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Accommodation and Phoria in Children Wearing Multifocal Contact Lenses

Gong, Celia R.; Troilo, David; Richdale, Kathryn

doi: 10.1097/OPX.0000000000001044

Purpose To determine the effect of multifocal contact lenses on accommodation and phoria in children.

Methods This was a prospective, non-dispensing, randomized, crossover, single-visit study. Myopic children with normal accommodation and binocularity and no history of myopia control treatment were enrolled and fitted with CooperVision Biofinity single vision (SV) and multifocal (MF, +2.50D center distance add) contact lenses. Accommodative responses (photorefraction) and phorias (modified Thorington) were measured at four distances (>3 m, 100 cm, 40 cm, 25 cm). Secondary measures included high- and low-contrast logMAR acuity, accommodative amplitude, and facility. Differences between contact lens designs were analyzed using repeated measures regression and paired t-tests.

Results A total of 16 subjects, aged 10 to 15 years, completed the study. There was a small decrease in high (SV: −0.08, MF: +0.01) and low illumination (SV: −0.03, MF: +0.08) (both P < .01) visual acuity, and contrast sensitivity (SV: 2.0, MF: 1.9 log units, P = .015) with multifocals. Subjects were more exophoric at 40 cm (SV: −0.41, MF: −2.06 Δ) and 25 cm (SV: −0.83, MF: −4.30 Δ) (both P < .01). With multifocals, subjects had decreased accommodative responses at distance (SV: −0.04; MF: −0.37D, P = .02), 100 cm (SV: +0.37; MF: −0.35D, P < .01), 40 cm (SV: +1.82; MF: +0.62D, P < .01), and 25 cm (SV: +3.38; MF: +1.75D, P < .01). There were no significant differences in accommodative amplitude (P = .66) or facility (P = .54).

Conclusions Children wearing multifocal contact lenses exhibited reduced accommodative responses and more exophoria at increasingly higher accommodative demands than with single vision contact lenses. This suggests that children may be relaxing their accommodation and using the positive addition or increased depth of focus from added spherical aberration of the multifocals. Further studies are needed to evaluate other lens designs, different amounts of positive addition and aberrations, and long-term adaptation to lenses.




State University of New York College of Optometry, New York, New York (all authors).

Kathryn Richdale, SUNY College of Optometry, 33 West 42nd Street, New York, NY 10036, e-mail:

© 2017 American Academy of Optometry