What Are the Options Now?
The onset of presbyopia can pose a challenge to practitioners when attempting to satisfy the visual needs of contact lens wearers, particularly those who require astigmatic correction as well.
By
Jessica Conroy, OD
DANIEL DELIGIO, OD
May 1, 2025
Clinical Scorecard: What Are the Options Now?
At a Glance
Category Detail
Condition Astigmatism and Presbyopia Key Mechanisms Advancements in contact lens technology for astigmatic and presbyopic correction. Target Population Adults aged 45 years and older, particularly those with astigmatism. Care Setting Eyecare practices and optical retail settings.
Key Highlights
42% of the US population is 45 years or older, increasing presbyopia prevalence. 16.7% of adults in the US wear contact lenses for vision correction. Silicone hydrogel lenses dominate the contact lens market with 64% share. Nearly 50% of contact lens wearers have astigmatism >0.75 D. Monovision is a viable option for astigmatic presbyopes. Guideline-Based Recommendations
Diagnosis
Assess refractive error and categorize astigmatism type (WTR, ATR, oblique). Determine corneal vs. refractive astigmatism. Management
Use toric lenses for patients with ≥0.75 D of astigmatism. Consider monovision for presbyopic patients to avoid reading glasses. Monitoring & Follow-up
Evaluate patient adaptation to monovision and adjust prescription as needed. Monitor for symptoms such as glare and stereopsis loss. Risks
Potential disorientation and longer adaptation time with monovision. Increased glare complaints, especially at night. Patient & Prescribing Data
Adults with presbyopia and astigmatism, particularly those over 45.
Soft toric lenses or toric GP lenses are preferred for patients with significant astigmatism.
Clinical Best Practices
Consider patient lifestyle and visual demands when prescribing lenses. Educate patients on the adaptation process for monovision. Regularly reassess visual acuity and comfort with contact lenses. References
