Options for the presbyopic astigmat
Soft multifocal toric lenses are lenses that have it all.
Coopervision offers Proclear Toric Multifocal lens in two base curves.
Many gas permeable labs have monthly to conventional soft multifocal toric lens options. These lenses are great for patients who have high prescriptions and need all prescription parameters to be included in their vision correction.
If a patient has astigmatism in only one eye, you can fit a multifocal toric lens in that eye and a spherical multifocal in the spherical eye. Both eyes will still have a multifocal lens option providing a full range of vision from both eyes. In this case, I try to keep the modality of both lenses the same for patient compliance and ease.
Modified monovision is fitting a multifocal contact lens in one eye and a toric lens in the other. The dominant eye typically carries the astigmatism, so fit the dominant eye with the toric lens. The non-dominant eye has little to no astigmatism, which can be masked with a spherical multifocal lens. The non-dominant eye will provide the near correction to the visual system while providing some intermediate and distance help.
This type of fit may be used if both eyes have astigmatism, but the dominant eye is unable to adapt to a multifocal lens. This option may also be chosen if a patient is interested in a modality such as a two-week or daily replacement schedule which is not available in a multifocal toric lens.
Monovision can be an option when the patient does not successfully adapt to multifocal contact lenses. The dominant eye is fit with a toric or spherical lens set for distance, and the non-dominant eye is fit with a toric or spherical lens set for near. If a patient has astigmatism in both eyes and wants a biweekly or daily disposable lens, this may be the only option. Difficulties that may arise with monovision include depth perception, night driving, and a lack of intermediate vision.