Toric Contact Lens Myth Busting

ABOUT MY PRACTICE

Name: McDonald Eye Associates

Location: Fayetteville and Rogers, Arkansas

Type: Private MD/OD practice in a fastgrowing suburban area

Demographics: A diverse population ranging from college students to corporate professionals.

Contact lens volume: Contact lens sales and services represent approximately 30% of all patients seen, with an emphasis on daily disposable options.

In the vibrant and fast-growing town of Bentonville, Arkansas, where corporate legends like Walmart, JB Hunt, and Tyson call home, I have the opportunity to serve a diverse and dynamic patient population. From college students to professionals, many of our patients spend their workdays in front of screens or attending virtual meetings. This screen-heavy lifestyle naturally leads to questions about vision correction options such as LASIK, refractive surgery, and contact lenses, as patients seek alternatives to glasses for everyday life.

When my contact lens patients express interest in LASIK, it’s often out of frustration—whether because of discomfort from ill-fitting lenses or dissatisfaction with the sharpness of their vision. What’s even more surprising is how many astigmatic patients have never been offered lenses specifically designed to fully correct their astigmatism. I take the opportunity to educate every suitable candidate about the toric contact lenses available, encouraging them to try this as an option before committing to surgery. This gives them the chance to “test-drive” the clearer vision they’ve been missing, and it also provides a preview of what LASIK might offer once the astigmatism is corrected.

Similarly, when I perform preoperative evaluations for cataract surgery, I frequently find myself explaining astigmatism and the option of toric IOLs to patients who are unaware of these corrective solutions. Ideally, patients shouldn’t be caught off guard by the mention of astigmatism as they prepare for cataract surgery, only to find out that a toric IOL, which would be most beneficial for their visual demands, has an additional cost. While it requires a bit more education, ensuring that patients are informed about their options is essential to helping them make confident, informed decisions about their visual future.

Toric contact lenses have long been burdened by an undeserved bad reputation. Historically, optometrists have hesitated to prescribe them unless treating significant levels of astigmatism, considering them to be too time-consuming, expensive, and/or uncomfortable for patients. Despite the introduction of advanced toric lens technologies in recent years, only about 10% of astigmatic patients currently wear them.¹ This surprisingly low figure highlights the lingering myths and misconceptions surrounding these lenses, both among practitioners and patients. It’s time for us, as optometrists, to rethink these outdated beliefs and embrace the potential of toric lenses to transform our patients’ vision. Let’s dive into some of these myths and explore whether it’s time to shift our perspective on toric contact lenses.

In toric contact lenses, comfort hinges on more than just the prescription—it’s influenced by factors like silicone content, base curve, wettability, lens matrix, and numerous other factors. My goal is to maximize comfort for my patients by offering the best options available, and for me, that most often means high-water-content daily disposable lenses. Clinically, frequently replaced lenses help minimize dryness, enhance comfort, and improve overall satisfaction—a win-win for both patients and practitioners.

When a patient has at least 0.75 D of astigmatism, I like to show them the difference in the phoropter with and without the mild cylinder correction. Thanks to advancements in contact lens technology, we can now correct up to 3.00 D of astigmatism with daily toric disposables, thus offering an even broader range of options.

While many of my patients are already using daily disposables, those still wearing biweekly or monthly lenses are given the opportunity to try daily disposables so they can compare the comfort firsthand. With today’s improved technology, the drop-out rate for toric lenses in my practice is much lower than it was with older designs. Countless patients have said, “This is how I wish my lenses had felt years ago,” proving that sometimes, the experience of comfort is just as important as the clarity of vision.

I also make it a point to educate patients on the variety of comfortable, accessible options available on the market today. For those particularly sensitive to wearing contacts, I often say, “Even if you prefer glasses, contact lenses could give you another option for activities or hobbies where glasses fall short.” I ensure my patients are well-informed about their choices and set clear expectations for how toric (and spherical) daily disposable lenses can enhance both their vision and comfort.

In the past decade, toric contact lenses have made significant advancements, transforming the experience for patients who may have previously struggled with older technology, specialty lenses, or hard contact lenses. It’s important to inform patients that today’s toric lenses are not only more comfortable but also much more precise and accessible than ever before. Manufacturers have expanded the range of sphere and cylinder powers, with options available in 0.25-D or 0.50-D steps and a wide variety of axis orientations, allowing us to fit a broader range of patients. For patients with even low levels of astigmatism, we no longer have to rely on aspheric lenses to mask their refractive error.

Research has shown that patients with mild to moderate astigmatism gain significantly better visual acuity with toric lenses compared to spherical lenses.² Not only do they achieve sharper vision, but studies also highlight improved contrast sensitivity and reduced eye strain.³ Specifically, in cases of digital eye strain, a study by Wiggins et al demonstrated that patients experienced greater comfort when their residual astigmatism was fully corrected while reading a digital screen, compared to leaving 0.50 D to 1.00 D of uncorrected astigmatism.⁴ Likewise, in a randomized clinical trial of patients’ near-vision performance on digital devices using spherical versus toric contact lenses, Logan et al found that toric correction enhanced patients’ near contrast visual acuity (high and low) by 0.5 to 1 full line (P < .0001), and the toric recipients could read one line smaller text on an iPad (P = .01). Furthermore, 85% of the patients reported that they preferred the toric correction (P < .0001).⁵ The message is clear: correcting astigmatism with toric lenses can provide a noticeable improvement in both vision and comfort, especially for today’s screen-heavy lifestyles (Figure 1).

Manufacturers have simplified the process of fitting toric contact lenses, providing intuitive, easy-to-follow guides that ensure each patient receives the optimal lens for their specific needs. These guides are so user-friendly that even my technicians can handle the fitting process seamlessly, saving me valuable chair time. Whether it’s myself or my staff doing the fitting, we now allocate the same amount of time for toric lenses as we do for spherical lenses, thanks to these streamlined tools.

Equally important is educating patients on how to properly insert their toric lenses. Often, when they express frustration, it’s not the lenses themselves, but rather improper insertion that leads to a poor experience. It’s not uncommon to discover that patients are unaware of the stabilization markings designed to help align the lenses correctly. Taking an extra 15 seconds to teach patients about these markings and proper placement can completely transform their experience. This small effort goes a long way toward retaining new patients, particularly those who didn’t receive (or don’t recall) this vital instruction at their original insertion and removal training. Even longtime contact lens wearers can benefit from this refresher, as we can’t assume they’ve been inserting them correctly all along.

It’s also essential to set realistic expectations, reminding patients that it’s normal to blink a few times to get the lens to settle into place. This helps them feel more confident and comfortable in their lenses from the start, improving both satisfaction and long-term success with toric contacts.

I emphasize the value of toric contact lenses by showing patients firsthand the difference astigmatism correction can make. At the phoropter, I compare their vision with and without astigmatism correction, sometimes creating a “wow” moment when they see how much sharper and clearer their sight can be. This experience often shifts their perspective—patients who appreciate the value of the enhanced vision are usually willing to invest in toric contact lenses.

Even for those who opt for spherical lenses, the key is education. I ensure patients understand that astigmatism may affect their visual quality and that leaving it uncorrected may impact their overall quality of vision. When they’re ready, or if they feel their vision is inadequate, I will be available with a more suitable contact lens option for their astigmatism correction.

For patients who are concerned about the cost of daily toric lenses, I offer alternatives like weekly or biweekly toric lenses, which provide a great balance between affordability and high-quality vision correction. In fact, some of my patients even alternate between these replacement schedules and daily disposables, giving them the flexibility to experience the benefits of both. This approach allows patients to enjoy the comfort and convenience of premium lenses without feeling limited by cost, empowering them to choose what’s best for their eyes and budget.

This brings me to another advantage of toric contact lenses: different options for different daily needs. Many of my patients lead active lifestyles—whether mountain biking, playing sports, or participating in hobbies that demand a little more from their vision. While they may rely on glasses or weekly or biweekly toric lenses for work or school, they often prefer daily disposable lenses for activities like cycling or gymnastics, appreciating the convenience of simply tossing them afterward. By informing patients about these customizable options, we empower them to invest in lenses that match their lifestyle. Many truly value the ability to mix and match lenses for different occasions, making their vision correction both practical and adaptable.

EDUCATE SO PATIENTS CAN PARTICIPATE

As optometrists, it’s our responsibility to demystify astigmatism and make it less intimidating for our patients. Whether they’re exploring glasses, contact lenses, or even considering refractive surgery, patients with astigmatism will inevitably hear the term. It’s essential they understand that, while astigmatism isn’t going to disappear, it’s completely manageable with a wide range of effective correction options. The last thing we want is for patients to be blindsided by this condition when they’re preparing for cataract surgery and suddenly learn about the need for a more costly toric IOL. That’s why my team and I make a point to educate every patient, at every visit, about the latest advancements in contact lenses—whether they’ve been wearing the same lenses for years or are new to contact lenses. Patients are often excited about innovations in vision care, just as they are with new digital technology.

Final Takeaways

Today’s toric contact lenses offer remarkable benefits that make them a win-win for both patients and the practice. Even a small amount of astigmatism correction can significantly improve patients’ vision for everyday activities like computer work or driving. The doctor who takes the time to explain astigmatism and the ways to manage it is the one who earns a patient’s trust and loyalty. Educating patients about their visual condition and their options sets us apart and helps ensure they feel confident and informed about their eye care journey.

1. Multi Sponsor Surveys Inc. The 2014 Gallup target market report on the market for toric contact lenses.
2. Richdale K, Bernsten DA, Marck CJ, et al. Visual acuity with spherical and toric soft contact lenses in low- to moderate-astigmatic eyes. Optom Vis Sci. 2007;84:969-975.
3. Berntsen DA, Cox SM, Bickle KM, et al. A randomized trial to evaluate the effect of toric versus spherical contact lenses on vision and eyestrain. Eye Contact Lens. 2019;45:28-33.
4. Wiggins NP, Daum KM, Snyder CA. Effects of residual astigmatism in contact lens wear on visual discomfort in VDT use. J Am Optom Assoc. 1992;63:177-181.
5. Logan A-KM, Datta A, Skidmore K, et al. Randomized clinical trial of near visual performance with digital devices using spherical and toric contact lenses. Optom Vis Sci. 2020;97(7):518-525.

Jade Coats, OD
cjadecoats2020@gmail.com 
Financial disclosure: Speaker (Alcon, Bausch + Lomb)