What’s new with multifocal toric lenses?

Combining multifocal and toric optics is a significant technological challenge.

(Image credit: ©Kitreel—stock.adobe.com)

In my boutique optometry practice in Gainesville, Georgia, I provide primary eye care, including specialty dry eye treatment. I’ve tried to develop the practice’s reputation as a place where patients know they will always have access to the latest spectacle, contact lens, and dry eye technology. That’s why I’m very enthusiastic that we are finally able to fill a major gap in our contact lens offerings with a new daily disposable multifocal toric lens, ACUVUE Oasys MAX 1-Day Multifocal for Astigmatism (Johnson & Johnson Vision, see Table 1 for parameters).

Until this lens became available, I had essentially given up on fitting multifocal toric lenses. The biggest issue was that none of the earlier generation lenses could satisfy all 3 of the astigmatic presbyope’s core requirements for comfort, crisp vision at all distances, in all lighting conditions, and stability. Most of the options available previously were custom-order lenses, and all of them were monthly replacement lenses. I am a big advocate of daily disposable lenses in general, because I find them to be the healthiest and most comfortable modality for my patients of all ages, and especially for the mature eye. To switch an existing daily disposable wearer to a monthly lens when they become presbyopic is really challenging from a comfort perspective. Patients don’t like to have to go back to cleaning lenses every day and they need to remember when it is time to change them, either, so often I just wouldn’t even suggest it in these cases.

When I did try to fit a patient in a multifocal toric lens, the process could be time-consuming, and the lenses would have to be ordered for the patient with multiple options. Patients would wait several weeks for the lenses to come in and then if we needed to tweak the add power or the refractive power—something that is not unusual when dealing with complex multifocal toric optics—it could be several more weeks for the replacement set of lenses to arrive. Lenses that have a diagnostic fitting set, including the ACUVUE Oasys MAX 1-Day Multifocal for Astigmatism and the Ultra Multifocal for Astigmatism (Bausch + Lomb), are much easier to integrate into the practice workflow because the lenses are on hand.

In addition, the new MAX Multifocal for Astigmatism has a number of technologies that make it a great option for patients. We know that senofilcon A material provides all-day comfort, especially when each lens is only used once. In the presbyopic age group, patients tend to struggle with end-of-day discomfort. They are at risk for dropout, so I really like to keep them in a daily disposable lens whenever possible. The lenses also filter out 60% of the short-wavelength, blue-violet light, the highest level blue light filter in the industry. This is the portion of the spectrum that causes the most light scatter, which leads to aberrations like halos and glare. Filtering some of that blue-violet light can be helpful for patients who are already struggling with fatigue from their declining accommodative system.

Crisp vision at all distances

Previously, I found that patients were often dissatisfied with their vision in multifocal toric lenses. Sometimes, they weren’t happy with vision at one particular distance (far, intermediate, or near), while in other cases, patients would complain their vision wasn’t crisp at any distance. Or that their vision would change with blinks. There is always the concern that a difficult contact lens experience may cause the patient to lose faith in the doctor entirely, so it often felt like it just wasn't worth the effort to fit this category of lenses if I didn’t have confidence that I could meet patients’ expectations of good vision.

As optometrists, we understand that combining multifocal and toric optics is a significant technological challenge. My preferred toric lenses share this new multifocal lens’s reliance on blink-stabilized design, with four stability zones to make use of the natural motion of the lids during blinking to restabilize the lens with each blink. The major advantage of such a design is that it is more resistant to gravity than ballasted, or weighted, designs. Ballasting approaches don’t matter as much when a lens wearer is looking straight ahead at a computer (or the eye chart). But for patients whose work or hobbies require them to tilt their head to the side, and even for those who just enjoy watching TV while lying on the couch, a weighted lens will rotate off-axis during those activities. With blink-stabilized design, I’m much more confident that the patient will have clear, stable vision regardless of their head position.

I also really like the pupil-optimization in the ACUVUE Oasys MAX 1-Day Multifocal for Astigmatism lenses. This design provides a slight change in the power profile for each combination of refraction and add power to optimize for the natural variation in pupil size with age and refractive error. Combined with the toricity features, it results in a very stable lens that is able to provide clear, crisp vision at all distances.

A few weeks ago, I fit a presbyopic woman in these lenses. Her daughter was about to get married, and the mom really didn’t want to wear reading glasses during the ceremony because she said they made her feel old. While the motivation may have been a one-time special event, she is now wearing the lenses full time and is out of readers most of the day, which she is thrilled about.

When I did a social media post on the new lenses, I was a little surprised to find that it generated several new patient visits, some from more than 20 miles away! These patients saw the post, thought the lenses could help them, and made an appointment, which I think speaks to the gap in the marketplace for a daily disposable toric multifocal.

Finally, being able to successfully fit more presbyopes with astigmatism is so important for our practices. Not only do these patients deserve comfortable, crisp vision just like everyone else, but 40- to 60-year-olds also represent an important demographic. They have influence over family members, coworkers and friends in their community. They find value and functionality in this lens and want to be able to wear it every day. Having more tools in our toolbox to ensure that we can deliver on those expectations is a great opportunity.

Brown is a practicing optometrist and founder of Key Optique in Gainesville, GA. She is a Professional Affairs Consultant for Johnson & Johnson. Contact her at keyleebrown@gmail.com.