title: Investigating the utility of clinical assessments to predict success with presbyopic contact lens correction.
abstract: OBJECTIVE
  To determine the utility of a range of clinical and non-clinical indicators to aid the initial selection of the optimum presbyopic contact lens. In addition, to assess whether lens preference was influenced by the visual performance compared to the other designs trialled (intra-subject) or compared to participants who preferred other designs (inter-subject).
  
  
  METHODS
  A double-masked randomised crossover trial of Air Optix Aqua multifocal, PureVision 2 for Presbyopia, Acuvue OASYS for Presbyopia, Biofinity multifocal and monovision was conducted on 35 presbyopes (54.3±6.2years). Participant lifestyle, personality, pupil characteristics and aberrometry were assessed prior to lens fitting. After 4 weeks of wear, high and low contrast visual acuity (VA) under photopic and mesopic conditions, reading speed, Near Activity Visual Questionnaire (NAVQ) rating, subjective quality-of-vision scoring, defocus curves, stereopsis, halometry, aberrometry and ocular physiology were quantified.
  
  
  RESULTS
  After trialling all the lenses, preference was mixed (n=12 Biofinity, n=10 monovision, n=7 Purevision, n=4 Air Optix Aqua, n=2 Oasys). Lens preference was not dependent on personality (F=1.182, p=0.323) or the hours spent working at near (p=0.535) or intermediate (p=0.759) distances. No intersubject or strong intrasubject relationships emerged between lens preference and reading speed, NAVQ rating, halo size, aberrometry or ocular physiology (p>0.05).
  
  
  CONCLUSIONS
  Participant lifestyle and personality, ocular optics, contact lens visual performance and ocular physiology provided poor indicators of the preferred lens type after 4 weeks of wear. This is confounded by the wide range of task visual demands of presbyopes and the limited optical differences between current multifocal contact lens designs.
authors.affiliation: Ophthalmic Research Group, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom; Specsavers, New Malden, London, United Kingdom.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Sivardeen
authors.affiliation: Ophthalmic Research Group, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom.
authors.forename: Deborah
authors.initials: D
authors.lastname: Laughton
authors.affiliation: Ophthalmic Research Group, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom. Electronic address: j.s.w.wolffsohn@aston.ac.uk.
authors.forename: James S
authors.initials: JS
authors.lastname: Wolffsohn
mesh_terms: D000328:Adult; D000368:Aged; D003261:Contact Lenses / Q000706:statistics & numerical data*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D057240:Patient Preference / Q000523:psychology* / Q000706:statistics & numerical data; D011305:Presbyopia / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D011379:Prognosis; D011788:Quality of Life / Q000523:psychology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014792:Visual Acuity
keywords: Contact lenses; Monovision; Multifocal; Presbyopia; Simultaneous images