Contact lens discomfort is often blamed on dryness alone. A new systematic review reminds clinicians that focusing and eye-teaming problems can feel a lot like lens intolerance, especially in younger soft-lens wearers.
What the reviewers examined
Researchers searched PubMed, Scopus, and Google Scholar through May 13, 2026, and included 23 studies (16 randomized trials, five non-randomized studies, and two cross-sectional studies) on accommodative and binocular function during soft lens wear in non-presbyopic people.
What they found
- Among symptomatic wearers, binocular vision dysfunction showed up in about 23% to 48% of participants and tracked with higher symptom scores on dry-eye and convergence surveys.
- Centre-distance multifocal, dual-focus, and extended-depth-of-focus soft lenses tended to increase accommodative lag and near exophoria and reduce accommodative facility compared with single-vision designs.
- Centre-near multifocal designs were linked to lower lag and less near exophoria in the pooled evidence.
- Toric soft lenses were associated with improvements in near point of convergence and subjective visual performance in some studies.
The authors could not run a full meta-analysis because designs and measurements differed widely, and most studies were short-term, so the relationship is association rather than proven cause-and-effect.
A short screening list worth asking for
The review suggests that when lenses feel “off,” a brief binocular screen can help:
- Accommodative facility
- Near heterophoria (eye alignment at near)
- Near point of convergence
- Fusional vergence ranges
Patient takeaways
- Do not assume every afternoon headache in contacts is only dryness.
- Tell your eye doctor if print blurs in and out, if one eye seems to wander, or if symptoms started after a lens-design change.
- Keep lenses clean and replace them on schedule; surface problems and binocular problems can coexist.
Surface dryness and focusing can overlap
Many symptomatic wearers have both an unstable tear film and a binocular issue. Treating only one side of that overlap leaves residual discomfort. If lubricants help for an hour but headaches or print “swim” persist, ask for the binocular screen listed above before switching lens brands again.
Khanna Vision Institute evaluates contact lens comfort as part of a full exam. More Conejo Valley eye-health reading is at thousandoakslasik.com.
Source: Association Between Binocular Vision Disorders and Contact Lens Discomfort During Soft Contact Lens Wear: A Systematic Review (Ophthalmic and Physiological Optics / related journal record (PubMed PMID 42873434), 2026). This article is an educational summary written by Khanna Vision Institute and is not a substitute for medical advice.