Why the question comes up
From the early to mid-40s, most people gradually lose the ability to focus up close. This is presbyopia, an age-related change in the lens inside the eye, and it continues through the 50s.[1] A standard scleral lens corrects one distance, so wearers who reach that age start to wonder whether their lens can do both.
Yes, but they’re uncommon
Multifocal scleral lens designs exist. They’re rarely prescribed. In an international survey in which fitters described one patient each, covering 419 eyes, only 5 lenses had multifocal optics.[2] The authors noted that newer optical designs had not been widely adopted.[2]
What the studies show
The research is small and early. Here’s what we found:
- Multifocal vs single-vision, same lens family. A pilot crossover study fitted 19 people with age-related near focus loss and regular corneas with both a single-vision and a multifocal version of the same scleral lens. The multifocal gave better intermediate and near vision. It also came with trade-offs: reduced depth perception, lower contrast sensitivity for fine detail, and weaker distance vision in dim light and on low-contrast tests.[3]
- Two multifocal designs compared. A study by the same group fitted 19 people with two multifocal scleral designs for a month each. A design with a customized, off-center optical zone gave better low-contrast near vision and better rated vision than the conventional multifocal.[4]
- Customized multifocal corneo-scleral lenses. Two small pilot studies of a related, slightly smaller lens type, fitted to 11 and 27 people with age-related near focus loss, reported good distance and intermediate vision. In the larger study, near vision was more limited and difficulty focusing was the most common complaint.[5][6]
Taken together: multifocal designs can work for some people, but every study here is small and short-term, and none focused on people with corneal disease. We didn’t find studies showing how well they work for irregular corneas such as keratoconus, even though irregular corneas are the main reason people wear scleral lenses.[2]
The trade-offs in plain terms
Many multifocal contact lenses work by giving your eye more than one focus at the same time. That often means a little less crispness at every distance than a single-vision lens gives at one distance. The pilot study above showed this most in dim light, which matters for night driving. See scleral lenses for night driving.
The usual alternative: reading glasses
For most scleral lens wearers, the simpler answer is a standard single-vision lens for distance, plus reading or computer glasses over the top when you need them. It keeps distance vision as sharp as your lens allows. See can you wear glasses over scleral lenses.
What to ask your fitter
- “Do you fit multifocal scleral lenses, and how often?”
- “Would my cornea suit one?”
- “What would I give up for distance vision, especially at night?”
- “If it doesn’t work, what does a change cost, and is it covered by the fitting fee?”
Common questions
Can I get multifocal scleral lenses if I have keratoconus?
Possibly, but evidence is thin. The studies we found were in people with healthy corneas or didn't focus on irregular corneas. Ask your fitter whether your eyes are a reasonable candidate and what they'd expect.
Are multifocal scleral lenses as sharp as regular ones for distance?
In good light and on high-contrast letters, one small study found distance vision held up well. In dim light, and on low-contrast targets, distance vision was measurably weaker with the multifocal design.
What's monovision, and does it work with scleral lenses?
Monovision means one eye is set for distance and the other for near. It's an approach used with many kinds of contact lenses. We didn't find published studies of monovision specifically with scleral lenses, so ask your fitter whether it's something they'd try for you.