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    Managing the astigmatic patient with contact lenses

    Case examples show how different lenses work for different patients with toric needs

    Renee E. Reeder, OD, FAAO, FBCLA, FSLS, FIACLE, is associate professor at Illinois College of OptometryIn the last 10 years, the disparity between the percentage of patients wearing astigmatic correction in their glasses vs. their contact lenses has been nearly eliminated.1-4 Today, roughly 40 percent of patients are currently wearing astigmatic correction in their spectacles, and about 30 percent of contact lens wearers are also wearing astigmatic correction.5-7 The majority of the remaining 10 percent have low levels of cylinder less than 0.50 D to 0.75 D of cylinder and do not experience significant visual decline.8,9

    These new statistics are a testament to the many and varied outstanding toric options available to improve vision and the advances in fitting techniques which optimize chair time.

    • Masking cylinder has been shown to be ineffective.10

    • Aspheric lenses do not improve vision.11

    • Empirically ordering both gas permeable (GP) and soft torics is highly successful even in patients with moderate to high astigmatism.12

    Related: 3 tips to upgrading astigmatic contact lens patients

    • Orthokeratology is now available in toric for patients with moderate cylinder.13

    • Hybrid lenses are also effective in the correction of regular astigmatism.14

    • Scleral lenses for the normal cornea provide yet another option for those patients with significant astigmatism.15

    Table 1 demonstrates the diverse options now available for astigmatism correction in contact lenses.

    Options for the low astigmat

    Patients with cylinder between -0.75 and -1.75 are easily fit with daily or traditional multipackaged soft contact lenses16,17 in an extremely wide range of spherical power. The lenses are highly successful, and newer designs provide extremely stable fitting and vision.18

    A recent study showed that patients wearing toric contact lenses had a better quality of life than patients who wore spherical lenses as determined by the NEI-RQL-42 survey.19 This study supported previous works that indicated nearly 92 percent of patients with a toric correction preferred their vision when they were fully corrected.9

    Young children (ages 4-10 years) with toric correction adapt extremely well to rigid modalities.20 Young patients with low to moderate myopic astigmatic prescriptions can easily be corrected with orthokeratology (ortho-k), which provides the benefit of full correction of their prescriptions and myopia control.

    For hyperopic astigmatism and those with higher amounts of myopia, spherical corneal GPs remain an outstanding option. The smaller overall diameter of corneal GPs can facilitate successful application and removal training due to the patient’s small eye. In addition, these lenses can be ordered empirically, allowing children to experience outstanding vision with their very first contact lens experience.

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

    Cost in these situations for spherical GP lenses on mildly toric corneas with mild to moderate refractive cylinder is significantly less in cost of goods.

    GPs remain an outstanding vision correction option due to the precise optical quality generated.

    For slightly older children, ortho-k may remain an outstanding option; however, cost and desire for disposability are attractive features of soft torics. Orthokeratology may also provide an alternative in adults who struggle with contact-lens–induced dry eye.

    For most adults and teens, daily disposables and multipackaged lenses dominate the lens selections with their expansive array of parameters, outstanding comfort, and convenience.

    Renee E. Reeder, OD, FAAO, FBCLA, FSLS, FIACLE
    Dr. Reeder is coursemaster for the specialty contact lens, microbiology, and anterior segment disease courses; the educational ...


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