Comparative Evaluation of Visual Performance and Patient-Reported Outcomes with Multifocal Contact Lenses in Presbyopic and Bilaterally Pseudophakic Patients: A Prospective Comparative Study

Abstract: Purpose: To comparatively evaluate visual performance, binocular functional vision, contrast sensitivity, and patient-reported near visual function following multifocal contact lens (MFCL) fitting in naturally presbyopic and bilaterally pseudophakic patients with monofocal intraocular lenses. Methods: This prospective, single-centre, comparative clinical study included 40 participants, comprising 20 naturally presbyopic and 20 bilaterally pseudophakic participants. All participants underwent standardized baseline ophthalmic assessment followed by MFCL fitting and post-fitting evaluation after an initial three-day adaptation period. Binocular distance and near visual acuity were assessed before and after MFCL wear. Post-fitting binocular visual performance was further evaluated using a defocus curve from +1.00 to −2.50 D. Binocular contrast sensitivity was assessed using the Pelli–Robson Contrast Sensitivity Chart. Patient-reported near visual function was evaluated using the Near Activity Visual Questionnaire, with exploratory Rasch-style analysis performed to characterize item difficulty and participant ability. Within-group changes were assessed using paired statistical tests, while between-group comparisons were performed using appropriate independent statistical tests. A two-sided p < 0.05 was considered statistically significant. Results: MFCL fitting was associated with significant improvement in binocular distance visual acuity in both presbyopic and pseudophakic participants. Mean distance visual acuity improved from 0.370 ± 0.382 to 0.105 ± 0.059 logMAR in the presbyopic group (t = 4.336, p < 0.001) and from 0.110 ± 0.109 to 0.030 ± 0.056 logMAR in the pseudophakic group (t = 4.258, p < 0.001). Near visual acuity also improved significantly, from 0.287 ± 0.106 to 0.1205 ± 0.0144 logMAR in presbyopic participants (t = 9.844, p < 0.001) and from 0.384 ± 0.0694 to 0.113 ± 0.0091 logMAR in pseudophakic participants (t = 22.680, p < 0.001). The post-fitting defocus curves demonstrated useful binocular visual performance across the tested range, with both groups achieving their best acuity at plano. Pseudophakic participants demonstrated significantly better visual acuity than presbyopic participants at −0.50 D (0.0095 vs 0.0476 logMAR; p = 0.030), whereas differences at other defocus levels were not statistically significant. Contrast sensitivity showed only small numerical changes following MFCL fitting. Patient-reported visual function was generally favourable in both groups, although selected visually demanding activities showed greater difficulty among presbyopic participants. Conclusion: MFCL fitting provided effective short-term binocular correction across distance and near viewing demands in both naturally presbyopic and bilaterally pseudophakic patients. The post-fitting defocus profile demonstrated a broad functional range of vision, while patient-reported findings supported useful performance during routine near activities. Overall, MFCLs appear to be a promising reversible option for presbyopic correction in both populations. However, longer follow-up and larger comparative studies are required to evaluate sustained visual performance, neuroadaptation, patient satisfaction, and long-term contact-lens tolerance.