Previously, I wrote about the topic of orthokeratology myopia management for astigmatic patients. A few have responded that they refuse to fit orthokeratology because they only fit soft multifocal on patients. But I suggest giving orthokeratology a try. It is rewarding and has some advantages for younger patients.
I’m not saying that I do not fit soft multifocal for myopia management. In fact, I have selected a daily disposable as my preferred soft multifocal for this purpose. The main drawback, however, is that it does not correct astigmatism.
In these instances, I will discuss with patients and parents up front that the main reason why we are using the lenses is not for vision correction, but rather for myopia management. I will also share that the child will need to wear over-glasses in instances for which he or she wants crisper vision (e.g., school, video games, go-cart racing, etc.).
In my experience, as soon as we take the focus off of the management of myopia progression, many patients and parents tend to base the success of the lenses solely upon the quality of vision.
When we need to focus on the vision for these children, we will utilize either one of the commercially available toric multifocal lenses that has a distance-center design, or we will order a custom design from a soft lens manufacturer. There are certain advantages to each option, but with children, we usually try to use lenses that have the shortest life span.
Don’t let astigmatism stop you from practicing myopia management on a child. If you choose to go the soft multifocal direction, consider using over-spectacles for additional correction. Or, you can choose from one of the stellar soft toric multifocals that are available on the market.
