This article was originally published in a sponsored newsletter.

Presbyopia and daily disposable contact lenses in patients who have an astigmatism create a challenge. Many of our non-presbyopic patients who have an astigmatism are fit successfully and wear their daily disposable lenses all the time. When presbyopia starts to sneak in though, what do you do? There are currently no multifocal toric daily disposable contact lenses on the market and options are limited with reusable multifocal, toric contact lenses. Additionally, many of those daily disposable wearers do not want to change to a reusable contact lens or wear reading glasses over their contact lenses. So, what’s your strategy?

Customize the Process

Start by understating patients’ occupations, hobbies, and daily visual requirements. This data will help to identify their daily visual needs and discuss proper expectations.

Utilize Available Tools  

We all remember LARS (Left Add, Right Subtract) when making toric lens adjustments, but a variety of online tools are available as well. Find toric lens calculators for more advanced alterations, and enable success with manufacturer fitting tools for each unique design. Make sure to ask about these tools at your next Optometry meeting or with that unique vendor. 

Utilize a Case to Develop Your Options

A 49-year-old male engineer presented for a contact lens exam and reported blurred vision at distance and at near (“loss of crispness”) with his current spherical, toric daily disposable lenses. He was a new patient who recently considered switching to full-time spectacle wear due to his dissatisfaction with the vision provided by his contact lenses. The patient’s refraction was OD: -1.00-1.00x175 D: 20/20 OS: -0.75-1.00x020 D: 20/20 with a +1.50 near add 20/20 OU.

This patient's astigmatism needed to be addressed because the uncorrected astigmatism resulted in an overall loss of sharpness everywhere and created a potential contact lens dropout. Additionally, his background as an engineer meant he was a critically observant patient, so spherical contact lenses of any modality were not an option. 

This patient was in daily disposable lenses and they remained a priority for him. He liked the convenience that daily lenses provided and prefered to stay in that modality. With this information established, he had a few options:

1. Refit with daily disposable soft toric lenses with a monovision enhancement. I am personally not a big fan of monovision due to the loss of binocularity, but it is a last-resort option.
2. Refit with daily disposable soft toric lenses with the addition of Vuity (pilocarpine HCI ophthalmic solution) 1.25%, the first and only eye drop approved for the treatment of presbyopia, instilled 10 minutes before contact lens use. Vuity has some limitations because it wears off during the day, but it may be a good option to consider for the workday.

I chose to start with option 2 while pushing the (+) spherical component as much as the patient could tolerate without any blur in the distance. This combination worked successfully and will buy us more years of successful contact lens wear.

Many of these types of patients are looking for someone to try a unique approach and take a little more time with them. Some may have considered giving up on contact lenses if they haven’t experienced the success they wanted or because of declining near vision, but if you can convert them, you will create your biggest advocate for your skills and the practice.