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    Top toric contact lens fitting tips from the experts



    Kristopher A. May, OD, FAAO

    Memphis, TN

    1. It’s time to stop masking.

    We would never leave 0.75 D of cylinder off a spectacle prescription; why do it with contact lenses? Our power ranges and lens stability are so good now, it’s easy to put a patient in a diagnostic lens at the exam without waiting on an order or even waiting long for the lens to settle. When the patient looks out the front window at his distance vision, you can get some “Wow!” moments.

    2. Don’t be afraid to try higher powers. 

    It’s amazing how many patients will still say they were told that cannot wear contact lenses because of astigmatism. While the extended range (XR) lenses do have to be special ordered and take some extra time, high cylinder and high power soft lenses can be surprisingly rotationally stable and make for very happy patients. The best part about these patients is they tend to tell the whole world how their new eye doctor did what they thought was impossible.

    3. Remember the basics: Vertex and left add, right subtract (LARS).

    It’s boring, but they are the difference between success and failure. Vertexing high cylinder powers with rules of thumb can be notoriously inaccurate. There are apps for that now...use them. Sometimes vertexing is the difference between a patient who you thought needed an XR but can be fit in a stock power. Rotationally adjusting power with LARS is not just for the initial dispense, it optimizes lens performance once the patient has worn the lens longer and sets them up for long-term success in her final Rx.

    Up next: John Mark Jackson, OD, MS, FAAO


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