AS 2017 is rolling along, evaluate your contact lens-prescribing numbers. Specifically, take time with your astigmatic numbers. Are you prescribing more toric contact lenses this year than last? With today’s technology, launches of new products and improvement of astigmatic designs, those numbers should be climbing.

Here are two populations who can be served, thanks to advances in technology with toric options.


Highly astigmatic patients who have failed with contact lenses in the past or who wear a traditional toric lens and are just not seeing as well as they could be, may now be well suited for custom toric contact lenses.

Many specialty contact lenses offer toric designs in higher prescriptions to potentially satisfy the visual and comfort requirements to make these patients happy. Options include soft toric, hybrid and RGP designs.

Discuss changes in the technology with these patients: “Traditional astigmatism-correcting contact lenses only come in (wider) 10° steps, while your spectacle prescription can be dialed in with greater specificity. We now have custom toric lenses that provide a higher level of specificity and are customized for the curvature of your cornea. These can provide you with your best vision.”


Contact lens wearers who have astigmatism and hit presbyopia may not be willing to give up their contact lenses — and they don’t have to. (I’m certainly not!)

Custom soft toric multifocal designs will meet their needs. These contact lenses combine a toric-stabilizing design with multifocal technology. For this reason, remember to fit the patient’s astigmatism first, and adjust for any rotation or instability before making multifocal adjustments.

“Custom” is the key word. Let your patient know, “these lenses are customized for your specific cornea and visual demands. They usually require some fine-tuning during the fitting process.” This also will help set patients’ expectations.

Hybrid and RGP options also are available to fit these patients.

Combat Ingrained Behavior

1. Down with masking

Masking, or under-correcting astigmatism, can cause visual frustration, headaches and even eye fatigue. With today’s successful toric designs allowing patients to meet their best visual outcomes, there’s no need for it. If there is any doubt with those 0.75D cylinder patients, demo the lens in the phoropter, and ask which they prefer.

2. Eliminate the phrase “not an option”

Many highly astigmatic patients have been told contact lenses are “not an option” for them. This amazes me. Options are available in multiple modalities for just about everyone. Visual challenges exist for patients who have high amounts of astigmatism and use spectacle lenses. Patients who have more than 3.00D of astigmatism are even categorized as “visually necessary” contact lens fits, according to some insurance plans. In some cases, these patients will even experience a higher insurance benefit if successfully fit in contact lenses.


This growth in technology makes astigmatic patients an exciting category. Finding a solution to fit their visual needs is also rewarding. Give these patients their best vision. OM