can contact lenses handle near/far like progressive eyeglasses

[mb0329]

I am thinking of getting contact lenses to replace my current PROGRESSIVE eyeglasses. I am very myopic with -5 diopters left eye and -9.25 diopters right eye. My current eyeglasses are progressive for both close and far distance.

Can contact lenses handle near and far vision in the same way as do progressive eyeglasses..or can you only get contacts for one distance (say near or far) and then have to wear eyeglasses on top of that? (hope not).

[JohnHaganMD]

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[chazas]

I was about -9 in both eyes before my recent detachment/EFM/cataract/IOl travails.  I used disposable multifocal contacts (Acuvue for prebyopia)  for several years before that, and I was very happy with them.  

The thing you have to realize is, they are a tradeoff.  Your near vision will not be as good as monofocal contacts even with readers, and your far vision will not be as good as multifocal contacts.  

I also found them not as comfortable as the standard monofocal brand fo the same contacts - had to take them out earlier in the evening sometimes, and be very careful about cleaning - enzyming them with Supraclens every night helped.

But for me, the tradeoff was great.   I could work fine in the office at computer or reading distance under bright flourescent lights, and I could drive fine.  I couldn't see small, distant things super clearly, or read well an extended period in dim light.  But I was willing to accept those tradeoffs for not having to always be looking for a pair of reading glasses.

And I preferrered the contacts to progressive glasses, because I had full vision all around with no distortions.  With a strong prescription, progressive glasses are such a crap shoot - the viewing area for any particular distance can be so narrow and picky.

Not everyone can adapt, though.  A few years before the Acuvues were available I had tried a different brand with a different kind of optics, and my brain just couldn't sort out the images.

Why not get a sample pair from your doctor and see?  

[SoftwareDeveloper]

There are multifocal lenses that give you correction for near and far at the same time without the need to look in different directions the way you would with progressive glasses, and many people do have good luck with them.  Every person is different so the only way to know for sure is to try them. Many eye doctors will give you multiple followup visits for one package price and let you try different lens brands to find one that works for you. (though its useful to check if price is an issue since not all include such followups to keep trying to find the best option).

I had good luck for a few years with multifocal contact lenses as a high myope before cataract surgery removed the need for them. There are a few different brands and I gather the one that works best varies depending on the patient so it may take a few tries. Many high myopes find vision better in contact lenses. Most people with a large difference in prescriptions between their two eyes report better vision with contact lenses (although in theory it depends on the reason for the imbalance, where in the eye it is, whether glasses or contacts should be better when there is a difference in prescriptions, usually that would require special glasses).

I suspect that often people wind up using an ophthalmologist rather than an optometrist due to having had some sort of eye issue, which may mean they are more likely to get patients that have difficulties with contact lenses.
These are some of the articles I've seen on the topic, this is in a contact lens publication which likely accounts for the preference for contacts over glasses among the doctors they surveyed:

http://www.clspectrum.com/articleviewer.aspx?articleID=112115
"Every year, Contact Lens Spectrum surveys our readers about trends and patterns in their practices,   ....

When fitting presbyopes with contact lenses, there is a continuing trend for most practitioners to prefer multifocal lenses (70% in 2014, compared to 72% in 2013) over monovision (22% in 2014, compared to 20% in 2013) and over-spectacles (8% for 2014 and 2013); interestingly, this hasn’t changed substantially from our Annual Report for 2009, which indicated that 68% of practitioners preferred multifocals. As far as what type of presbyopic lenses are actually fitted, our respondents prescribed a multifocal to 46% of contact lens-wearing presbyopes, compared to prescribing monovision to 36% of contact lens-wearing presbyopes. The most popular modalities prescribed were soft multifocals (40% of presbyopic lens wearers) and soft monovision (29%), which is consistent with the data for 2013."

http://www.clspectrum.com/articleviewer.aspx?articleID=112500
"Research has shown that when patients are fit with either monovision or multifocal contact lenses, although their monocular visual acuities may measure better at a given distance with monovision, patients prefer the multifocal lenses (Richdale et al, 2006; Woods et al, 2014).
... With current multifocal technologies and those that will be coming to market in the next several years, we would argue for multifocal lenses for presbyopes as the new norm.  "

http://www.clspectrum.com/articleviewer.aspx?articleID=112351
"However, comparison studies have found that, in a forced choice situation, 68% to 76% of lens wearers preferred multifocal contact lenses to monovision (Benjamin, 2007; Richdale et al, 2006; Situ et al, 2003; Johnson et al, 2000). In a study comparing vision performance of GP multifocals, soft multifocals, monovision, and progressive addition spectacle lenses, monovision had the poorest performance in all categories compared, whereas GP multifocals exhibited parity with the spectacle correction (Rajagopalan et al, 2006). Multifocal contact lenses also provide better stereoacuity and near range of clear vision, resulting in a better balance of real-world visual function because binocularity is less disrupted (Gupta et al, 2009).

It is encouraging, therefore, that contact lens prescribing habits have changed in recent years. In an annual survey performed by Contact Lens Spectrum, 70% of practitioners said that they prefer to fit multifocal contact lenses (versus 59% in 2008), whereas 22% prefer monovision (versus 27% in 2008), and 8% prefer over-spectacles (versus 14% in 2008) (Nichols, 2015; Nichols, 2009)."

http://www.pubfacts.com/detail/25525891/Visual-Performance-of-a-Multifocal-Contact-Lens-versus-Monovision-in-Established-Presbyopes
"Twenty-five participants (51%) preferred multifocals, 18 (37%) preferred monovision, and the remaining 6 (12%) declared both unacceptable."

These stats show in the UK multifocals are more common than monovision correction with contacts:

http://www.opticianonline.net/trends-uk-contact-lens-prescribing-2014/
"Trends in UK contact lens prescribing during 2014"http://www.optometricmanagement.com/articleviewer.aspx?articleID=112202
"According to a 2008 Gallup poll, eight of 10 contact lens wearers older than age 50 were interested in multifocal contact lenses. In my experience, interest has not waned. Yet in 2011, only one-third of contact lens visits for patients older than age 40 was for a multifocal lens, reports Clinical and Experimental Optometry. Is your practice missing out on this opportunity?"

This is an article addressing the fact that there is some outdated information   out there about multifocals which may prevent some doctors considering them:

http://www.clspectrum.com/articleviewer.aspx?articleID=111875
"Multifocal Contact Lens Success: Fact or Fiction?
Investigating the prevailing notion that multifocal contact lenses do not work"

[JohnHaganMD]

Yes such lens are available but the success rate is low. Reasons include older people have dryer eyes, more sensitive eyes, lower motivation, the contacts are not as comfortable as regular contacts.  For this reason many ophthalmologists and some optometrists do not fit this type of contacts. Some try single vision contacts one set for distance and one for near. This is known as monovision.

Glasses are not worn over contacts as this defeats the reason the person is trying to wear these contacts.

If things don't work out see a corneal-refractive surgeon to discuss refractive surgery.

JCH MD