Presbyopia and astigmatism: a special case

Why it is a special case

Astigmatism means the cornea is not perfectly spherical and the image is distorted at all distances. Presbyopia, meanwhile, limits near focus. When both conditions coincide, the lens must correct two things at once: the toric prescription (cylinder and axis) and the different powers for distance and near.

For years, this combination was one of the great limits of multifocal contact lenses. Today there are specific designs that solve both corrections in a single lens.

What toric multifocal contact lenses are

A toric multifocal contact lens combines an astigmatism correction with a multifocal design. To work, it must remain stable on the eye in a specific orientation, because the cylinder only corrects if it is aligned with the axis of the astigmatism.

Current designs use stabilisation systems that keep the lens oriented blink after blink. Even so, achieving that stability is the most delicate part of the fitting.

How the fitting works

It is a more technical fitting than a standard multifocal lens and may require more follow-up visits. The professional's experience and the quality of the tear film notably influence the result.

• Precise measurement of the astigmatism (cylinder and axis) and the near addition.
• Assessment of the cornea, tear film and eyelids, key factors for lens stability.
• Trial with toric multifocal lenses and control of the orientation on the eye.
• Fine adjustments of power or axis until vision is stable.

Realistic expectations

Many wearers with both conditions achieve very good functional vision with toric multifocal contact lenses, but it is worth being realistic: the result may not match the sharpness of glasses in every situation, and not all degrees of astigmatism have a solution with every design.

When the astigmatism is high or the cornea is irregular, other specialised options can be considered. An assessment in Barcelona will tell you exactly where your case stands.