Association Between Binocular Vision Disorders and Contact Lens Discomfort During Soft Contact Lens Wear: A Systematic Review.

Abstract

Purpose: To synthesise and critically evaluate the evidence regarding accommodative and binocular vision dysfunction systematically in relation to visual discomfort during soft contact lens wear in non-presbyopic individuals, and to examine the association between soft contact lens optical designs and objective measures of accommodation and vergence.

Recent findings: A systematic search of PubMed, Scopus and Google Scholar (inception to 13 May 2026) identified 403 records, of which 23 studies met the inclusion criteria, including 16 randomised trials, five non-randomised studies and two cross-sectional studies. Evidence demonstrated consistently that centre-distance multifocal, dual-focus and extended-depth-of-focus (EDOF) soft contact lenses increased accommodative lag (1.0-1.7 D), accommodative variability (0.36-0.86 D) and near exophoria (1.8-2.4Δ), while reducing accommodative facility (4.5-9 cpm) compared with single-vision designs. Similar effects were observed across a broad range of myopic refractive errors (-1.00 to -9.25 D). In contrast, centre-near multifocal lenses were associated with lower accommodative lag and reduced near exophoria relative to single-vision and centre-distance multifocal designs. Toric soft contact lenses demonstrated improvements in near point of convergence (NPC) and subjective visual performance. Across studies evaluating symptomatic wearers, binocular vision dysfunction was reported in 23%-48% of participants and was associated with significantly greater symptom severity, as reflected by higher Ocular Surface Disease Index (OSDI) and Convergence Insufficiency Symptom Survey (CISS) scores (p < 0.001). Collectively, these findings indicate that alterations in accommodative and vergence function associated with specific soft contact lens optical designs may be associated with visual discomfort during lens wear. Given the high prevalence of binocular vision dysfunction among symptomatic contact lens wearers, a brief binocular vision screening, including accommodative facility, near heterophoria, NPC and fusional vergence testing may assist clinicians in identifying underlying causes of visual discomfort and guiding targeted management strategies.