Design of Progressive Addition Lens for Presbyopia: A Systematic Review

PURPOSE: Presbyopia is a common age-related condition and progressive addition lenses (PALs) are a primary corrective method. This systematic review synthesised recent evidence (2015-2025) on the technical design of PALs for presbyopia, focusing on key developments in design methodologies, performance evaluation and emerging lens concepts. METHODS: A systematic search of six databases (PubMed, Embase, Web of Science, Cochrane Library, Scopus and SPIE Digital Library) was conducted following PRISMA guidelines. Eligible studies addressed PALs design principles, algorithms, methodologies or optical performance evaluation. Study quality was assessed using a customised 12-dimensional framework. RESULTS: The review included 17 eligible studies. Four major thematic areas of advancement were identified: the maturation of freeform surface design as the primary method for creating complex optical surfaces; the evolution of strategies for the control of surface astigmatism; the development of advanced optical performance quantification techniques enabling objective quantification of lens performance and the emergence of novel lens concepts expanding design possibilities beyond conventional refractive approaches. Key progress was noted in algorithmic optimisation for the control of surface astigmatism and the shift from subjective assessment to data-driven performance validation. CONCLUSION: PAL design has evolved significantly toward customised, algorithm-driven solutions. However, challenges remain in standardising clinical fitting, understanding neural adaptation and developing personalised designs for diverse presbyopic subpopulations. Future progress will hinge on deeper interdisciplinary integration and ongoing technological innovation to evolve PALs from standardised corrections into adaptive visual wearables.