For patients who have presbyopia, the overwhelming majority of contact lens options incorporate some type of simultaneous vision add power to the contact lens in an effort to optimize distance, intermediate, and near vision. With most of these options, the power profile present in the lens is rotationally symmetric 360º around the lens. In the case of soft contact lenses, this presents a challenge, as the manufacturer designs a lens to correct for astigmatism because the lens additionally needs to be stabilized through some ballasting system.

As time has gone on, the level of innovation with these soft toric multifocal contact lenses has increased. The majority of soft toric multifocal contact lenses are custom in nature. In terms of managing presbyopia, this custom nature presents several advantages. The first is greater power availability, as the distance power range is quite extreme; the same is true for the add power, which is often higher than many of the traditional off-the-shelf molded soft multifocal contact lenses.

In terms of managing the astigmatic correction, the cylinder power range is often quite high—up to –8.00DC in some products—and the cylinder axis can be specified in 1º increments, thereby optimizing visual outcomes. Once a custom soft multifocal contact lens is selected, an additional advantage is that the add power and multifocal zones placed in the lens can be designed to accommodate a patient’s unique pupil size.

If the source of astigmatism is corneal in nature, a non-flexing GP lens begins to emerge as an excellent option because its inherent non-flexing nature eliminates the patient’s astigmatism and the unique multifocal power profile can be placed within the lens.

Another unique option in the contact lens management of individuals who have presbyopia and astigmatism is overnight orthokeratology. As corneal topography systems and contact lens manufacturers have improved their devices in recent years, the level of precision with which orthokeratology lenses are made has improved tremendously.

To stabilize the orthokeratology lens on the astigmatic cornea, a toric landing is recommended. This can be done with as small as a 25- to 30-micron differential between the flat and steep meridians. The central treatment curve is left spherical in an effort to sphericalize the cornea and eliminate the patient’s astigmatism (Figure 1). The resultant power profile in the post-orthokeratology cornea very much resembles that of a center-distance aspheric multifocal (Figure 2).

It is thanks to some of these unique contact lens options that we are able to better care for patients who have presbyopia and astigmatism. CLS