19.130)=7.658, p=0.01). Pairwise comparisons revealed that distance contrast sensitivity with UL was higher than with CM (p<0.01). However, there was no difference found between NC and UL (p=0.06). Additionally, there were no significant difference of distance contrast sensitivity between NC and CM (p=1.00) (Fig. 4). Near contrast sensitivity was not measured because during the experiment, there was no significantly different response from the subjects.

    Ⅳ. Discussion

    It has been widely reported that creation of simultaneous retinal images by multifocal contact lens may reduce certain amount of visual function under photopic and mesopic conditions comparing to single vision contact lenses.17,20,21)

    However, in this experiment, simultaneous image multifocal contact lens provided less than 0.00 logMAR visual acuity with high contrast chart and it was only 3.5 letter difference than no correction. This result is similar to other studies.22-24) In study by Richdale et al., the authors used Bausch & Lomb Soflens multifocal contact lens and soflens 59 for single vision contact lens.25) Under high contrast condition, patients with multifocal lost two letters from the best spectacle correction at distance.

    Many studies presented multifocal contact lens provide good best distance visual acuity under photopic condition.20,22,24,25) Madrid-Costa et al. performed the study with more than one multifocal contact lens. They used Purevision multifocal low add (addition up to +1.50 D) and Acuvue Oasys for presbyopia medium add (+1.50 D and +1.75 D). Under photopic condition, both lens provided good visual acuity whereas under mesopic condition, visual acuity of acuvue oasys for presbyopia was slightly worse, which is similar result in other study.26) In addition, there was less reduction of distance visual acuity with multifocal contact lenses than undercorrection with +1.00 D. This is due to optical characteristics of multifocal contact lens where the visual performance with multifocal contact lenses is depending on the pupil size, therefore visual function with multifocal contact lenses up to +1.00 D addition relatively were maintained well.27)

    There was no significant difference for near visual acuity because of the subject sample composition. In this study, subjects are aged 20-30 years, which is the limitation of this study design, thus the near visual acuity would not be affected as much as presbyopic subjects. In Madrid-Costa et al.’s study, both lenses provide comparable near visual quality.

    Simultaneous-image multifocal contact lenses are known to be associated with a reduction in contrast sensitivity to some degree because both in-focus and out-of-focus images are projected onto the retina.28) In Madrid-Cost et al.’s study, contrast sensitivity of both multifocal contact lenses was reduced. In this study, the type of vision correction worn presented a significant effect on contrast sensitivity that full correction and multifocal contact lens provide good contrast sensitivity whereas undercorrection with +1.00 D reduce the contrast sensitivity. The contrast sensitivity chart used in this experiment is a MARS contrast sensitivity chart, which can be measured at various distances, and the subtending will vary depending on the distance. Letter on MARS contrast sensitivity chart subtends 2ﾟ at 50 cm and 3.3ﾟ at 3 m, which means a visual acuity of 0.25 (0.083ﾟ at 5 minutes of arc). Thus, when the subject is undercorrected and the visual acuity is better than 0.25, the contrast sensitivity is not affected by the undercorrection but is affected by less sensitive contrast sensitivity.

    Overall, no correction provided the best result of all parameters and undercorrection with +1.00 D lens presented the poor vision functioning, yet multifocal contact lens provide comparable visual functioning as no correction. However, this study has a sample of 17 subjects and we consider the possibility of developing future studies with a larger sample to generalize the data. Also, this study was a single-visit study and does not offer insight into the long-term effect of multifocal contact lenses. Therefore, it will be of interest to study these parameters in young adults for a longer period of time, such as 6 months.

    Ⅴ. Conclusion

    Multifocal contact lens did not alter the best corrected visual acuity and contrast sensitivity and maintain good overall visual functioning that are comparable to no correction. Therefore, using this center near multifocal contact lens in young adults can provide the high quality visual acuity for distance and near and relieve the accommodative burdens on near tasks.

    Figure

    JMBI-21-2-201_F1.gif

    Distance visual acuity with high contrast (LogMAR).

    JMBI-21-2-201_F2.gif

    Distance visual acuity with low contrast (logMAR).

    JMBI-21-2-201_F3.gif

    Near visual acuity (logMAR).

    JMBI-21-2-201_F4.gif

    Distance contrast sensitivity (log contrast).

    Table

    Summary of visual functioning measurement (both eyes) for each correction method

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