Prescribing toric contact lenses
Astigmatism is not a disease. Many of our patients have been told they have “stigmatism” and equate this term with familiar eye diseases, such as glaucoma and macular degeneration.
Unfortunately, some patients have been told they can’t wear contact lenses (CLs) “because of my astigmatism.” That response gives the doctor an opportunity to explain that astigmatism is not a disease but a refractive error that distorts vision and reduces visual clarity. That opportunity is definitely present because an estimated 45 million Americans have significant astigmatism.1 Patients may not wear soft toric lenses because they think astigmatism precludes CL wear. Perhaps the patient had a bad experience with older versions of toric lenses, or he or she may not know there are CLs available for astigmats.
There may be some doctor bias factored into this as well. The old school of thought was that soft toric CLs were difficult to fit, yielded inconsistent vision, and lacked reproducibility in the manufacturing process to the point where no two toric lenses were alike.
Timing is everything
This gives the progressive optometrist an opportunity to gain a patient’s loyalty by providing sharper, crisper vision with toric lenses. Toric lenses are available for most every prescription, from low astigmats to high astigmats, in both hydrogel and silicone hydrogel materials. It is important to educate your astigmatic patients from the outset that their prescription is more challenging to fit, and more than one lens type may need to be tried. Get off to a good start by conducting a subjective refraction. The most important data points include the amount of cylinder power in relation to the sphere power, the total amount of astigmatism, and the cylinder axis. If a patient presents with an outside prescription, take the time to verify that it is correct. This small investment of your time on the front end can save you some time and frustration down the road. Always err on the lesser side of the patient’s need with cylinder power. For instance, if the patient’s refractive cylinder power is -1.00 DC, choose a diagnostic lens with -0.75 DC as opposed to one with a -1.25 DC.
Demonstrate the patient’s cylindrical correction in the phoropter. Show the patient what the full spherocylindrical correction looks like, then present the spherical equivalent and listen for his or her response. More often than not, the patient appreciates the increased clarity of the cylindrical correction, making this a good point to explain the value of a toric CL. In fact, it is this necessary dialogue with your patient about toric lenses that adds time to the patient visit, not the actual CL fitting itself. Yet all toric lenses need time to settle. One way to speed this process along is to position the laser markings into their proper alignment when applying the lens to the eye, which will reduce the distance the lens has to travel to stabilize. Be a critical observer as well as a critical listener. Signs such as injected eyelid margins and excessive blinking may be harbingers of eyelid disease or concomitant dry eye, which need to be addressed for a successful CL fit.
Keep in mind: You deserve to be compensated for this increased level of skill and expertise. Modify your fee schedule to incorporate differing levels of service with the appropriate fee charges.
Consumer polls and surveys reveal a large, enthusiastic, yet underserved, astigmatic population. These patients are just waiting to be introduced to toric soft CLs. After all, your patients are looking to you for their best vision correction options. Today’s toric CL designs have been refined to yield consistent, clear vision. Toric lens fitting does not require significantly more chair time and their cost is no longer prohibitive.
Educating your patients about all of their vision correction options is imperative. For your astigmatic patients, that warrants a discussion about toric soft CLs.ODT
1. Miller J. It takes one to know one: Reasons to fit more toric lenses. Contact Lens Spectrum, February 2011. www.clspectrum.com/articleviewer.aspx?articleid=105186. Accessed April 8, 2013.