PURPOSE No prospective double-masked study has evaluated whether low astigmatism benefits or harms patients with presbyopia, whose intermediate and near vision might theoretically benefit from enhanced depth of focus provided by astigmatism. The purpose of the first Myopic Astigmatism and Presbyopia (MAP I) study was to determine whether low myopic astigmatism enhances or harms the visual acuity, stereopsis, or quality of life in patients with presbyopia. DESIGN Prospective, randomized, double-masked, crossover design clinical trial. METHODS Fifteen patients with presbyopia aged 45 to 68 years were recruited from an academic center population. These patients were given a baseline eye examination, including manifest refraction, Early Treatment of Diabetic Retinopathy Study (ETDRS) logarithm of minimal angle of resolution (logMAR) visual acuity at distance, intermediate, and near, accommodative amplitudes, and stereo vision. Each patient was then cycled in random order through three masked pairs of soft contact lenses. The power of each contact lens pair was calculated by the subtraction method to maintain a spherical equivalent of -0.5 diopters, while providing either no astigmatism (spherical arm, SPH), 1 diopter of with-the-rule (WTR) astigmatism, or 1 diopter of against-the-rule (ATR) astigmatism. Actual refractive errors produced were measured by masked examiner. Outcomes measured at the end of 1 week of usage of each contact lens arm were binocular (ETDRS) logMAR visual acuity at three distances (far [4 m], intermediate [1 m], and near [33cm]); near stereoacuity, using the quantitative Titmus Stereotest; and quality of life, measured using the Refractive Status and Vision Profile (RSVP), a standardized questionnaire. RESULTS Visual acuity results across the three arms were similar. However, 1-m logMAR visual acuity was better for the spherical arm than either astigmatic arm (-0.06 SPH, +0.01 WTR, +0.02 ATR). Near (33 cm) and distance (4 m) acuities were similar across arms. Stereoacuity was better in ATR than WTR (50 vs 102 seconds, P =.01). Subjects preferred SPH slightly over the WTR astigmatic arm by the RSVP quality-of-life survey instrument (101 vs 104, P =.05). Other intergroup comparisons showed no difference in RSVP scores. CONCLUSIONS This study has demonstrated that intermediate distance acuity and refractive quality of life are slightly better with spherical low myopic refractive error vs either astigmatic arm. Near and far distance acuity were unaffected by low myopic astigmatism compared with spherical low myopia. Near stereopsis was best in the ATR arms, but this did not produce better near visual acuity or RSVP quality of life.