prescribing for astigmatism

Stalking the Soft Multifocal Toric Lens

BY PETER D. BERGENSKE, OD, FAAO
June 2001

A trick that the soft lens industry needs to pull from its hat is a reliable multifocal toric contact lens. Close to 40 percent of patients seeking contact lenses have at least 0.75D of astigmatism. Until quite recently, the presbyopic astigmat was limited to rigid lens choices unless both fitter and patient wanted to deal with the vagaries of toric soft lens monovision or reading glasses.

Spherical soft multifocals have seen dramatic growth following the success of the Acuvue Bifocal. It is no surprise that the marriage of toric lens technology and multifocal magic has appeal and, potentially, a large market. There are currently at least 10 manufacturers with a total of 12 soft toric multifocal designs marketed in the United States (Table 1).

Keys to Success

Successful design coupled with availability of trial lenses and disposability prompted the skyrocketing growth of the soft multifocal market. We are not there yet with soft multifocal torics, but finding the right design will be the first step.

Fitting any of these lenses is a trial and error process. All of the manufacturers provide consultation services to help practitioners. Lifestyle and Ocu-ease have helpful websites (www.lifestylecompany.com and www.ocuease.com).

Consider a lens design that best fits the patients' needs, as you would for other multifocal correction. All of these lenses have spherical counterparts on which they are based; if spherical trials are available, it is reasonable to test the effectiveness of the multifocal using a sphere equivalent or an over-refraction. Keep in mind that a high percentage of successful spherical multifocal fits involve some degree of modified monovision. Expect the same with the torics.

So far this continues to be a niche product available only from smaller, innovative manufacturers. But with the clear demand, the development of a mainstream, disposable, soft lens product for the presbyopic astigmat cannot be far away. 

Dr. Bergenske, a Past Chair of the American Academy of Optometry's Section on Cornea and Contact Lenses, has practiced for over 20 years in Wisconsin and now is on the faculty at Pacific University College of Optometry. Email him at: berg1101@pacificu.edu.