Corrective eyeglasses are the most commonly used method of presbyopia treatment. One alternative to monofocal near-vision eyeglass lenses are bifocal lenses, comprising two areas with different optical powers, for distance vision (top and central segment) and for near vision (lower segment). The lower segment may be circular or semi-circular, with a clear split line. Progressive lenses use something called a “transition channel”, with a seamless progression of lens power for clear vision at any distance. In some cases, progressive lenses cannot be used or are less comfortable, and so it is really important to talk about each patient’s individual needs when making the choice. Semiprogressive lenses may be a good alternative for those who work a lot at near and intermediate vision distances.

Monovision is a technique for presbyopia correction used in contact lenses, refractive surgery, and cataract surgery. It involves the deliberate creation of anisometropia, or unequal optical power, so that one eye is corrected for distance, and the other — for near vision. The natural configuration, with the dominant eye set for distance vision and the non-dominant eye for near vision, is most commonly used. Alternatively, crossed monovision may be used, with the non-dominant eye corrected for distance and the dominant eye corrected for near vision, but this is much less common. Historically, monovision involved establishing anisometropia of more than 2 diopters (D), but such a large difference was unacceptable to many patients due to problems with differences in the perceived size of images from each eye (aniseikonia) and loss of stereopsis, i.e. depth perception. With mini-monovision, resulting in anisometropia of 1.0–1.5 D, or micro-monovision (anisometropia below 1 D), stereopsis is affected to a much lesser extent. Thus, the methods are well tolerated by the vast majority of patients. Micro-monovision does not allow for dispensing with reading glasses altogether, but limits the need to use them, e.g. just to reading very small print.

With contact lenses , options include monovision and multifocal lenses. Multiple focal points in contact lenses can be achieved by making them segmented or concentric. Segmented contact lenses have a near vision area in the bottom part, similarly to progressive eyeglass lenses. Concentric multifocal contacts can be adjusted for near vision in the central zone and for distance vision in the peripheral zone (N-lens), or for distance vision in the center and for near vision in the periphery (D-lens). Currently, concentric contact lenses with near addition in the center are commercially available. To optimize near vision in patients with presbyopia, various configurations of lenses may be used:
– multifocal lenses on both eyes
– monofocal lens on the dominant eye, monofocal lens for near vision on the non-dominant eye (monovision)
– monofocal lens on the dominant eye, multifocal lens on the non-dominant eye
– any of the above optionally combined with near-vision eyeglasses used for a limited number of activities (e.g. precision work).

Richdale et al. compared quality of vision in patients using contact lenses for presbyopia correction. Their study included 38 patients randomly assigned to one of two groups. Patients in group one received a monofocal lens with distance correction for the dominant eye, and a monofocal lens with near correction (full addition) for the non-dominant eye. In the other group, patients requiring addition up to +1.5 D received a low-add multifocal lens for each eye, and those requiring addition between +1.75 D and +2.25 D received a low-add lens a low-add multifocal lens for the dominant eye and a high-add lens for the non-dominant eye. After one month, patients in group one switched to multifocal lenses and patients in group two switched to monovision with monofocal lenses, following the same protocol. Under high-contrast conditions, patients in both groups retained full distance visual acuity. Under low-contrast conditions, all patients lost less than 1 line of distance visual acuity when using the contact lenses. Under the same conditions, patients with monovision lost 2 symbols, and those with multifocal lenses — 6 symbols for near vision. Stereoacuity was worse by 79 arc seconds in the monovision group. Patients in both groups reported more satisfaction in terms of appearance, but poorer quality of vision and more dysphotopsias in the National Eye Institute Refractive Error Quality of Life (NEI-RQL) survey. 76% patients preferred multifocal lenses, and only 24% preferred monovision. One conclusion of the study was that multifocal lenses offer good visual acuity without a loss of stereoacuity.