"The question is no longer whether to prescribe the lens, but which lens to prescribe" they authors of this review paper state. The majority of soft multifocal contact lens (MFCL) designs incorporate two or more power “zones” that continually cover the pupillary area, resulting in multiple images being superimposed on the retina. The patient’s brain suppresses or ignores the blurred images and chooses the one that is clearest for the visual task being undertaken. The term “simultaneous vision” is frequently used to describe MFCL designs; however, as these lenses do not rely on movement on the eye, as is the case with a corneal rigid alternating or translating design, the preferred terminology of “simultaneous image” designs is recommended. By increasing the depth of focus, the reduction of amplitude of accommodation that occurs with presbyopia can be counteracted; however, visual performance can be compromised, particularly in conditions of low lighting. MFCLs can be broadly classified as being spherical, concentric (or annular), or aspheric, and having more than two refractive powers, or a combination of these design features. Concentric MFCL designs usually incorporate a primary viewing zone in the center of the lens which may be of greater plus power (center-near) or less plus power (center-distance), surrounded by concentric rings of near, intermediate, or distance powers. These lens designs differ from soft bifocal lens designs, which only incorporate two distinct powers in different zones, one power for distance vision and one for near vision.

Little research has been done on the effect of astigmatism on myopia management therapies. This study quantified changes in peripheral refraction induced by toric orthokeratology (TOK) and soft toric multifocal (STM) contact lenses in adult subjects. Moderate-to-high astigmatic eyes were able to achieve refractive correction with both toric lens modalities. Empirical fitting was successful in 63% and 95% of eyes with TOK and STM, respectively. Empirical ordering of STM and TOK in myopic astigmatic patients led to higher initial success rates for STM. In patients fitted with both TOK and STM contact lenses, greater myopic defocus was induced by toric orthokeratology - more specifically, greater amounts of peripheral myopic defocus and J₀ astigmatism. For patients who have astigmatism requiring toric correction, STM may be more expedient to fit, but TOK may be more effective in slowing myopia progression, in theory. Larger longitudinal studies in children are needed to confirm this hypothesis.

A new myopia management book based pm the Montreal Experience is available. It covers all intervention methods, but it also digs into soft lens options. In particular, the book reinforces the fact that myopia management must be customized for each patient, as different optics may lead to different outcomes. The design of contact lenses must take into account the physiological parameters of the patient. There are two ways to increase the dose of myopic defocus on the retina using soft lenses. First, a larger area of myopic defocus causes a slowing of myopia progression, and second, it is possible to increase the signal strength by increasing the power of the addition. Both can potentially be applied in a controlled manner with custom-made soft lenses. Choroidal volume analysis is a new and promising means to evaluate the ocular response to any of these visual stimulations, according to the authors.