EyeTools Optometry Skills

257: Fitting contact lenses for low levels of astigmatism

I have recently qualified and am working in my first practice where we have a lot of contact lens patients. One of the more experienced contact lens opticians tells me she only corrects for astigmatism when it is above 1.00 DC. Many patients with astigmatism of 0.75 and 1.00 DC are corrected using only spherical contact lenses. Some complain of problems seeing as clearly as they want. Others complain of visual discomfort-headaches, eyestrain, and blurred vision. How can these patients be better served?
When I was a novice optometrist I remember being surprised that contact lens opticians accepted not correcting low levels of astigmatism for contact lens wearers but would never consider doing this for spectacle lens wearers. The opinion was that low levels of astigmatism were too difficult to correct for contact lens wearers and/or that they would not notice the reduction in vision caused by using only spherical lenses for astigmatic patients.
Even today toric contact lenses are underprescribed for astigmatic patients. While about 50 percent of all soft contact lens wearers have astigmatism of 0.75 D or greater, only about 25 percent of all soft contact lens wearers are fitted in toric lenses. The perception that toric soft lenses take more time to fit patients with low amounts of astigmatism and patients do not need a toric lens to achieve acceptable vision sadly, still exists.
In my experience, there is no difference in the time required to fit soft toric lenses compared to soft spherical lenses.
It has also been shown that patients prefer vision with toric correction, even in low amounts, compared to spherical correction and that full astigmatic correction improves symptoms associated with visual discomfort.
In my opinion, patients are best served by using toric soft contact lens options for all patients who have astigmatism of 0.75 D or more, especially if they report discomfort with spherical correction.
Even if a low toric patient has historically had success with spherical lenses, trialing a toric lens that maximally corrects refractive error could eliminate the discomfort associated with under-corrected astigmatism.
It’s our job to provide people with the best possible vision that modern corrective devices allow.


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