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Journalof the British ContactLensAssociation,Vol.16,No.

1,pp 25-36,1993 © 1993BritishContactLensAssociation

Printedin GreatBritain



Russell L Woodsi', John E. Saunders¢, and MichaelJ. A. Port~[

(Received 13th August 1991; in revisedform 18th April 1992)

Abstract--Experimentalrigid bifocal contact lenses of a concentric design with varying central @ticzone diameter (COZD) and
of both centre-distance (CD) and centre-near (CN) format were investigated. Modulation transfer functions (MTF) of the bifocal
co~tact lenses were measured on a solid-state EROS M T F Analyser. The M T F varied with COZD, aperture size, and decentration.
~D lenses were shown to give slightly better optical performance with one of the two optical performance indices. Differences may
have been due to optical aberrations inherent in the back-surface design of these contact lenses. As expected, with increased COZD,
optical performance improved when the central optic zone (COZ) formed the focus, and reduced when the peripheral optic zone
formed the focus. With the bifocal contact lenses centred over the aperture the optimal aperture coverage of the COZ (equal distance
and near optical performance) was found to remain at 37% of the aperture area for apertures of 3-6mm diameter. Decentration of
the bifocal contact lens over the aperture caused marked changes in both image form and the MTF, which were only partly
explained by changes in the proportion of the aperture covered by the COZ. The M T F was shown to be a useful measure of changes
in the optical performance which influence visual performance.

KEYWORDS:Bifocal contact lens, optical performance, modulation transfer function.

Introduction both optical portions being over the pupil at all times.
here are few reports in the literature of the system- This is usually the case with diffractive bifocal contact
T atic investigation of the effects of changes in the
design of bifocal contact lenses upon visual or optical
lenses 2 and with some of the more exotic designs pro-
posed. 3,4 When worn, however, both optical sections of
performance. In this article, the first of two parts, we a concentric-design bifocal contact lens do not neces-
report an examination of the optical performance of sarily lie over the pupil at all times and the proportion
simultaneous-vision bifocal contact lenses. In particular, of pupil coverage may vary. A simple change in pupil
the line spread function (LSF) and the modulation size leads to a change in the proportion of the pupil cov-
transfer function (MTF) of both centre-distance (CD) ered by the two optical sections of a concentric-design
and centre-near (CN) rigid concentric-design bifocal bifocal contact lens, as shown in Figure 1. This change
contact lenses of varying central optic zone diameters
(COZD) were examined. In Part II 1 a variety of visual
performance measures are reported in relation to lens
design and fitting characteristics of the same bifocal
contact lenses.

Pupil Size and Decentration

In an attempt to explain the rationale behind this study,
we first discuss image formation with a concentric-
design bifocal contact lens and the effects of imperfect (a)
on-eye contact lens centration. For the purposes of this
article, when light passing through the central optic
zone (COZ) focuses on the retina, the COZ is referred
to as being 'in-focus', and similarly for the peripheral
optic zone (POZ). The term 'vergence' is used herein to
denote the different focal powers of the bifocal contact
lenses (i.e., distance or near).
Simultaneous-vision bifocal contact lenses rely upon
Figure 1. (a) A diagrammatic representation of the COZ
* Sections of the data used here were presented at the 1991 Applied (white) of a concentric-design bifocal contact lens centred over
Vision Association Annual Conference in the presentation Visual and the pupil (black) and iris (shaded). In this instance the COZ
Optical Performance with Concentric Bifocal Contact Lenses, and covers approximately 50% of the pupil area, the remainder
at the 1991 British Contact Lens Association Conference in the pre-
sentation Choosing the Correct Bifocal Segment Diameter: an being covered by the POZ section, which has a different optical
Optical and VisualAssessment. power to achieve the bifocal effect. (b) A reduction in pupil size
t PhD, BOptom, MBCO. as compared to (a) leads to a reduction in the area of the pupil
¢ PhD. covered by the POZ of the bifocal contact lens. Also, the propor-
~[MSc, FBCO, FAAO, DCLP. tion of the pupil covered by the COZ increases.


Distant object

(a) ® (b)

Figure 3. (a) Image formation with a CA[ bifocal contact lens

when a distant object is viewed. The (near power) COZ
(shaded) focuses before the retina, creating a blurred out-off
focus image. A focused image is formed by the POZ. The resul-
tant image is a combination of the two. (b) A schematic LSF for
this arrangement shows the out-of-focus pedestal of light formed
by the COZ overlaid on the in-focus image formed by the POZ.

Figure 2. (a) Decentration of a bifocal contact lens alters the Near object
location of the C{~. (white) over the pupil (black) and iris
(shaded). If the C(YZ remains within the pupil area the propor-
tion of pupil coverage by the COZ remains the same as that
shown in Figure l(a). As shown, decentration may lead to a
change in the area of the pupil which is covered by the COZ. (b)
Reduction of pupil size as compared to (a) results in a reduc-
tion of the area of the pupil covered by the COZ of a bifocal con-
tact lens. Hence the proportion of the pupil covered by the POZ
increases as compared to that shown in Figure l(b)
© (b)

Figure 4. (a) Image formation with a CN bifocal contact lens

when a near object is viewed. The POZ (shaded) focuses beyond
is compounded by contact lens decentration and move- the retina, hence creating an annular blurred image. A focused
ment. It is unusual to have on-eye a perfectly centred image is formed by the COZ. The resultant image is a combina-
rigid contact lens. Decentration of a concentric-design tion of the two. (b) A schematic LSF for this arrangement shows
the annular form of the out-of-focus image overlaid on the in-
bifocal contact lens may lead to a variation in the pro- focus image formed by the COZ.
portion of the pupil covered by the COZ, as shown in
Figure 2(a). Reduction in pupil size may then further
reduce the proportion of the pupil covered by the COZ, pupil. This has been explained as being a result of the
as shown in Figure 2(b). Obviously, for certain configu- Stiles-Crawford effect.6
rations of pupil size, COZD, and contact lens decentra-
tion the C0Z may not cover any portion of the pupil. Modulation Transfer Function
Concentric-desigu bifocal contact lenses form images The most common measure of optical performance cur-
which vary slightly depending upon whether the COZ rently in use is the modulation transfer function (MTF).
or the P0Z is in-focus, as shown in Figures 3 and 4. The While having a more precise definition7, the MTF may
line spread function (LSF) is a cross-section intensity be considered as the optical transfer function (OTF)
plot of the image of a slit object. As shown in Figure without the phase information. In effect, the MTF is a
3(b), when the POZ is in-focus the blur constitutes measure of the ability of an optical system to transmit
essentially a pedestal superimposed upon the in-focus optical information. An optical system could constitute
image. The LSF when the C0Z is in-focus, Figure 4(b), a camera lens, a contact lens 8, or even the human
is different as the out-of-focus image creates an annular eye.9,1° Typically, the modulation (the ratio of the con-
blur. This annular blur on the in-focus image has been trast of the image to the contrast of the object) is
shown to be less detrimental to visual performance plotted against the spatial frequency of the object. The
than is the pedestal form.5 The central portion was development of techniques of MTF measurement has
more efficient than the POZ~, such that, given an equal lead to its common use as a method of describing the
pupil coverage by the COZ and POZ of the CN bifocal quality of an optical system. Retinal image formation is
under discussion, the near visual performance would be a result of interaction between the OTF of the eye and
slightly better than the distance visual performance. the OTF of any optical device used. The contrast sensi-
From a similar analysis of a CD bifocal contact lens it tivity function (CSF) may be considered, in part, a cor-
can be shown that the same situation occurs in reverse, relate of the MTF of the retinal image. The CSF reflects
with visual performance being slightly better at dis- changes in the MTF of the retinal image, which are
tance than at near. Hence, to achieve equal visual per- influenced by alterations to the MTF of a bifocal contact
formance the COZ needs to cover less than 50% of the lens. As the eye and contact lens are not coherent sys-


tems, and since there are variable phase differences ited, since relatively simple aberration-free models of
across the human retina 1°,11, the variation of the ocular the human eye have been used in the calculations.
MTF due to a contact lens cannot be predicted theoreti-
cally simply from a knowledge of the MTF of the con- Optical Measurements
tact lens. Despite this, it might be expected that the Grey and Sheridan s reported the MTFs of a series of
measured CSF and other visual performance measures single vision contact lenses. The measured MTFs were
would reflect the MTF of contact lenses being worn. all very high and close to the diffraction limit of the
Visual performance with the bifocal contact lenses used measurement system. This is not the case for bifocal
in this study are reported in Part II. ~ contact lenses. The measured MTFs of concentric-
design bifocal contact lenses have been shown to be
Theoretical Investigations similar to theoretically calculated MTFs, and the pre-
In previous reports, three different theoretical dicted pupil (aperture) dependence has been demon-
almproaches have been taken to investigate the optical strated72,2~-26 The shape of the MTF appears to vary
performance of bifocal contact lenses. These have with lens design and spatial frequency, as suggested by
involved the simple calculation of relative pupil cov- the calculations of O'Neill. 27 When the COZ was in
erage 12,13, the calculation of retinal image formation focus the MTF was depressed in the median spatial fre-
with concentric-design bifocal contact lens by ray quencies, but appeared to retain fair modulation
tracing techniques 14-19, and the calculation of the MTF transfer for higher spatial frequencies, and the MTF
of the bifocal contact lens. 17-21 reduced with increasing aperture size. Conversely,
From geometrical considerations, bifocal contact when the POZ was in focus the MTF was better at
lenses have been shown to be sensitive to pupil size median spatial frequencies and improved with
and bifocal contact lens decentration. 13 Changes in increasing aperture size.
image form with pupil size and bifocal contact lens There have been no published reports of optical mea-
decentration have also been demonstrated by simple sures of decentred simultaneous-vision bifocal contact
ray tracing. 14 More informatively, spot diagrams based lenses. In a discussion of the pupil dependence of alter-
upon computer-generated ray tracing calculations, nating-vision bifocal contact lenses, Borish 2s showed
which indicate the image intensity, have been demon- the measured MTF of an alternating-vision bifocal con-
strated to vary significantly with changes in pupil tact lens, which demonstrated the effect of the decen-
size ~6,~8, changes in COZD ~6, and with bifocal contact tred optic in this form of bifocal contact lens.
lens decentration. 15,16,2~ As commercially available bifocal contact lenses have
Calculated MTFs for concentric-design bifocal con- been used in previous studies, other aspects of lens
tact lenses have been produced. 17,~8,2°The calculations design (e.g., the amount of blending of the COZ junc-
by Klein and Ho 17 appear to suffer from some arith- tion, base curves, and contact lens material) have often
metical problem as indicated by their axial intensity confounded the effects reported. The interaction
plot for the 'two-zone' bifocal contact lens on page 29, between COZD and pupil size has not been previously
which bears no resemblance to measured axial inten- reported. With the optical arrangements used previ-
sity22 or other calculations. 2~ The calculated MTFs of ously there has been a possibility that the magnification
concentric-design bifocal contact lenses have been of the image introduced by the different focal lengths of
shown to be reduced at all but the lowest spatial fre- the distance and near images may have introduced an
quencies. The MTFs appear to vary between the two erroneous comparison between distance and near (as
different foci, although this is difficult to determine as magnification is a function of angular size of the object
the spatial frequency ranges given have been relatively and image in a non-unit magnification system29).
restricted. When the COZ is in focus, the MTF appears It would appear that the information available about
slightly better than when the POZ is in focus. the optical performance of concentric-design bifocal
Charman and Saunders 2° have demonstrated contact lenses is incomplete. It is the aim of this study
changes in the calculated MTF with pupil size. As to investigate the optical performance of concentric-
would be expected, as the coverage of the pupil by the design bifocal contact lenses with different optical char-
COZ of the CN bifocal contact lens increases, the near acteristics. In particular, to investigate the effect of
MTF improves and the distance (POZ) MTF reduces, aperture size (pupil), lens design, COZD, and contact
and vice versa. Similarly, changes in the calculated lens decentration.
MTF with pupil size 16,19 and decentration 16 have been
demonstrated for multifocal contact lenses. Methods
By direct measurement of image contrast with a sim- Equipment
ulated concentric-design intraocular lens and a magni- An Ealing Electro-Optics (Wafford, UK) solid state
fied schematic eye, Atebara and Miller 23 suggested that EROS MTF apparatus was used to measure the MTFs
equal performance was achieved when the COZ cov- of the experimental contact lenses. Atmospheric and
ered about 40% of the pupil. This model could be appli- other conditions in the laboratory conformed to the UK
cable to bifocal contact lenses, but obviously the Instrument Industry Standards Committee (British
location of the COZ in relation to the pupil would be dif- Standard 4779: 1971). A few modifications were made
ferent. Most of these theoretical investigations are lira- to the conventional arrangement of the equipment to


allow testing of bifocal contact lenses. formed by the two different focal powers of each bifocal
Normally, the extent of the image is limited by the contact lens was of equal size. All measurements were
program to reduce the effects of stray light. This soft- made using 'white' light from a dichroic halogen cap-
ware feature was designed to control for stray light, but sule lamp and a filter with a combined spectral output
had a tendency to occasionally treat outer portions of a (Figure 6), which simulates the-human photopic spec-
poor bifocal contact lens image as stray light. Hence, tral sensitivity.
due to the width of the image formed by bifocal contact
lenses the conventional software potentially may over- Experimental Bifocal Contact Lenses
estimate the quality of the image. Ealing Electro-Optics The contact lenses were made by Pilkington
provided a modified version of the controlling software VisionCare on high precision lathes. Contact lenses
(version: Eros451p) which did not limit the extent of were PMMA back-surface concentric-design bifocal
the image. contact lens with COZDs of 3.4, 3.0, 2.6, 2.2, and
To allow the contact lens under test to lie horizontally 1.8ram. The POZD was fixed at 7.5mm. Contact lenses
in a saline filled wet cell, the optical path was altered were available in both CD and CN formats with a near
with mirrors (M1, M2) to form a periscope arrangement addition of 2.00D in saline. The junction between the
(Figure 5). A variable aperture was placed 3mm below COZ and the POZ was distinct and less than 5v~m, with
the test contact lens. The two objective lenses (L1, L2) no blending for either lens design (CD or CN). The
were fixed at their respective focal lengths (381mm) bifocal contact lenses were made for this study and
from the test contact lens in a Badal optometer arrange- have not been available on a commercial basis.
ment which was thus a unit magnification system. 3°The
distance of the slit object was varied to form a best- Experimental Design
focus image at the detector array. Hence, the image Bifocal contact lenses were selected in a random order.
Aperture diameters were selected randomly and the
L2 object vergence (distance or near) presented in a
P pseudo-random order for each contact lens. With the
J contact lens located centrally within the saline-filled wet
Slit Lamp cell, the wet cell was placed in the appropriate position
Wet ceII~,.,~ ~ Contact
lens above the aperture. To test the effect of decentrafion of
Variable aperture
the bifocal over the aperture, the bifocal contact lens
was moved in relation to the aperture, which remained
I , ,r'M~ centred on the optical bench. Any required decentrafion
of the contact lens (and wet cell) was introduced with
array kl engineering thickness gauges (Matrix M-79, Coventry
Figure 5. The optical arrangement for the M T F measurement Gauge & Tool Co. Ltd, UK). All the results were
with a solid state EROS M T F Analyser. The lamp and filter recorded for a range from 0-10 cycles/mm (which, due
were used to form a slit object which was imaged through the to the optical arrangement, equated to 0-64c.p.d.).
system onto the detector array. The two objective lenses (L1, L2) To investigate the relationship between lens design,
were placed at their respective focal lengths from the test contact COZD, and aperture size, MTF measurements were
lens in the saline-filled wet cell to form a Badal optometer with
unit magnification. A variable aperture was placed 3ram taken for a variety of aperture sizes (6, 5, 4, 3.5, 3, and
beyond the wet cell. To allow the contact lens to remain hori- 2ram) with at least two contact lenses of each design
zontal a periscope arrangement was constructed with two mir- (CD or CN) and each COZD. Measurements were
rors (M1, M2). (Not to scale.) taken at both distance and near focal lengths for each
bifocal contact lens. To investigate the effect of decen-
300 tration, MTF measurements were taken with two con-
tact lenses of each design with the 2.6ram COZ using

decentrations of 0.25, 0.5, 0.75, 1.0, 1.25, 1.5, and 2.0mm
200 over a 4mm aperture. LSFs for various contact lens,
aperture, and decentration configurations were also
150 recorded to illustrate the changes in image shape.
In an attempt to simplify the analysis of optical perfor-
mance, the MTF data were treated in two ways. First,
50 the area under the MTF curve between 4-50c.p.d.
(approximately equivalent to 6/3.6-6/45) was deter-
25O 850 460 550 660 750
mined (Area). This Area may be considered as a figure
Wavelength (nm) of merit for the overall optical performance. Area might
be expected to relate to the general form of the CSF
Figure 6. The spectral energy of the 'white' light used in the with the particular contact lens. Second, the spatial fre-
optical measurement of the bifocal contact lenses was similar to
the human photopic spectral sensitivity. The spectral energy was quency at which the modulation fell below 0.1 (range
determined by the spectral irradiance of the lamp and the spec- 1.0-0.0) was recorded. It was felt that this cut-off fre-
tral transmission of the filter. quency (CF) may equate to subjective visual acuity [in



rO 0.8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0,6 ................................................................................................................................................................................... 0.6'

°L 0.4 ..............................................................................................................................................................



0 E IE ~==
00 0 0 ~
0.0 lb
, ,
10 100
Spatial frequency (c.p.d.) Spatial frequency (c.p:d.)
Figure 7 . The two indices of optical performance used to aid
analysis are shown: (a) M T F cut-offfrequency (CF) , the spatial Figure 9. The mean MTF for centre-near concentric-design
frequency at which the modulation fell below 0.1; (b)area under bifocal contact lenses (2.6mm COZD) over a 4mm aperture
the MTF curve between 4-50c.p.d. The M T F shown was mea- (s.d. reduced from 0.041 at 4c.p.d. to 0.004 at 66c.p.d.; n = 6).
sured with the near focus of a CN bifocal with a 2.6mm COZ
centred over a 4 m m aperture. The difference in the shape com- noted previously.8
pared to the MTF shown in Figure 8 is apparent, and is typical
of all bifocal contact lenses measured. An example of an MTF measured for a CN lens with
a 2.6mm COZ centred over a 4mm aperture is shown in
Figure 9. As expected, the MTF with bifocal contact
.(b lenses was approximately half that with single-vision
0.8 contact lenses. 16,18,20,22,24-26
• o Despite the different basis for the selection of the two
~ 0.6 o @BO measures of optical performance (Area and CF), the

correlation between them was high (r=0.92, p<0.0001).
~ 0.4,
~ 0.2 @l [2
To assess the overall reliability of the optical perfor-
mance measures, 11 pairs of nominally identical (i.e.,
0.0 same configuration) bifocal contact lenses were mea-
1'0 1oo
Spatial frequency (c.p.d.) sured at distance and near, with seven apertures, and
• 2mm [] 3 m m • 3.5mm
o 4mm • 5mm 0 6mm
the results compared (Figure 10). The reliability coeffi-
cient (95% confidence limit: BS 5479: part 1, 1979) of CF
was found to be +_29c.p.d. or 63% of the average CF
Figure 8 . The variation in M T F with aperture for the solid
state EROS M T F system including the wet cell but with no (n=156), and there was a tendency for greater variance
experimental bifocal contact lens. The M T F varied with aper- at larger values of CF [Figure lO(a)]. T h e reliability
ture size as expected and was virtually diffraction limited. coefficient of the Area was _+0.11 units or 58% of the
average Area (n=156). Similar reliability has been found
such tasks the contrast of the target, a dark letter on a by the authors with other types of simultaneous-vision
light background, is maintained and the spatial fre- bifocal contact lens (unpublished data). The manufac-
quency (letter size) reduced until the subjective visual turer quoted an error of 1% (equivalent to a reliability
threshold is reached]. Figure 7 gives an example of the coefficient of _+0.01 units) for MTF measurement) 2
Area (shaded) and CF (arrow) of the MTF curve for Gray and Sheridan 8 reported a standard deviation of 1%
one of the bifocal contact lenses. These two indices of with single-vision contact lenses. It is worth noting that,
optical performance were arbitrarily chosen from any in that study, only three measurements were averaged
number of other possibilities, but might be expected to in each 'experiment'.
correlate with measures of visual performance. The poor reliability with bifocal contact lenses sug-
gests that if the MTF is to be used for the testing or
Results development of bifocal contact lenses, a number of rep-
General Considerations etitions would be required to improve reliability.
The MTF for the system with the saline-filled wet cell
(no contact lens) did not differ significantly from the Centred Bifocal Contact Lenses
MTF measured for the system without a wet cell or As expected (Figure 11), with increasing aperture the
from the calculated system diffraction limit for the MTF decreased with the COZ in-focus and increased
given optical configuration. Figure 8 shows the varia- with the POZ in-focus. This was in agreement with pre-
tion in the MTF with aperture. This was expected, since vious reports36 Similarly, as expected (Figure 12), with
the diffraction limit of an optical system is a function of increasing COZD the MTF increased with the COZ in-
the sine of the aperture angle. 29,31 Results with single- focus and decreased with the POZ in-focus. This was in
vision contact lenses were not significantly different, as agreement with theoretical predictionsY



20 " .
o) 0.6

o o im

•[] °
. o.
o °o li
I.k • •. ,....;~
-40 " ", " 0.O
1'o -- 16o
Spatial frequency (c.p.d.)
-6 20 40 80 80 1 O0 120 140 (a) • 1.8mm [] 2.2mm • 2.6mm
(a) Average CF (c.p.d.) o 3mm • 3.4mm

(b) POZ



. "

, ..

.. "-.

D •

~ •

o o
" ' ~ ' - . --". . ~ ,.'- -. " ,. . . . .
• ""
o o
" °:.i
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0-01 lb 160
Spatial frequency (c.p.d.)
(b) • 1.8mm [] 2.2mm • 2.6mm
o 3mm • 3.4ram
-0 0 1 0 2 0.8 0.4 0.6 0.6
(b) Average MTF area
F i g u r e 1 2 . The variation in M T F with changes in the COZD
of concentric-design bifocal contact lens over a 4ram aperture:
F i g u r e 10. The reliability of the optical performance measures
(a) the COZ in-focus; (b) the POZ in-focus.
(a) CF and (b) Area. The spread of the difference between the
optical performance of 11 pairs of nominally identical bifocal The relationship between lens design (CD or CN),
contact lenses increased with average optical performance (dis- COZD, vergence (distance or near), and aperture
tance and near with seven apertures) (n = 156). (pupil) was examined with an analysis of variance
(ANOVA). MTF Area and CF results were evaluated
with COZD (D), lens design (L), vergence (V) and
ro 1.o aperture size (P) as factors. Results of the ANOVA,
0.8 shown in Tables 1 and 2, were very similar. Most of the
Table 1. ANOVA for Area (under M T F curve) with COZD
0.4 (1.8, 2.2, 2.6, 3.0, 3.4ram), lens design (CD, CN), vergence
(distance, near), and aperture size (2, 3, 3.5, 4, 5, 6ram) as
• •uB~
~ 0.0.
fo 16o Sum of Mean Significance
Spatial frequency (c.p.d.) squares dF square F off
(a) • 3mm [] 3.5ram • 4mm
o 5mm • 6mm
COZD(D) 0.129 4 0.032 38.15 <0.001
Lens design(L) 0.008 1 0.008 9.15 0.003
Vergence (V) 0.002 1 0.002 1.92 0.168
Aperture (P) 0.160 5 0.032 37.86 <0.001
tO 1.0 D x L 0.005 4 0.001 1.58 0.180
D x V 0.062 4 0.015 18.32 <0.001
D xP 0.115 20 0.006 6.78 <0.001
0.6 L x V 0.176 1 0.176 208.89 <0.001
L x P 0.015 5 0.003 3.66 0.003
0.4 V xP 0.094 5 0.019 22.33 <0.001
D xLx V 2.882 4 0.721 852.83 <0.001
o o
D x L x P 0.017 20 0.001 1.01 0.455
0.0~ I • i I I
D x Vx P 0.045 20 0.002 2.68 0.01
10 - 160
Spatial frequency (c.p.d.) L x Vx P 3.625 5 0.725 858.08 <0.001
• 3mm [] 3.5mm • 4mm D x Lx V xP 0.597 20 0.030 35.30 <0.001
o 5mm • 6mm Expl~ned 7.971 119 0.067 79.28 <0.001
Residu~ 0.170 201 0.001
F i g u r e 11. The variation in M T F with changes in aperture for
concentric-design bifocal contact lens with a 2.6mm COZD: (a) Total 8.140 320
the COZ in-focus," (b) the POZ in-focus.

(1.8, 2.2, 2.6, 3.0, 3.4ram), lens design (CD, CN), vergence
(distance, near), and aperture size (2, 3, 3.5, 4, 5, 6ram) as
1 ooo]

Table 2. ANOVA for MTF cut-off frequency (CF) with COZD

Sum of Mean Significance

squares dF square F ofF 1 o o T .....................
--- " ' " ' ~ .............. ~'~"7":~:':':~............... "" .:.~..~.'. ...........
COZD (D) 51.54 4 12.89 7.03 <0.001
Lens design (L) 4.30 1 4.30 2.35 0.127 u...
Vergence (V) 2.12 1 2.12 1.16 0.284
Aperture(P) 550.49 5 110.10 60.03 <0.001 10
DxL 3.39 4 0.85 0.46 0.764
Dx V 34.07 4 8.52 4.64 0.001
DxP 57.47 20 2.87 1.57 0.064
L× V 25.89 1 25.89 14.11 <0.001
L×P 16.37 5 3.27 1.79 0.117
V× P 38.18 5 7.64 4.16 0.001 11,8 2.2 2.6 8.0 8.4
D xL x V 1771.81 4 442.95 241.50 <0.001 COZD (mm)
DxLxP 12.21 20 0.61 0.33 0.997
-'~-. C O Z / S m m + COZ/4rnm .-~.- C O Z / 6 m m
D x Vx P 29.73 20 1.49 0.81 0.699
-.o-, POZ/Smm --e- P O Z / 4 m m ..o.. P O Z / 6 m m
L x V× P 1782.93 5 356.59 194.41 <0.001
D x L x Vx P 397.92 20 19.90 10.85 <0.001
Explained 4796.73 119 40.31 21.98 <0.001 Figure 13. MTF cut-offfrequency (CF) varied with COZD. As
Residual 368.67 201 1.83 the COZD increases the CF increases for the COZ (asterisks)
and decreases for the POZ (open circles). This relationship also
varied with aperture size, as shown for 3ram (dashed lines),
Total 5165.40 320
4ram (solid lines), and 6ram (dotted lines) apertures.

factors and interactions were significant, and those con- addition, as indicated by the strong interaction
sidered to be important are discussed below. between lens design, COZD, and vergence (D x L x
Both measures of optical performance, as 10, with increasing COZD the distance optical perfor-
expected 29,31, increased significantly with increasing mance improved with CD lenses and reduced with CN
aperture size,, as indicated by the significance of the lenses, and conversely the near optical performance
factor in Tables i and 2. Optical performance also reduced with CD lenses and improved with CN lenses.
varied significantly with COZD, with the largest COZD This variation with COZD was also dependent upon
giving the best overall optical performance. aperture size, as indicated by the strong interaction
CD lenses had a slightly better MTF Area than did between all four factors (D x L x V x P). For
CN lenses as indicated by the factor lens design in example, the variations in CF with COZD for COZ and
Table 1, but not with CF (Table 2). Apart from the COZ, POZ are shown in Figure 13 for apertures of 3, 4 and
the lens design was the same for CD and CN lenses. It 6mm.
is most likely that the differences in the curvature of Further analysis of the data indicated that there was
the optical surfaces required to produce back-surface a significant, but trivial, difference between CD and CN
concentric-design bifocal contact lens resulted in differ- lens optical performance if the COZ and POZ were con-
ences in the optical aberrations which affected optical sidered. As the difference was considered trivial, the
performance. Spherical aberration would have reduced optic of the bifocal contact lens which was in-focus was
the effective separation of the two loci of the CN design considered (i.e., either COZ or POZ), rather than the
compared to the CD design, thereby comparatively lens design and vergence.
restricting the spread of the out-of-focus image, which
would have had a more detrimental effect upon higher
spatial frequencies.
As indicated by the interaction L × V, CD lenses per-
formed better at distance than at near, while CN lenses
performed better at near than at distance. This was
probably a function of the choice of aperture sizes and
COZDs, and was complicated by changes with aperture
size and COZD.
As indicated by the strong interaction between lens •[ ...................................................................................................................................

design, vergence, and aperture size (L x V x P),

optical performance with the COZ (CD distance, CN 0 i_ , i r

near) reduced with increasing aperture size, while 2 3 4 6 6 7

optical performance with the POZ (CD near, CN dis- Aperture size (mm)
tance) improved with increasing aperture size. This Figure 14. The optimal COZD may be considered as that
was expected as the proportion of the aperture covered which gives equal optical performance between the COZ and the
by the POZ increased with increasing aperture size. In POZ. Optimal COZD increases with increasing aperture size.


Optimal Central Optic Zone Diameter aperture size. The optimal COZD for a given aperture
As noted, an increase in COZD resulted in an improve- may be considered to be the COZD at which the
ment in optical performance with the COZ, while optical performance with the COZ and with the POZ
optical performance with the POZ was reduced (Figure was equal, i.e. the best compromise in optical perfor-
12). As shown in Figure 13 the effect also varied with mance. As can be seen in Figure 13, the optimal COZD

800" 800

0 0
600" 600

400" 400

200' 200

jL __ 0
(a) Detector location (b) Detector location

800 800'

600 600,


400 -= 400

200' 200

O ~ 0
(c) Detector location (d) Detector location

Figure 15. The change in image shape with decentration. Line spread functions for the POZ of a 2.6ram COZD bifocal contact
lens in-focus, with a 4ram aperture. The effects of decentrations of (a) Omm, (b) 0.5ram, (c) 1ram, and (d) lo5mm are shown. At
1ram some of the COZ was outside the aperture.


increased with increasing aperture size. Figure 14 Decentred Bifocal Contact Lenses
shows, for both measures of optical performance, the Each of four 2.6ram COZD bifocal contact lenses were
change in optimal COZD with aperture size. The decentred across a 4mm aperture. Examples of the
optimal COZD was 37%(+4%) of the aperture size for effect of decentration upon the measured LSF are
apertures of 3-6ram. shown in Figures 15 and 16. T h e MTF, as shown in

800" 800'

0 0
600 600'

4001 400'

200" 200"

0 0 I

(a) Detector location (b) Detector location

800 800

600 600

400 4oo!

200 200

o[ o
(c) Detector location (d) Detector location

Figure 16. The change in image shape with decentration. Line spread functions for the COZ of a 2.6ram COZD bifocal contact
lens in-focus, with a 4ram aperture. The effect of decentrations of (a) Omm, (b) 0.5ram, (c) 1ram, and (d) 1.5ram are shown. At
1ram some of the COZ was outside the aperture.


.Cb 1°0" optical performance presented herein and the visual

(3 performance reported in Part II. 1The complex relation-
0.8' ship shown by the present study between lens design
0.6' (CD or CN), vergence (distance or near), COZD, and
aperture size has been suggested fl'om theoretical con-
0.4 @
siderations 1s,2°,2~ but not previously demonstrated by
0.2 *o =o ~ =o= ."===.._
• • • o_ o. = , = , ~ . . ,
actual measurement.
Conventionally, it has been suggested that the COZ
0.0 of a concentric-design bifocal contact lens should cover
1'0 1 O0
Spatial frequency (c.o.d.) 50% of the pupil 4,33, although suggestions have varied
• Omm [] O.5mm • 1.0mm from 20%34 to 80%.12,35 Optical performance measures
[] 1.5ram • 2.0rnm
indicated that the optimal COZ covered slightly less
than 40% of the aperture. The optimal pupil coverage
by the COZ predicted from the visual performance
0.8' measures on the same bifocal contact lenses was found
to be larger for vision tests with a lower spatial fre-
0.0' g quency content. 1 The optimal pupil coverage for tests
with a high spatial frequency content was found to be
about 40%. This comparison was confused by the on-
0.2 eye decentration of the bifocal contact lenses.
Calculations based upon the Stiles-Crawford effect
1'0 100 (reported in Part IP) suggest that, for equal relative
Spatial frequency (c.p.d.)
• Omm [] O.5mm • 1.0mm efficiency between the COZ and POZ, the pupil
o 1.5mm • 2.0mm coverage by the COZ would vary from 43% at a pupil
size of 2mm to 35% at one of 6ram. It is interesting
Figure 17. The variation in MTF with decentration of a con- that the optical performance measures should suggest
centric-design bifocal contact lens with a 2.6turn COZD over a a similar optimal pupil coverage. The human eye is
4mm aperture: (a) the COZ in-focus; (b) the POZ in-focus.
subject to aberrations which reduce optical perfor-
60 mance with increasing pupil size 9, while the MTF
measured here increased with increasing aperture, as
5o ~, expected. 7 Hence, it might be expected that there
would be differences between certain optical and visual
40 ~'~
results, particularly the prediction of an optimal pupil
LL The variation in the predicted optimal pupil coverage
2o ~ with spatial frequency content found in the visual per-
formance measures, reported in Part II 1, may be
matched by similar effects in the measure of optical
0 0.5 1.0 t6 2.0
0 performance, but to establish this would have required
COZ decentration (mm) a more sophisticated analysis-of the MTF results than
Figure 18. The variation in MTF cut-off frequency (CF) with presented here. A variation might be expected given
decentration of a bifocal contact lens with a 2.6ram COZ over a the different shapes, with COZ or POZ in focus, of the
4mm aperture. Results are averaged for four bifocal contact predicted MTF 17,27and shown in Figures 11 and 12 for
lenses. The reduction in CF for central focus with increasing the measured MTF.
decentration is not fully explained by the percentage aperture In addition, the human pupil is not fixed in size; for
coverage by the COZ. an average 55-year-old the pupil varies from about
5.5mm in the dark to about 3.25mm under normal
Figure 17, was also affected by decentration of the 'room' illumination. 36 Hence, on-eye, a COZD which is
bifocal contact lens. With increasing decentration, there optimal for one luminance condition will not be for
was a slight improvement in both Area and CF for the another. In addition, the pupil size decreases with con-
POZ, and a reduction for the COZ, as shown for CF in vergence and, as noted by Baude and Miege 21, most
Figure 18. T h e reduction became more marked once near-vision tasks are performed at higher illuminance
the COZ reached the edge of the aperture, and hence levels than are distance tasks, which would cause a fur-
the proportion of the aperture covered by the COZ ther reduction in pupil size. Obviously, this would
decreased. favour the CN design.
When concentric-design bifocal contact lenses were
Discussion deceutred across the aperture (pupil) there was a slight
The results of this study were generally in good agree- improvement in the optical performance with the POZ
ment with previous studies and theoretical calculations. in-focus and a dramatic reduction in the optical perfor-
In addition, there was good agreement between the mance with the COZ in-focus (Figures 17 and 18).


There was a detectable difference with only small Address for Correspondence
amounts of decentrafion (i.e., while the pupil coverage Russell L. Woods, School of Optometry, Queensland
by the COZ remained unchanged), and the difference University of Technology, GPO Box 2434, Brisbane,
increased considerably once a portion of the COZ was Queensland 4001, Australia.
outside the pupil zone (i.e., the proportion of the pupil
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