Your patient with astigmatism sits in your exam chair already half-convinced contact lenses won’t work for them anymore.
They’ve worn them before—successfully, even. But after 40, everything changed. Reading became a struggle. Screens became exhausting. And the last time they tried multifocal contact lenses, they were left frustrated by blurry vision at both distance and near.
They don’t want to wear readers over contact lenses. They don’t want monovision as this made them dizzy and nauseous. And they’re hesitant to invest in another multifocal contact lens that may not deliver.
And they’re not alone.
What happens when nearly half of your presbyopic patients aren’t receiving their full correction? There has been a long-standing gap in the availability of multifocal toric contact lens options, with about 46% of presbyopic contact lens wearers being fitted with a “non-presbyopic fit”.2 For years, clinicians have been forced to compromise—working around gaps in available lenses rather than truly solving the problem.
But that’s changing.
Rather than compromising, clinicians can now reach for their toolbox and choose TOTAL30® Multifocal for Astigmatism, which helps astigmatic patients stay comfortably1* in contact lenses and provides the vision1 patients have come to expect from TOTAL30® lenses.
*Rated after at least 12 hours of wear, measured at day 30.
Meeting Patients Where They Are: The Case for a Reusable Multifocal Toric
Alcon offers an array of contact lenses across all modalities, ranging from daily to monthly, that use the same WaterInnovations™ technology (Figure 1). This shared technology provides a consistent fitting approach for practitioners and a visual experience for patients across the portfolio.
Multifocal contact lenses are generally preferred over spectacles for many professions and active lifestyles, particularly in roles that require clear distance and near vision, as well as in nearly all sports. Proper correction can enhance quality of life (QoL) as patients increasingly work later in life in visually complex, demanding environments, largely due to the rise in digital device use.2
Multifocal toric contact lenses are a good option for correcting presbyopia and astigmatism, providing optimal visual quality for distance and near vision without compromising stereopsis.2
This underscores the importance of innovation in this field, which TOTAL30® Multifocal for Astigmatism delivers as a modern monthly lens solution. By introducing a monthly multifocal toric lens, Alcon is meeting patients where they are today—providing an option that aligns with the preferences of existing reusable toric wearers while addressing their evolving visual needs over time.
In addition, the TOTAL30® portfolio corrects myopia, hyperopia, astigmatism, and presbyopia, allowing patients to stay within the same lens portfolio even as their visual needs evolve.
Alcon offers an array of contact lenses across all modalities, ranging from daily to monthly, that use the same WaterInnovations™ technology (Figure 1). This shared technology provides a consistent fitting approach for practitioners and a visual experience for patients across the portfolio.
*Refers to lens replacement schedule. **Based on in vitro measurements of unworn lenses. †Based on the mean subjective ratings on a scale of 1 (Poor) to 10 (Excellent) for overall vision, overall comfort, and overall handling in subjects wearing PRECISION1® contact lenses from a clinical study, measured at 3-month follow-up visit; n=69
Figure 1. WaterInnovations technology across Alcon’s portfolio
Although daily disposable lenses are often seen as the best option for patients, many toric lens wearers already use monthly lenses, making it difficult to switch them to daily disposables, as cost can be a significant factor in their choice.
Case Highlight: Transitioning from TOTAL30® for Astigmatism to TOTAL30® Multifocal for Astigmatism
Dr. Lagunas recalls a patient who was wearing TOTAL30® for astigmatism contact lenses. The patient's near-vision needs had been changing rapidly, so transitioning to TOTAL30® Multifocal for Astigmatism was an excellent choice for her. It allowed her to transition to a multifocal lens that maintained outstanding distance visual acuity (DVA) while also providing the near vision she required.
The Clinical Challenge—and the Opportunity
One pressing question is, "Why have presbyopic astigmatic patients been difficult to fit historically?" To answer this, we must analyze both the patient's and the clinician's perspectives.
Clinician
Practitioners may face challenges balancing comfort and clear vision across a range of distances when correcting presbyopia with multifocal contact lenses. Some clinicians may be hesitant to prescribe multifocal lenses due to concerns about the fitting process, and they may view the perceptual trade-offs associated with these lenses as significant, worrying that patients might struggle to adapt during the trial period. These factors lead to decreased confidence among prescribing practitioners.2
Despite nearly 47% having astigmatism in at least one eye, few suitable options exist for these patients. Clinicians have attempted to address this issue by fitting patients with monovision and spherical equivalent multifocal contact lenses.5
Patients
Patients often make decisions based on their past experiences with contact lenses. If they have previously stopped wearing contact lenses due to discomfort, dry eye, or poor visual performance, they are generally less inclined to try contact lenses again. In some cases, inadequate patient education about lens options contributes to these concerns.6
Practice Benefits
There is now an opportunity to offer a solution specifically designed for patients with presbyopia and astigmatism. Reusable multifocal contact lenses allow individuals who typically use distance-correcting lenses to transition smoothly to multifocal options, while maintaining the same replacement schedule and material. Since patients are staying in the Total 30 family, they can continue to experience the comfort of water gradient technology.2,7,8
Proactively recommending contact lenses to non-wearers and discussing upgrades with current wearers can significantly enhance patient satisfaction and retention. According to a study by Naroo et al. (2022), 63.7% of participants indicated that practitioners influenced their decision to wear contact lenses.6 This suggests that TOTAL30® Multifocal for Astigmatism enables eye care professionals (ECPs) to offer an affordable lens option that provides comfort, clear vision at both near and far distances, and supports the growth of their practice.
Designed for Confidence: An Easy9, Predictable Fit10,11
The PRECISION PROFILE design of TOTAL30 Multifocal contact lenses has been shown to give predictable fits, with 96% or better fit success with two lenses or less* using the latest fitting process.
*At the initial fitting visit
Alcon’s TOTAL30® Multifocal for Astigmatism is designed to be easy to fit.9 This design offers a wide parameter range readily available, including 6,642 SKUs that cover ~90% of presbyopes.12 Additionally, ECPs rated the ease of fit at 9/10, with 97% of eyes successfully fitted on the first attempt.9†
†Based on lens movement, centration, and orientation at initial fitting.
Wearers rated TOTAL30® Multifocal for Astigmatism 8 out of 10 for end-of-day comfort after at least 12 hours of wear, even on Day 30. The TOTAL30® Multifocal for Astigmatism design features PRECISION PROFILE®, PRECISION BALANCE 8|4®, along with CELLIGENT and Water Gradient technologies, offering an exceptional wearing experience.
Case Highlight: Transitioning an existing multifocal wearer to TOTAL30® Multifocal for Astigmatism
Dr. Lagunas recalls a patient who experienced dryness and blurred distance vision while wearing their current contact lenses. To enhance the patient's distance vision and comfort, he switched them to TOTAL30® Multifocal for Astigmatism. The patient immediately noticed a significant improvement in comfort compared to the previous contact lenses, as well as better distance vision. The first trial fit was good, and the patient ordered a year's supply of the new lenses.
PRECISION PROFILE® DESIGN
This is the number one multifocal lens design in the US.13 The smooth transition of power gradients ensures clear and seamless vision at all distances, from near to far (Figure 2).9
Figure 2. PRECISION PROFILE DESIGN®
PRECISION BALANCE 8|4®
This provides the stability that individuals with astigmatism need for consistent and stable vision. It settles quickly on the eye within 3° of ideal orientation‡ and < 5° of oscillation with a blink (Figure 3).9
Figure 3. PRECISION BALANCE 8|4®
CELLIGENT® Technology
A biomimetic surface helps resist bacterial growth and lipid deposits,§|¶ ensuring the lens lasts for a full 30 days (Figure 3).14-18
§CELLIGENT Technology combines a biomimetic surface and a unique lens chemistry to help resist bacteria and lipid deposits
¶Based on in vitro studies on unworn lenses.
Figure 4. CELLIGENT® Technology
Water Gradient Technology
The water gradient material provides three times greater surface lubricity and a lens surface at least five times softer.19-20#|| The surface is almost entirely water, ensuring that only a thin layer of moisture reaches the eye (Figure 4).21-22**
#Based on critical coefficient of friction as measured by nano-tribometer (“worn” lenses were worn on-eye for a full wearing schedule: 14 days for ACUVUE OASYS^, 30 days for Biofinity^, ACUVUE VITA^, Bausch+Lomb ULTRA^); p<0.05
||Based on surface modulus measured with AFM nanoindentation (“worn” lenses were worn on-eye for a full wearing schedule: 14 days for ACUVUE OASYS^, 30 days for Biofinity^, ACUVUE VITA^, Bausch+Lomb ULTRA^); p<0.05
**Based on in vitro measurements of unworn lenses.
Figure 5. Water Gradient Technology
How to Fit TOTAL30® Multifocal for Astigmatism: A Practical Step-by-Step Guide
The good news is that fitting this lens is very similar to fitting other Alcon multifocal lenses, with the added step of incorporating astigmatic correction.
Step 1: Identifying the Right Patient
Patient education is crucial when fitting someone with multifocal lenses. The ideal candidate for the TOTAL30® Multifocal for Astigmatism is any patient who has clear expectations about their vision after the fitting. It’s ideal for any patient who wants good comfort,23-26 and vision at all distances.4,27
It's important to recognize that some patients may have had negative experiences with previous fittings, which could influence their expectations. Additionally, some patients may desire perfect vision at all distances, so it is crucial to set realistic expectations before the fitting.
Step 2: Selecting the Initial Lens
It is important to follow the fitting guide for these lenses carefully.
Begin with an updated, most plus vertex-corrected manifest refraction and then add +0.25 D to the sphere power. When selecting the cylinder power, round down if the patient is between values and round the axis to the nearest 10°. If the patient has more than -2.00 D of cylinder, it is advisable to use the MyAlcon Fitting Hub app or rely on clinical judgment.
For the patient's ADD, determine the lowest acceptable ADD for functional vision, and then select the ADD power using the provided chart, as shown in Table 1 or the MyAlcon Fitting Hub.
Table 1. ADD Selection for TOTAL30® Multifocal for Astigmatism
To determine the lowest acceptable ADD, follow the following steps:
- Place the patient in the refractor with a near card at 16 inches (40 cm)
- Ask the patient to focus on the second line from the bottom, even if it is blurry
- Slowly add plus power until they can read it clearly
The first plus power at which they can read the line is the lowest acceptable add.
An example of this process is shown in Figure 5.
Figure 5. Example of Patient Lens Selection
Allow the lenses to settle for 5-10 minutes outside the exam room before assessing visual performance.
Step 3: Assessing Fit and Vision
Check the lens for proper centration and orientation. If the axis rotation exceeds 5°, consider adjusting the axis.
With both eyes open, use hand-held lenses for each eye and add +0.25 D incrementally until the patient reports a decline in distance vision. Confirm the over-refraction by having the patient look at both distance and near objects through the lenses.
When adjusting the distance vision, keep the ADD the same and apply new trial lenses based on the over-refraction results.
If vision is good, dispense the lenses and schedule a follow-up appointment for the patient in one week.
When adjusting the distance vision, keep the ADD the same and apply new trial lenses based on the over-refraction results.
If vision is good, dispense the lenses and schedule a follow-up appointment for the patient in one week.
Step 4: Making Adjustments When Needed
Patient education is crucial at every step of the fitting process.
What This Means for Our Practices and Patients
If you are just starting out fitting these lenses, a great candidate is someone who already wears reusable toric wearers and is beginning to show signs of presbyopia.
When reintroducing contact lenses to patients who have had unsuccessful experiences with multifocal toric lenses, Dr. Cifuentes follows a simple approach: she first listens to the patient to understand the specific issues they faced. The strategy includes discussing new contact lens technologies and innovations, as well as setting clear expectations and defining the patient's visual goals before trying a new lens. By aligning with these expectations and goals, Dr. Cifuentes helps to create a successful framework for navigating the new contact lens journey.
For many patients, a reusable lens is more financially manageable, so TOTAL30® Multifocal for Astigmatism encourages them to choose contact lenses when they might not have otherwise. This not only builds patient loyalty and trust by addressing the big elephant in the room—cost—but also helps grow your practice. This is one of the tools in your toolbox and can be the first contact lens you reach for when fitting presbyopic astigmatic patients.
Cases
This case guides readers through selecting and adjusting the initial lens.
Case 1: Dr. Lagunas
A 41-year-old male presented for a contact lens evaluation. He had previously worn only glasses and underwent bilateral LASIK in 2005.
Unaided Visual Acuity (OU)
Distance: 20/40+
Near: 20/40++
Refraction
OD: +2.00 -1.25 × 165
OS: +2.50 -0.75 × 010
ADD: +1.75
Contact Lens Fitting
Initial Trial:
OD: +2.25 -1.25 × 170 LOW
OS: +2.75 -0.75 × 010 LOW
OU VA: Distance 20/40-, Near 20/40+
The patient reported blurry vision with the initial trial lenses, primarily affecting near vision, and his trial lens parameters were adjusted.
Finalized Prescription
OD: +3.50 -1.25 × 180 LOW
OS: +4.00 -0.75 × 180 LOW
OU VA: Distance 20/30-, Near 20/30
After adjusting the prescription, the patient experienced a significant improvement in both distance and near vision. The patient opted to use Total30 Multifocal Toric lenses exclusively and did not trial alternative brands. He purchased a one-year supply and reported excellent comfort and visual quality. The patient expressed a strong preference to remain spectacle-free following his prior LASIK surgery.
Case 2: Dr. Cifuentes
A 46-year-old woman presented with blurred vision at both distance and near, even without corrective lenses. She indicated that she does not regularly use glasses. Currently, she wears toric contact lenses for distance and relies on over-the-counter reading glasses. She expressed growing frustration with near tasks and difficulty with visual transitions throughout the day.
Unaided Visual Acuity (OU)
Distance: 20/200, Pinhole: improved to 20/40
Near: 20/30
Refraction
OD: -2.25 -1.75 x 150
OS: -2.00 -2.00 x 030
ADD: +1.25
Contact Lens Fitting
Initial Trial:
OD: -2.00 -1.75 x 150 LOW
OS: -1.75 -1.75 x 030 LOW
OU VA: Distance 20/20, Near 20/30
Finalized Prescription
OD: -2.00 -1.75 x 150 LOW
OS: -1.50 -1.75 x 030 LOW
OU VA: Distance 20/20, Near 20/20
This patient presented with a classic yet difficult scenario: a desire for a single, all-day visual solution that required a toric correction and no dependence on readers or contact lenses. Most notably, the patient’s immediate subjective response was “It’s a miracle!” This reaction underscores not only the visual improvement but the emotional impact of restoring seamless vision in patients who have struggled with multifocal and toric limitations.
Key Takeaways
Clinicians have historically struggled to fit presbyopic astigmatic patients for various reasons, but understanding their needs and advances in lens technology can enhance patient satisfaction and visual performance. TOTAL30® Multifocal for Astigmatism contact lenses were specifically designed to help patients with astigmatism comfortably1* continue using contact lenses, even as their vision requirements evolve.
*Rated after at least 12 hours of wear, measured at day 30
See product instructions for complete wear, care and safety information. ℞
©2026 Alcon Inc. US-TMA-2600023
