Avoiding Reading Glasses in Contact Lens Wearers with Astigmatism

Presbyopia is a natural process that typically occurs in the 40’s and reduces ones ability to read when vision is corrected for distance.  This problem is a frustrating one, especially for those who enjoy contact lenses.  When contacts are used to correct far away vision in someone who is presbyopic, additional options are needed to allow comfortable reading.  Over-the-counter reading glasses and mono vision are two options that offer both advantages and compromise.  Multifocal contacts continue to improve in viability but typical “one-size-fits-all” lenses don’t offer options for patients with astigmatism. It is important to remember that, unlike bifocal or progressive glasses where distance and near vision can be put in different parts of the lens, contact lenses are stable on the eye and all powers must be contained in a small pupil-sized region, making the task of crisp vision at all distances much more difficult.  Here we will discuss options for patients with astigmatism who need distance and near correction and desire binocular vision free from reading glasses:
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• B&L ultra multifocal toric

This new offering from Bausch and Lomb offers the ability to correct astigmatism and incorporate multifocal optics into a one-size-fits-all monthly disposable lens.  These lenses offer great comfort and vision but have certain “canned” parameters, meaning they cannot accommodate complex prescriptions and parameters cannot be adjusted on fit or optics zone sizes.  They are a great starting point for patients who fall within the set parameter ranges.  For those who have prescriptions or corneal dimensions outside these parameters, or for those who cannot achieve appropriate vision, a custom lens option is the next step.  It is also important to remember that soft lenses for astigmatism must be stabilized to keep the optical correction in proper orientation for good vision, and any lens rotation can result in blurry vision.

• Custom rigid, scleral and hybrid multifocal lenses

The beauty of rigid lenses (gas permeable, scleral and hybrid lenses) is that they “mask” most astigmatism, meaning you don’t have to correct it optically and that lens rotation is a non-issue.  Also, rigid lenses not only offer far superior optics to soft lenses, they are actually more optically pure than the natural corneal surface, meaning that they give the absolute best vision possible, even superior to refractive surgery in many cases.  These lenses are fit to each patient and can be specifically customized to maximize both comfort and vision as they are tailored specifically for your eye.  Originally, only corneal gas permeable lenses occupied this category.  These lenses had significant “awareness” and required adaptation to achieve all day wear.  New options like scleral and hybrid lenses offer comfort that is often superior to soft disposables but with all of the optical benefits of custom rigid lenses.

Custom soft multifocal toric lenses
Unlike one-size-fits all soft contact lenses, custom soft lenses are made based on a patients corneal parameters including diameter, curvature and eccentricity (rate of flattening).  Not only is the fit customized to improve comfort, the optics are also made to specifically match the patients prescription.  These lenses are made-to-order and therefore all specifications are customizable, even the material the lens is made from.