Pupil Diameter and Variable Multifocal Zone Sizes Relate to Success Authors: Matthew Lampa, OD, FAAO; Robert

Authors: Matthew Lampa, OD, FAAO; Robert Davis, OD, FAAO; P. Douglas Becherer, OD, FAAO; Lindsay McCorkle, MSEd; John Hayes, PhD
Introduction
we performed a stepwise regression to identify relevant variables in predicting Standardized Regression Coefficients (beta) Figure 4: This graph depicts
The regression equations from Figures 7 and 8 were used to develop tables Near-Center Zone Diameter Table 1: This table depicts

C
factors associated with the size of the Pupil Radius near-center zone diameter. Line
-1 -0.5 0 0.5 1 1.5 Size 7.6 7.7 7.8 7.9 8 8.1 8.2 8.3 8.4 8.5 8.6

linical experience indicates that the success of multifocal contact lenses is influenced by multiple near-center zone diameters. Next, we applied a Wilcoxon non-parametric test Pupil Size
near-center zone diameter (average
R2=.79). In regular lighting, pupil
to assist in determining the near-center and peripheral zone diameter 3
3.2
1.74
1.75
1.75
1.77
1.77
1.79
1.79
1.81
1.81
1.82
1.82
1.84
1.84
1.86
1.86
1.88
1.88
1.89
1.90
1.91
1.91
1.93
up the pupil size and radius to
determine the suggested near-center
3.4 1.78 1.79 1.81 1.83 1.85 1.86 1.88 1.90 1.92 1.93 1.95

to all near-center and peripheral zone diameter models to determine if there size was the primary factor impacting
values. The average successful diameter can be identified at the intersection 3.6 1.81 1.82 1.84 1.86 1.88 1.89 1.91 1.93 1.95 1.97 1.98 zone diameter.
factors. These include lens centration, relationship of cornea to contact lens base curve, lens Radius
the size of the near-center zone.
3.8
4
1.84
1.89
1.86
1.91
1.88
1.92
1.90
1.94
1.91
1.96
1.93
1.98
1.95
1.99
1.97
2.01
1.98
2.03
2.00
2.05
2.02
2.06

was a significant difference in model residuals (the deviation from the line) Diameter When the lighting conditions were of the row representing the patients pupil size and the column representing 4.2 1.94 1.96 1.98 1.99 2.01 2.03 2.05 2.06 2.08 2.10 2.12

movement, limbal coverage, optical placement, line of sight, lens orientation, lens dehydration,
4.4 2.00 2.02 2.03 2.05 2.07 2.09 2.10 2.12 2.14 2.16 2.17
altered, add power also affected the 4.6 2.06 2.08 2.10 2.12 2.13 2.15 2.17 2.19 2.20 2.22 2.24

between successful and unsuccessful patients. We expected that the successful Power
size of the near-center zone. the radius. (Refer to Table 1 for near-center zone diameter and Table 2 for 4.8
5
2.14
2.22
2.15
2.23
2.17
2.25
2.19
2.27
2.21
2.29
2.22
2.30
2.24
2.32
2.26
2.34
2.28
2.36
2.29
2.37
2.31
2.39

pupil size, lens design, optic-zone sizes, patient adaptation, and accommodation, among others. patients would be a better fit than the unsuccessful patients. The model
Cylinder
peripheral zone diameter.) For example, if the median pupil size is 4.2mm
5.2
5.4
5.6
2.30
2.40
2.50
2.32
2.41
2.51
2.34
2.43
2.53
2.35
2.45
2.55
2.37
2.47
2.57
2.39
2.48
2.58
2.41
2.50
2.60
2.42
2.52
2.62
2.44
2.54
2.64
2.46
2.55
2.65
2.48
2.57
2.67
Axis 5.8 2.60 2.62 2.64 2.66 2.67 2.69 2.71 2.73 2.74 2.76 2.78

predicted near-center and peripheral zone diameter values at the 8.1mm and the median radius is 8.1mm, the tables indicate the recommended 6 2.72 2.74 2.75 2.77 2.79 2.81 2.82 2.84 2.86 2.88 2.89

This poster will examine pupil size in relation to near-center and peripheral optic-zone diameters as a predictor Add Power
6.2
6.4
2.84
2.97
2.86
2.99
2.87
3.00
2.89
3.02
2.91
3.04
2.93
3.06
2.94
3.07
2.96
3.09
2.98
3.11
3.00
3.13
3.02
3.14

radius, which were then used to test the association with values generated by Lighting Other OD n=13 Lighting Other OS n=13
near-center zone diameter would be 2.03mm and the peripheral zone 6.6
6.8
3.10
3.25
3.12
3.26
3.14
3.28
3.16
3.30
3.17
3.32
3.19
3.33
3.21
3.35
3.23
3.37
3.24
3.39
3.26
3.40
3.28
3.42

of positive patient outcomes when finalizing a custom soft multifocal contact lens prescription. the SpecialEyes Multifocal Simulator (see Figure 3).
Regular Lighting OD n=69 Regular Lighting OS n=66

diameter would be 3.68mm.

7 3.40 3.41
Note: All measurements in mm.
3.43 3.45 3.47 3.48 3.50 3.52 3.54 3.55 3.57

Figure 1A: This image depicts Figure 5: This graph depicts 4. There is a strong linear association (see Figure 9) between the values Table 2: This table depicts

Terminology Dened
Standardized Regression Coefficients (beta) Peripheral Zone Diameter
SpecialEyes 54 Multifocal Aspheric Design the multifocal lens design used in
this study. Results Pupil Size
-0.6 -0.4 -0.2 0 0.2 0.4 0.6 0.8 1 1.2
factors associated with the size of the
peripheral zone diameter (average
R2=.75). In regular lighting, pupil
generated by the SpecialEyes Multifocal Simulator and the models predicted
near-center and peripheral zone diameter values from the data set (see
Pupil
Size
3
3.2
3.4
7.6
2.95
2.99
3.05
7.7
2.99
3.03
3.09
7.8
3.04
3.08
3.14
7.9
3.08
3.12
3.18
8
Radius

3.13
3.17
3.23
8.1
3.17
3.21
3.27
8.2
3.21
3.26
3.31
8.3
3.26
3.30
3.36
8.4
3.30
3.34
3.40
8.5
3.35
3.39
3.45
8.6
3.39
3.43
3.49
peripheral zone diameter. The
peripheral zone diameter uses the
near-zone prediction and requires no
size was the primary factor impacting 3.6 3.13 3.17 3.21 3.26 3.30 3.35 3.39 3.44 3.48 3.52 3.57 additional measurements.
Radius 3.8 3.22 3.26 3.31 3.35 3.40 3.44 3.49 3.53 3.57 3.62 3.66
the size of the peripheral zone.
Near-Center Zone: A customizable diameter value in the center of the 1. Pupil size had a clinically relevant and statistically significant impact on Diameter When the lighting conditions were
Table 3), thus validating the simulators pupil-size fitting methodology. 4
4.2
3.33
3.46
3.38
3.50
3.42
3.55
3.46
3.59
3.51
3.64
3.55
3.68
3.60
3.73
3.64
3.77
3.69
3.81
3.73
3.86
3.77
3.90
4.4 3.61 3.65 3.70 3.74 3.78 3.83 3.87 3.92 3.96 4.01 4.05
altered, add power also affected the
near-center SpecialEyes 54 Multifocal lens that is comprised of full near power. Near
both near-center and peripheral zone diameter sizes. We used multiple Power
size of the peripheral zone. The black line of identity in Figure 9 shows similarity between the
4.6
4.8
3.77
3.96
3.82
4.00
3.86
4.04
3.91
4.09
3.95
4.13
3.99
4.18
4.04
4.22
4.08
4.27
4.13
4.31
4.17
4.35
4.22
4.40
5 4.16 4.20 4.24 4.29 4.33 4.38 4.42 4.47 4.51 4.55 4.60

See Figures 1A and 1B. Intermediate regression to examine the association between measured variables (pupil Cylinder
SpecialEyes Multifocal Simulator and the Regression Model developed
5.2
5.4
4.37
4.61
4.42
4.65
4.46
4.70
4.51
4.74
4.55
4.79
4.59
4.83
4.64
4.87
4.68
4.92
4.73
4.96
4.77
5.01
4.82
5.05

(Progressive) Axis
5.6
5.8
4.86
5.13
4.91
5.18
4.95
5.22
5.00
5.27
5.04
5.31
5.08
5.35
5.13
5.40
5.17
5.44
5.22
5.49
5.26
5.53
5.30
5.58

Intermediate Area: Located between the near-center zone and peripheral size, radius, lens diameter, power, cylinder, axis, and add power) and the from the data. The R2 values are very high (0.9807 and 0.9604). R2 values 6
6.2
5.42
5.73
5.47
5.77
5.51
5.82
5.55
5.86
5.60
5.91
5.64
5.95
5.69
5.99
5.73
6.04
5.78
6.08
5.82
6.13
5.86
6.17
Distance Add Power
6.4 6.05 6.10 6.14 6.19 6.23 6.27 6.32 6.36 6.41 6.45 6.49

zone, this area contains aspheric intermediate powers. See Figure 1A. assigned near-center and peripheral zone sizes. Figures 4 and 5 report the Lighting Other OD Lighting Other OS
vary from 0 to 1 and represent the proportion of variance shared by the 6.6
6.8
6.39
6.75
6.44
6.80
6.48
6.84
6.53
6.89
6.57
6.93
6.62
6.97
6.66
7.02
6.70
7.06
6.75
7.11
6.79
7.15
6.84
7.20
7 7.13 7.18 7.22 7.26 7.31 7.35 7.40 7.44 7.48 7.53 7.57
beta weights from the regression equations and show pupil size as having Regular Lighting OD Regular Lighting OS

two variables. Points share 100% of the variance if they fall directly on Note: All measurements in mm.

Peripheral Zone: This customizable diameter value in the periphery of the

near-center SpecialEyes 54 Multifocal lens represents the location in the lens at Figure 1B: In this image, the yellow
dashed circle represents the near-
2. The variables examined in the study did not reveal why some patients were
which full distance power is reached. The lens remains at full distance power center zone diameter value and the
white dashed circle represents the
from this diameter value to the end of the 8mm optic zone. See Figure 1B. peripheral zone diameter value. Both
a significant impact on near-center and peripheral zone sizes. a single straight line. The magnitude of deviations from the best-fit line
Near-Center Zone Diameter in Relation to Pupil Size Figure 6: This graph predicts Multifocal Simulator and Regression Model Relationship Figure 9: This graph illustrates the
near-center zone diameter in relation (residuals) illustrates variability not shared between the two variables. relationship between the SpecialEyes
3.5 to pupil size. 6 Multifocal Simulator and the
successful and others were unsuccessful. However, by using multiple logistic There are barely visible dotted lines that are the best-fit linear lines Near Zone R = 0.9807
Regression Model.
5.5
Peripheral Zone R = 0.9604

Near-Center Zone Diameter (mm)

of these parameters are customizable. regression analysis and controlling for all variables, we found the choice 3 between Model and Simulator. Both lines fall very close to the black line 5

4.5
Line of Identity

of identity. This also illustrates the one-to-one comparison between the

Model (mm)
4
of peripheral zone diameter size to be a modest predictor of success
Methods significantly for OD (p=.01) and marginally for OS (p=.067).
2.5

two computations. The slight curve in the peripheral zones comparison

3.5

2.5
2 to the line of identity is probably due to the quadratic component of the
This study analyzed data from 48 successful and 39 unsuccessful custom 3. Multiple regression analysis revealed that pupil size and radius were the 2

pupil size in the predicted model. 1.5

soft multifocal contact lens patients, with a total of 91 eyes in the successful best predictors of success (R2 = .92). Some failures were shown to be a 1.5
3 3.5 4 4.5 5 5.5 6 6.5
1
1 2 3 4 5 6

group and 70 eyes in the unsuccessful group. The near-center and peripheral result of not following the predicted model for near-center and peripheral
zone size selection (see yellow circles in Figures 7 and 8). We performed a
Pupil Size (mm)

Conclusions Simulator (mm)

zone diameter values of the SpecialEyes 54 Multifocal contact lenses were Figure 2: This image depicts Figure 7: This graph illustrates the Diameter Values Table 3: This table depicts
Pupil Size Distribution Observed Near-Center Zone Diameters on Predicted Values

designed from a pupil-size fitting methodology, where zone sizes were pupil size distribution. The No regression of near-center zone diameter values on pupil size for successful relationship between the predicted Pupil size effectively assisted in determining near-center and peripheral Simulator Regression Model diameter values as determined
No Adjustment Adjusted Adjustment column represents 3.5 model and the observed near-center Peripheral Peripheral by the Multifocal Simulator and

determined by pupil size. 80- pupil sizes as measured in regular patients under regular room illumination to build a prediction model for the 3.3
Failure
zone diameter values. It features a zone diameter values.
Pupil Size
3
Near Zone
1.8
Zone
3
Near Zone
1.82
Zone
3.17 the Regression Model.

Observed Near-Center Zone Diameter (mm)

Success
room illumination. The Adjusted Jitter plot of all observed near-center 3.2 1.8 3 1.84 3.21

column represents pupils measured near-center zone diameter values (see Figure 6). The association was strong 3.1
Line of Identity zone diameters on predicted values.
3.4 1.8 3 1.86 3.27

We performed a multiple logistic regression analysis to examine the likelihood 60-

in photopic or mesopic conditions
2.9
The Wilcoxon test of success on the
The regression models summarize the near-center and peripheral zone 3.6 1.9 3.2 1.89 3.35

and subsequently adjusted to reflect

(R2 = .66). However, the deviations from the line appeared systematic. 2.7
absolute value of the residuals was
3.8
4
2
2
3.4
3.5
1.93
1.98
3.44
3.55

of success as a function of the measured variables: pupil size, radius, lens diameter values of successful patients and indicate that peripheral zone
count

2.5 4.2 2 3.5 2.03 3.68

40- effective pupil size in regular room significant at p = .002. Absolute
4.4 2 4 2.09 3.83
illumination. All near-center and For further model development, we analyzed separate stepwise regression 2.3 residuals were tested because of the
diameter is related to success. 4.6 2.1 4.2 2.15 3.99
diameter, spherical contact lens power, cylinder, axis, add power, near-center peripheral zone diameter values 2.1 distribution of errors above and 4.8 2.2 4.4 2.22 4.18
20-
were initially chosen based on equations for each eye (using a sample of the data) to identify relevant below the line of identity, which is 5 2.3 4.6 2.3 4.38

zone diameter, and peripheral zone diameter.

1.9
pupil-size measurements in regular 1.7
drawn through the center of the The prediction models used pupil size and radius to predict the near-center 5.2
5.4
2.4
2.4
4.8
4.9
2.39
2.48
4.59
4.83

0-
room illumination. variables in predicting near-center zone diameters. The final model was a graph. The Wilcoxon test used only 5.6 2.5 5 2.58 5.08

By analyzing the multiple regression, we were able to determine the 3 4 5 6 7 3 4 5 6 7

1.5
1.5 2 2.5 3 3.5 samples not included in developing zone diameter. The predicted near-center zone diameter was sufficient to 5.8 2.6 5.2 2.69 5.35

Pupil Size (mm) polynomial regression with pupil size and radius: Predicted Near-Center Zone Diameter the model.
6 2.8 5.5 2.81 5.64

association between the measured variables and the assigned near-center predict the peripheral zone diameter. Note: All measurements in mm.

Predicted Near Center = 1.001435 + (-0.462633 * PupilSize) + (.087728 * PupilSize2)

and peripheral zone diameter values. Using a regression of near-center Figure 3: This image displays Observed Peripheral Zone Diameters on Predicted Values Figure 8: This graph illustrates the
Though the ability to predict success from the variables included in the
a sample screen capture of the + (0.175540 * Radius) relationship between the predicted
zone diameter on pupil size for all successful patients under ambient room SpecialEyes Multifocal Simulator. 7.5 model and the observed peripheral study was limited, the findings demonstrated that pupil size and radius
Failure
zone diameter values. It features a
illumination conditions, we then built a prediction model for the near- Figure 7 illustrates the relationship between the predicted model and 7
Success Jitter plot of all observed peripheral
could identify successful patients, while those not following the pupil-size
6.5

Observed Peripheral Zone (mm)

center zone diameter. the observed near-center zone diameter values. Figure 8 illustrates the 6
Line of Identity zone diameters on predicted values.
The Wilcoxon test of success on the
fitting methodology (average successful near-center and peripheral zone
Due to the over-sampling of patients with 4mm pupils (see Figure 2), we opted relationship between the predicted model and the observed peripheral 5.5 non-absolute value of the residuals
was significant at p = .046. Non-
diameter selections) were more likely to fail.
5

to revise our sample before further developing the model; so we compiled a zone diameter values. The predicted near-center zone diameter alone was 4.5
absolute residuals were used in the
test because all the outlying residuals Correlation of the data revealed a strong association between the values
sample of successful patient data consisting of a random selection of 20% of sufficient to find the best-fitting peripheral zone diameter value using the 4 were below the line of identity, which
generated by the SpecialEyes Multifocal Simulator and the models
3.5 is drawn through the center of the

patients with pupil diameters of 4mm and all other successful patients with following equation: 3
graph. The test used only samples not
predicted near-center and peripheral zone diameter values, thus validating
3 4 5 6 7 8 included in developing the model.
Predicted Peripheral Zone Diameter
pupil measurements based on ambient room illumination. Utilizing this data, Predicted Peripheral = -1.43 + (2.521 * Predicted Near Center) the simulators pupil-size fitting methodology.