Subjective Quality of Vision in Progressive Addition Lens Users: Evidence of Neurovisual Adaptation from a Rasch-Validated Patient-Reported Outcome Study

Abstract

Background: Progressive addition lenses (PALs) are the most frequently prescribed optical device for presbyopia, providing a seamless range of vision in the distance, intermediate and near viewing zones. PALs have optical advantages over conventional lenses, but they also can induce visual disturbances that are not well captured by conventional visual acuity measurements. The objective of this study was to assess the subjective quality of vision in PAL users with the Rasch-validated Quality of Vision (QoV) questionnaire and to determine the factors associated with visual symptom burden.

Methods: A cross-sectional observational study was carried out on 59 presbyopic adults aged 40 years and above who were current users of progressive addition lenses. Participants filled out the QoV questionnaire, which measures ten visual symptoms in terms of frequency, severity and bothersomeness.

Results: The mean age of participants was 47.7±7.0 years and 74.6% were male. More than half of the participants (54.2%) had used PALs for more than six weeks, and 78.0% reported wearing their lenses for at least 4 hours per day. Visual disturbances were generally infrequent and mild, the most commonly reported symptoms being starbursts, glare, focusing difficulties, and problems with depth perception. The mean total QoV score was 22.0 ± 18.3, suggesting generally good subjective visual quality. Duration of PAL use was significantly negatively correlated with QoV score (r = −0.389, p = 0.002). Duration of PAL use was the only significant predictor in multivariable regression analysis (β = −6.36, p = 0.036), suggesting better visual quality with longer PAL wear.

Conclusion: Longer use of PAL is associated with better visual quality and suggests a role of neurovisual adaptation in successful PAL wear. Routine optometric practice incorporating patient-reported outcome measures may provide a more comprehensive assessment of presbyopic correction outcomes over and above traditional measures of visual acuity.