Turning 40 often brings a new frustration: you can see the road just fine, but the text on your phone is getting blurry. If you also have astigmatism, you may assume contacts are off the table and that bifocal glasses or reading glasses over your contacts are your only choices.
That is not the case. Contact lens designs have come a long way, and many people with both astigmatism and age-related near vision changes wear contacts comfortably. Here is how these lenses work, what your options are, and what to expect if you want to try them.
The Short Answer
Yes, bifocal contacts for astigmatism exist. They are usually called toric multifocal (or toric bifocal) contact lenses, and they correct astigmatism and presbyopia in the same lens. They are available in soft and rigid gas permeable designs. Monovision, where one eye is set for distance and the other for near, is another option. A contact lens fitting with an eye doctor is the best way to find out which approach works for your eyes.
What Is Astigmatism?
Astigmatism happens when the cornea (the clear front of the eye) or the lens inside the eye is curved more in one direction than the other, a bit like a football instead of a basketball. Light focuses unevenly, so vision is blurred or distorted at all distances.
Common signs include:
- Blurry or stretched-looking vision, near and far
- Eye strain or headaches after reading, screen work or driving
- Squinting to see clearly
- Glare or halos around lights at night
Astigmatism is very common and is often present along with nearsightedness or farsightedness. It is corrected with glasses or with toric contact lenses, which have different powers in different directions and are designed to stay in the right orientation on the eye.
What Is Presbyopia?
Presbyopia is the gradual, age-related loss of the ability to focus up close. The lens inside your eye becomes less flexible over time and cannot change shape as easily to focus on near objects. Most people notice it in their 40s, when they start holding menus and phones farther away.
Presbyopia happens to everyone eventually, whether or not you have astigmatism. It is the reason people need bifocals, progressive lenses or reading glasses. Learn more in do I need reading glasses.
Astigmatism and presbyopia are different problems. Astigmatism is about the shape of the eye; presbyopia is about the lens losing flexibility. Many adults have both, and that is exactly who toric multifocal contacts are designed for.
What Are Bifocal and Multifocal Contact Lenses?
Bifocal and multifocal contacts put more than one prescription power in a single lens, so you can see at different distances without reading glasses.
- Bifocal contacts have two powers: one for distance and one for near.
- Multifocal contacts include a range of powers for distance, intermediate (such as a computer or dashboard) and near. Most modern soft lenses for presbyopia are multifocal designs.
Unlike bifocal glasses, where you look through the top or bottom of the lens, most soft multifocal contacts use simultaneous vision: the different powers are arranged in rings or zones, and your eyes receive all of them at once. Your brain learns to pay attention to whichever image is in focus. Some rigid gas permeable designs work differently, shifting slightly on the eye as you look down to read.
Are There Bifocal Contacts for Astigmatism?
Yes. Toric multifocal contact lenses combine the two technologies: a toric design to correct astigmatism and multifocal zones to help with near and intermediate vision.
Your options generally include:
- Soft toric multifocal lenses. Available from several manufacturers, often as monthly or other planned-replacement lenses. Choices depend on your exact prescription, and some strong or unusual prescriptions may need custom-made lenses.
- Rigid gas permeable (RGP) multifocal lenses. Because a rigid lens holds its own shape, it can mask much of the astigmatism coming from the cornea. RGP multifocals can give very crisp vision for some people, though they take longer to get used to.
- Specialty lenses. For high or irregular astigmatism, custom soft lenses or scleral lenses can sometimes be made with multifocal optics. See scleral lenses for keratoconus and dry eye.
Your eye doctor will recommend lens types based on your prescription, the shape of your cornea, your tear film and how you use your eyes day to day.
Monovision: An Alternative to Multifocal Contacts
Monovision is a different approach that some people prefer. One eye (usually your dominant eye) wears a lens for distance, and the other wears a lens for near. If you have astigmatism, toric lenses can be used in one or both eyes.
- Pros: each eye gets a single, clear prescription, and many people adapt well.
- Cons: depth perception can be slightly reduced, and some people find night driving or precise distance tasks less comfortable.
A related option, sometimes called modified monovision, uses a multifocal lens in one eye and a distance lens in the other. Your eye doctor can help you compare these approaches, often by letting you try them.
Contacts vs. Glasses for Astigmatism and Presbyopia
Both work well, and many people use both.
- Progressive or bifocal glasses correct astigmatism and presbyopia easily and need little maintenance. See what are progressive lenses.
- Toric multifocal contacts give a wider, natural field of view, do not fog up and suit active lifestyles, but they require daily care and good hygiene.
Many contact lens wearers keep a current pair of glasses for evenings, long screen days, or when their eyes need a rest.
What to Expect at a Fitting
A contact lens prescription is different from a glasses prescription, and multifocal lenses in particular need a careful fitting. A typical process includes:
- An eye exam and measurements of your prescription, corneal curvature and pupil size.
- A look at your tear film and eye health to make sure your eyes can support lens wear.
- A conversation about your daily vision needs, such as driving, computer work, reading or hobbies.
- Trial lenses, often worn for several days at home and work.
- Follow-up visits to fine-tune the power or switch designs if needed.
Expect an adjustment period. Multifocal vision can feel slightly soft at first while your brain adapts, and it is common to need one or more lens changes before settling on the right combination. Patience during this phase usually pays off.
Who May Not Be a Good Candidate?
Toric multifocal contacts are a good fit for many people, but they are not ideal for everyone. They may be harder to wear successfully if you:
- Have significant dry eye that is not well controlled
- Have very high or irregular astigmatism (specialty lenses may still be an option)
- Need extremely sharp vision at one specific distance for work, such as certain detailed or night-time tasks
- Are bothered by any reduction in contrast or night-time halos
- Find it hard to keep up with lens cleaning and replacement schedules
- Have certain eye diseases or past eye surgery that affect the cornea
If your eyes are dry, treating dry eye first often makes contact lens wear more comfortable. Not sure contacts are right for you at all? Read deciding if contacts are right for you.
Get Fitted for Contacts in East Tennessee
Tennessee Eye Care fits toric and multifocal contact lenses, including specialty lenses, as part of our contact lens services at clinics in Harriman, Knoxville, Lenoir City, Morristown and Powell. To see whether bifocal contacts for astigmatism could work for you, choose a location and schedule a contact lens fitting.