Managing presbyopia in patients with astigmatism has long been one of the more complex challenges in contact lens practice. While the desire for spectacle independence continues to grow, particularly among today’s aging yet highly active adults, the combination of presbyopia and astigmatism has historically forced clinicians to make compromises in vision quality or lens design.
Until recently, daily disposable options simply did not exist, leaving many patients in glasses, monovision, or dissatisfied with their contact lenses. The arrival of ACUVUE MAX Multifocal for Astigmatism, the first and currently the only daily disposable multifocal toric contact lens commercially available, has changed this conversation.
This new addition to our options for presbyopic patients with astigmatism allows us to offer a comfortable, easy-to-fit daily disposable lens that incorporates the latest technologies, including blue-light filtering. It provides clear vision and convenience, helping us better meet the needs of this patient group.
Presbyopia and astigmatism: A growing patient population
Presbyopia is a universal condition. By the early to mid-40s, virtually every patient will begin having trouble with near vision. Global estimates suggest that by 2030, more than 1.8 billion people will be presbyopic.1
At the same time, astigmatism remains highly prevalent, with many of these patients presenting with 0.75D or more.2 When these conditions overlap, as they do in up to a third of presbyopes,3 the visual demands become even more complex.
This overlap represents a significant and underserved demographic. Many of these patients are still working, raising families, and pursuing active lifestyles. Today’s “aging” adult is not slowing down—whether it’s keeping up with their children and grandchildren, biking, or even joining the fastest-growing recreational sport in the United States: pickleball.
These patients are motivated to remain spectacle independent, and yet, until recently, lens options for presbyopic astigmats were limited at best. Compounding this need, astigmatism itself tends to increase with age, meaning that many individuals who did not require a toric solution earlier in life will find that they do once they become presbyopic.3
Understanding why presbyopic patients drop out
The history of presbyopic contact lens wear is marked by high dropout rates. The reasons are consistent across studies and clinical experience.
The most prominent is inadequate vision, particularly when astigmatism is left uncorrected in a multifocal design. Visual compromise—whether at near, far, or intermediate—erodes patient confidence quickly, making glasses the “easier” or “safer” option.4
Comfort or dryness with contact lenses is another frequent culprit. As patients age, ocular surface disease and meibomian gland dysfunction become increasingly common, reducing tolerance for reusable lenses.5
Finally, fitting complexity has traditionally been a barrier. Without sufficient toric and multifocal parameter combinations, clinicians were often forced into monovision or spherical equivalent corrections, leaving patients dissatisfied.6 The end result was predictable—frustrated presbyopic astigmats returning to glasses or abandoning contact lenses altogether.7
The limitations of past options
Before the advent of daily disposable multifocal torics, practitioners relied on monthly replacement or custom lenses. While these designs were functional, they came with challenges.
From my clinical perspective, the older lens designs and stabilization approaches tended to slow down adaptation, making it harder for many of my patients to commit to long-term wear. And as reusable lenses, they often caused end-of-day discomfort—particularly problematic for older eyes already battling dryness.
For years, daily disposables have been regarded as the gold standard for comfort, ocular health, and convenience.8 Yet for presbyopic patients with astigmatism, this gold standard remained frustratingly out of reach.
Innovations in daily disposable multifocal toric technology
Recent years have seen remarkable advances in contact lens optics and materials. Stabilization designs have become more sophisticated, delivering consistent lens performance and minimizing rotational blur.
Multifocal optics have been refined to better balance vision at all distances, offering smoother transitions between near, intermediate, and distance tasks. Material improvements have also enhanced oxygen delivery and surface wettability, directly addressing comfort concerns.9,10
Design innovations that have changed the game include:
- BLINK STABILIZED design: This proprietary stabilization system maintains consistent lens orientation despite natural eye and head movements. By ensuring stable alignment, it supports crisp, reliable vision across all distances throughout the day.11
- PUPIL OPTIMIZED design: This advanced design customizes the optical profile to accommodate natural variations in pupil size that occur with age and refractive error. The result is balanced, predictable visual performance under diverse lighting conditions.12
- TearStable technology: Engineered to enhance end-of-day comfort, this moisture management system evenly distributes a wetting agent across the lens surface, helping sustain hydration and lens smoothness from morning to night.13
- Blue-violet light filtration: Certain modern lenses now integrate filters that significantly reduce blue-violet light transmission. This helps minimize glare and halos, providing clearer, more comfortable vision—particularly in environments with challenging or variable lighting.14
- Integrated astigmatism and multifocal correction: A breakthrough in contact lens design, this approach merges toric optics for astigmatism with multifocal optics for presbyopia into a single, daily disposable lens. It expands presbyopic options for astigmatic patients and simplifies the fitting process for practitioners.15
Who do these technologies benefit?
Until Johnson & Johnson Vision launched ACUVUE MAX Multifocal for Astigmatism in June of 2025 in the US and Canada, the market lacked a daily disposable multifocal toric option.
This portfolio was introduced to provide consistent material performance, advanced stabilization for clear and stable vision, and modern multifocal optics that support comfortable wear throughout the day for a broad range of patients.16
Using the innovations listed above, the ACUVUE MAX family addresses the full spectrum of patient needs across presbyopia and astigmatism including:16
- Presbyopes without astigmatism
- Presbyopic astigmats
- Astigmatic patients who are not yet presbyopic.
- Myopes and hyperopes seeking a daily disposable option
Prescribing pearls for success
Success with multifocal toric lenses begins with patient education. Setting the stage that these are new, cutting-edge lenses designed to eliminate past compromises helps build enthusiasm. Following manufacturer fitting guides is critical, as these designs are optimized for straightforward success when used as directed.
It is also important to be proactive, rather than reactive, and manage your patients' expectations. Patients should understand that lighting conditions, contrast sensitivity, and adaptation (neuroadaptation) play a role in visual experience. Optimizing the ocular surface before and during wear will further improve outcomes, as dry eye disease can undermine even the best-designed lenses.
That said, one of the most exciting advancements with MAX technology is its ability to expand candidacy. I have been able to successfully fit patients who historically could not tolerate contact lenses due to dryness, and now they can enjoy lens wear—even if it’s only on a part-time basis.
Finally, lifestyle should remain central to the conversation. Daily disposables align perfectly with today’s active adults who want clarity for reading a menu, driving at night, or winning their next pickleball match, all without the hassle of lens care.
Conclusion
The introduction of daily disposable multifocal toric lenses marks an important development in contact lens practice. Presbyopic patients with astigmatism can now benefit from the convenience and ocular health advantages of daily disposable wear, combined with designs that address both multifocal and astigmatic needs.
This advancement provides a valuable new option for a patient group that has historically had limited choices. As the presbyopic population grows, eyecare professionals who adopt these innovations will enhance patient satisfaction and broaden their practice reach.
For today’s active adults—at work, with family, or on the pickleball court—clear and convenient vision is now within easy reach.
