In the past, if you wore toric soft contacts for astigmatism, you had to make a decision if, sometime after age 40, you also began to have trouble reading due to presbyopia: Either start wearing reading glasses over your contacts or switch to bifocal rigid gas permeable lenses.
For many people, neither of these were desirable options.
First of all, having to wear and carry around reading glasses defeats the purpose of wearing contact lenses, which is to be less dependent on glasses. And though reading glasses can help your near vision after age-related presbyopia becomes apparent, readers blur your distance vision — so you have to keep putting them on (for reading) and taking them off (to see across the room).
For some people with astigmatism, switching to bifocal gas permeable (GP) lenses after age 40 can allow them to see well at all distances. But getting used to wearing GP lenses after comfortably wearing soft lenses can be a challenge, and some people simply can't adapt.
Also, to remain comfortable, GP lenses must be worn every day. This eliminates the convenience of a flexible wearing schedule that soft contacts offer for people who don't want to wear contact lenses all day, every day.
And while it's true that soft multifocal contact lenses have been available for many years, these lenses didn't correct astigmatism. But now that has changed.
New soft multifocal contacts that also correct astigmatism — called toric multifocal contact lenses — offer people with both astigmatism and presbyopia vision at all distances they desire, with the wearing comfort they've come to expect with single vision (non-presbyopic) toric soft contact lenses.
Bifocal contact lenses for astigmatism allow people over age 40 who have irregular corneas to see clearly at all distances and eliminate the need to wear reading glasses over contacts.
History: Bifocal vs multifocal
Today, bifocal contact lens designs only exist in GP lenses, while multifocals are available in both GP and soft contact lens designs. Both bifocal and multifocal designs have prescriptions for near and distant vision in the lenses. But in bifocals, these magnification powers are distinct, while in multifocals, there are different designs which allow for a smoother transition between the visual zones from distance to intermediate arm’s length to near.
Features of soft bifocal contacts for astigmatism
Several multifocal soft contact lenses for astigmatism are available in the United States. During your contact lens exam and fitting, your eye care practitioner will be able to determine whether you are a good candidate for them, and which brands could be appropriate choices for your particular needs.
To keep the astigmatism correction properly positioned in front of the eye, most of these lenses are designed with a stabilization system.
Some are fully customized to each wearer's prescription needs, while others come in a more limited range of distance and near powers, as well as astigmatism correction.
Generally, there are two types of designs for soft multifocal contacts for astigmatism. One type features a progressive power design, similar to the design of progressive eyeglass lenses. The other features concentric rings of different powers for different viewing distances.
In some concentric ring designs, the portion of the lens covering the center of the pupil has the power for near vision ("center-near" designs). In others, the central zone of the lens contains the power for distance vision ("center-distance" designs).
Materials used for soft multifocal contacts for astigmatism include conventional hydrogels and more highly breathable silicone hydrogels. Monthly and daily disposable lens replacement schedules are possible, depending on the lens brand, design and material.
Hybrid bifocal contacts for astigmatism
Another option worth considering if you have both astigmatism and presbyopia is multifocal hybrid contact lenses.
Hybrid contacts have a central optical zone made of GP plastic material, which is surrounded by a peripheral (non-optical) zone made of a soft contact lens material for easier adaptation. For some people, this offers greater wearing comfort than conventional GP lenses.
Cost of bifocal contacts for astigmatism
Because of the complexity of the design of astigmatism-correcting multifocal contacts and the time and expertise required to fit them, you may have to pay significantly more for them.
You still may need glasses (occasionally)
Multifocal contacts for astigmatism usually provide exceptional functional vision for daily activities. But for some tasks, you might see better and/or be more comfortable with readers over your contacts or with prescription eyeglasses rather than contact lenses.
For example, it's a good idea to have a pair of reading glasses handy to wear over toric multifocal contacts for reading very small print (such as that on medicine bottle labels) or for fine detail work, like threading a needle and hand sewing.
Also, for prolonged computer work and extensive reading, you might have greater clarity and comfort wearing glasses rather than contact lenses of any kind. This is because we tend to blink less frequently during these tasks, which may cause contact lenses to become dry. Your eye doctor can prescribe computer glasses that are specifically tailored to provide the sharpest vision and greatest comfort for your preferred working distance in front of your computer screen.
The quality of vision of specialty contact lenses such as multifocal contacts for astigmatism can be especially affected if the lenses dry out and don't move adequately or remain properly positioned on the eye for accurate astigmatism correction. Also, people over age 40 are generally more prone to dry eyes than younger adults.
If you are interested in multifocal soft contact or hybrid lenses for astigmatism, schedule a comprehensive eye examination with your eye doctor. They can help you determine which options might be appropriate to fit your visual needs.
