Visual Acuity Fails to Predict Quality of Vision in Progressive Addition Lenses

Patients with presbyopia may prefer progressive addition lenses with less peripheral astigmatism (soft designs), even though near point visual acuity (VA) is statistically worse in these lenses, according to research published in the Journal of Optometry. Clinical, high contrast visual acuity examinations may not predict quality of vision in these patients.  

Researchers enrolled 20 participants (age range: 48-62 years; best corrected VA: <0.0 logMAR) with presbyopia and graded the magnitude of their preference between a soft and hard (rapidly increasing peripheral astigmatism) progressive lens design (2.0 diopter [D] add). The participants’ visual acuities were measured with both lenses at different eccentricities from -12 to +12 mm from the near vision point every 3 mm under controlled conditions. 

Overall, soft lens designs were favored by 75% of the participants. However, visual acuity was better with the hard design among all points close to near vision (-6 to +6 mm) and demonstrated statistical significance at the near point of vision (0 mm; P =.003). The soft progressive lens design had better peripheral visual acuity in the lens periphery (-12 to -9 mm and +9 to +12 mm) compared with the hard design. Eccentricity affected visual acuity (P <.001), according to the report, but the lens itself did not show any significant effect (P =.76). 

The choice of the preferred lens was predicted for only 35% of the participants when considering central VA (up to 6mm) and 80% of the participants when considering peripheral VA (9 to 12mm). However, the extent of the difference was predicted by peripheral VA in only 60% of the participants.

“[E]ven under the controlled conditions of this study, it was not possible to predict the quality of vision, as measured by a subjective appreciation, through progressive addition lenses at various eccentricities from the near vision with an addition of 2.0D,” according to the researchers. “A recommendation of a design of progressive ophthalmic lens for a specific person should thus not be based on high contrast visual acuity measurements only.”

Study limitations include failure to obtain ophthalmic measurements for optimal lens placement. 

Disclosure: This research was supported by Essilor International. One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.