Cortical dynamics in visual areas induced by the first use of multifocal contact lenses in presbyopes

Fabrizio Zeri, Assunta Di Vizio, Stefania Lucia, Marika Berchicci, Valentina Bianco, Sabrina Pitzalis, Silvia Tavazzi, Shehzad A. Naroo, Francesco Di Russo

Research output: Contribution to journalArticlepeer-review


A common non-spectacle strategy to correct presbyopia is to provide simultaneous images with multifocal optical designs. Understanding the neuroadaptation mechanisms behind multifocal devices usage would have important clinical implications, such as predicting whether patients will be able to tolerate multifocal optics. The aim of this study was to evaluate the brain correlates during the initial wear of multifocal contact lenses (CLs) using high-density visual evoked potential (VEP) measures. Fifteen presbyopes (mean age 51.8 ± 2.6 years) who had previously not used multifocal CLs were enrolled. VEP measures were achieved while participants looked at arrays of 0.5 logMAR Sloan letters in three different optical conditions arranged with CLs: monofocal condition with the optical power appropriate for the distance viewing; multifocal correction with medium addition; and multifocal correction with low addition. An ANOVA for repeated measures showed that the amplitude of the C1 and N1 components significantly dropped with both multifocal low and medium addition CL conditions compared to monofocal CLs. The P1 and P2 components showed opposite behavior with an increase in amplitudes for multifocal compared to monofocal conditions. VEP data indicated that multifocal presbyopia corrections produce a loss of feedforward activity in the primary visual cortex that is compensated by extra feedback activity in extrastriate areas only, in both early and late visual processing.

Original languageEnglish
Article number102137
Pages (from-to)102137
Number of pages11
JournalContact lens & anterior eye : the journal of the British Contact Lens Association
Issue number3
Early online date13 Mar 2024
Publication statusE-pub ahead of print - 13 Mar 2024

Bibliographical note

Copyright © 2024 The Authors. Published by Elsevier Ltd on behalf of British Contact Lens Association. This is an open access article under the CC BY license (


  • Simultaneous images
  • Presbyopia
  • Visual-evoked potential (VEP)
  • Neural adaptation
  • Multifocal contact lenses
  • Visual Cortex/physiopathology
  • Humans
  • Middle Aged
  • Male
  • Visual Acuity/physiology
  • Presbyopia/physiopathology
  • Contact Lenses
  • Evoked Potentials, Visual/physiology
  • Female


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