Experts weigh in: What do you wish ODs knew about fitting torics?

October 6, 2017

Article

Our previous story on toric fitting tips went over so well, we decided to bring you more! This time, we asked experts what they wish their colleagues knew about fitting toric contact lenses.

Our previous story on toric fitting tips went over so well, we decided to bring you more!

This time, we asked experts what they wish their colleagues knew about fitting toric contact lenses.

Take a look at what they wish you knew. Did you already know?

Crystal Brimer, OD, FAAO

Wilmington, NC

Optometry Times Editorial Advisory Board member

Fitting toric contact lenses is very similar to fitting multifocal contact lenses.

• Often, these contact lenses will be a compromise from glasses.

• Set expectations. It makes life so much easier.

• Treat the underlying ocular surface disease problems! If the patient is dry, there will likely be more compromise with torics than in a spherical lens. As the lens dries, it may cause additional lid influence and secondary rotation.

• Consider the influence of material, not just the Rx, when fitting torics. In some cases with small amounts of astigmatism, the patient may be more successful with a better material or modality, even if it only masks the cylinder. The same is true in cases where the cylinder maxes out at 2.75 D. Always consider the material options as much as the Rx parameters in cases where the patient has underlying concerns.

• Daily disposables will typically provide more consistent vision by nearly eliminating the influence of build-up and its impact on lens rotation.

Renee Reeder, OD, FAAO

Chicago

• Masking does not work. Patients with increasing astigmatism also have increasing higher order aberrations. Therefore, fully correcting their astigmatism is critical to improving their vision. This also improves their intermediate digital tasks as well as reading, which is crucial in this day and age and in particular for young patients.

• Gas permeable torics can be ordered empirically with excellent success. Young people adapt very quickly and even adults who may have struggled with vision with soft lenses accept them for the improved clarity.

• New soft designs have improved stability as they have spread the stabilization across two to four zones. Therefore, there is less fluctuation in visual acuity associated with the latest designs. These too can be ordered empirically, saving chair time.

Kris May, OD

Memphis, TN

• I wish we would stop punishing our patients for wanting better vision. Do you charge more for a toric fit and wonder why your patients keep saying they are “fine” in their spherical lenses. Do you really want to drive on the same roads at night as someone with a diopter of uncorrected against-the-rule cylinder? We simplified our fit fee schedule and found that when we removed the financial factor, we had more successful patients.

• I wish we would stop complaining about what we don’t have and start being amazed at what we do have. No, I do not have an oblique axis toric multifocal in opaque purple-but I do have unbelievable power ranges and replacement modality choices. I hereby solemnly swear I will stop complaining to my reps about an Rx that only one patient on the planet needs.

• I wish we would never say, “If it ain’t broke, don’t fix it” ever again.

Newer technology, even if in the same modality, deserves to go on patients’ eyes.

Patients tell us over and over that they want to experience new technology, and then we leave them in the lens they have been in for years because they read 20/20 on entry. And we wonder why patients no longer value our fits and want to order generic contact lenses online.

Given the advances in aspheric optics and design, the same power in a new lens design and material could be a completely different experience for the patient. And even if it is not, you prove you have the latest in lens technology and you have your patients’ best interests in mind.

Tom Quinn, OD, FAAO

Athens, OH

• Science has demonstrated that not correcting as low as 0.75 D of astigmatism leads to meaningful visual compromise, especially under mesopic lighting conditions.

• Science has demonstrated that masking astigmatism with spherical soft lenses doesn't work.

• Science, and clinical experience, has demonstrated that toric fitting success with low astigmats is very high (97 percent), with 91 percent successful with the first lens applied¹ and takes only about one minute longer than fitting a spherical lens.²

We are vision care specialists. Let's provide that astigmatic correction!

References

1. Bayer S, Young G. Fitting low astigmats with toric soft contact lenses: what are the benefits and how easily it is achieved? Poster presented at Academy of Optometry annual meeting, December 8-11, 2005, San Diego.

2. Cox SM, Berntsen DA, Bickle KM, Mathew JH, Powell DR, Little BK, Lorenz KO, Nichols JJ. Efficacy of Toric Contact Lenses in Fitting and Patient-Reported Outcomes in Contact Lens Wearers. Eye Contact Lens. 2017 Sep 21. doi: 10.1097/ICL.0000000000000418.

David I. Geffen, OD, FAAO

San Diego

Optometry Times Editorial Advisory Board member

• If a lens rotates 10 degrees you lose 30 percent of the astigmatic power. So, it is important to take rotation into account.

• Correcting low amounts of cylinder, even 0.50 D, can add quality to a patient’s life.

• Torics are not more difficult to fit, so stop making astigmatism!

Brian Chou, OD, FAAO

San Diego

• Although extended range soft toric contact lenses exist for high astigmats, these patients will often enjoy better vision with rigid contact lens optics, including hybrid and scleral lenses.

• For presbyopic soft contact lens wearers with symptomatic uncorrected astigmatism, it’s always a good idea to demonstrate how correcting astigmatism can improve distance vision but at the expense of near vision.

• Front surface toric scleral contact lenses perform surprisingly well at addressing residual astigmatism with good wearing comfort and lens stability.

Charissa Young, OD

Seattle

• For patients requiring precision vision not satisfied with soft toric lenses, remember your corneal gas permeable options.

• Scleral lenses are an option for healthy corneas too, including regular astigmats.

• Patients who have previously dropped out of toric lenses may be more successful candidates today with the range of newer designs. Convert your dropouts to happy contact lens wearers again.