title: Through-focus performance with multifocal contact lenses: effect of binocularity, pupil diameter and inherent ocular aberrations.
abstract: OBJECTIVE
  To evaluate the effects of the wearer's pupil size and spherical aberration on visual performance with centre-near, aspheric multifocal contact lenses (MFCLs). The advantage of binocular over monocular vision was also investigated.
  
  
  METHODS
  Twelve young volunteers, with an average age of 27 ± 5 years, participated in the study. LogMAR Visual Acuity (VA) was measured under cycloplegia for a range of defocus levels (from +3.0 to -3.0 D, in 0.5 D steps) with no correction and with three aspheric MFCLs (Air Optix Aqua Multifocal) with a centre-near design, providing correction for 'Low', 'Med' and 'High' near demands. Measurements were performed for all combinations of the following conditions: (1) artificial pupils of 6 and 3 mm diameter, (2) binocular and monocular (dominant eye) vision. Depth-of-focus (DOF) was calculated from the VA vs defocus curves. Ocular aberrations under cycloplegia were measured using iTrace.
  
  
  RESULTS
  VA at -3.0 D defocus (simulating near performance) was statistically higher for the 3 mm than for the 6 mm pupil (p = 0.006), and for binocular rather than for monocular vision (p < 0.001). Similarly, DOF was better for the 3 mm pupil (p = 0.002) and for binocular viewing conditions (p < 0.001). Both VA at -3.0 D defocus and DOF increased as the 'addition' of the MFCL correction increased. Finally, with the centre-near MFCLs a linear correlation was found between VA at -3.0 D defocus and the wearer's ocular spherical aberration (R(2) = 0.20 p < 0.001 for 6 mm data), with the eyes exhibiting the higher positive spherical aberration experiencing worse VAs. By contrast, no correlation was found between VA and spherical aberration at 0.00 D defocus (distance vision).
  
  
  CONCLUSIONS
  Both near VA and depth-of-focus improve with these MFCLs, with the effects being more pronounced for small pupils and for binocular rather than monocular vision. Coupling of the wearer's ocular spherical aberration with the aberration profiles provided by MFCLs affects their functionality.
authors.affiliation: Institute of Vision & Optics, University of Crete, Heraklion, Crete, Greece. plainis@med.uoc.gr
authors.forename: Sotiris
authors.initials: S
authors.lastname: Plainis
authors.forename: George
authors.initials: G
authors.lastname: Ntzilepis
authors.forename: David A
authors.initials: DA
authors.lastname: Atchison
authors.forename: W Neil
authors.initials: WN
authors.lastname: Charman
mesh_terms: D000328:Adult; D003261:Contact Lenses; D004867:Equipment Design; D005260:Female; D006801:Humans; D007498:Iris / Q000033:anatomy & histology; D008297:Male; D011305:Presbyopia / Q000503:physiopathology / Q000628:therapy; D011680:Pupil / Q000502:physiology*; D012030:Refractive Errors / Q000503:physiopathology / Q000628:therapy*; D015348:Vision, Binocular / Q000502:physiology; D015349:Vision, Monocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology*; D055815:Young Adult