BCLA CLEAR Presbyopia: Evaluation and diagnosis

James S. Wolffsohn, David Berkow, Ka Yin Chan, Suraj K. Chaurasiya, Daddi Fadel, Mera Haddad, Tarib Imane, Lyndon Jones, Amy L. Sheppard, Marta Vianya-Estopa, Karen Walsh, Jill Woods, Fabrizio Zeri, Philip B. Morgan

Research output: Contribution to journalArticlepeer-review


It is important to be able to measure the range of clear focus in clinical practice to advise on presbyopia correction techniques and to optimise the correction power. Both subjective and objective techniques are necessary: subjective techniques (such as patient reported outcome questionnaires and defocus curves) assess the impact of presbyopia on a patient and how the combination of residual objective accommodation and their natural DoF work for them; objective techniques (such as autorefraction, corneal topography and lens imaging) allow the clinician to understand how well a technique is working optically and whether it is the right choice or how adjustments can be made to optimise performance. Techniques to assess visual performance and adverse effects must be carefully conducted to gain a reliable end-point, considering the target size, contrast and illumination. Objective techniques are generally more reliable, can help to explain unexpected subjective results and imaging can be a powerful communication tool with patients. A clear diagnosis, excluding factors such as binocular vision issues or digital eye strain that can also cause similar symptoms, is critical for the patient to understand and adapt to presbyopia. Some corrective options are more permanent, such as implanted inlays / intraocular lenses or laser refractive surgery, so the optics can be trialled with contact lenses in advance (including differences between the eyes) to better communicate with the patient how the optics will work for them so they can make an informed choice.

Original languageEnglish
Article number102156
Number of pages32
JournalContact lens & anterior eye : the journal of the British Contact Lens Association
Early online date18 Apr 2024
Publication statusE-pub ahead of print - 18 Apr 2024

Bibliographical note

Copyright © 2024. The Authors on behalf of British Contact Lens Association. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/)


  • Accommodation
  • Defocus curve
  • Diagnosis
  • Evaluation
  • Presbyopia
  • Questionnaires


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