Taking the Stigma Out of Astigmatism

The improved wettability and comfort of today’s toric contact lenses make them a great option for a larger number of patients with astigmatism than ever before. Although many eye care providers may have been trained to think of toric lenses as being more difficult to successfully fit than spherical lenses, at least one recent review found that fitting time and likelihood of success are similar for toric and spherical soft contact lenses.¹

In my practice, choosing the right toric lens for patients with astigmatism starts with a conversation to assess their understanding of their diagnosis and listen to their lifestyle needs. Read on to see how I handle this dialogue and the steps that I follow in order to optimize my success fitting this patient population.

LENS EDUCATION

Patients with a new diagnosis of astigmatism may not understand what astigmatism means. In fact, I have even had patients ask me, “How did I catch astigmatism?” Educating them about what astigmatism is and what we can do to correct their resulting vision is a crucial first step in their care.

On the other hand, patients who were diagnosed with astigmatism in the past may have been told that contact lenses are not a good option for them, or they were not satisfied with the designs that were available. As such, former toric contact lens wearers may think their only vision correction option is spectacles.

Letting patients know about the benefits of new technologies and advances in toric contact lenses can be enlightening for them, opening up opportunities for improved vision and comfort. You want a patient’s first experience with contact lenses to be great. Being proactive with education can help you and your patients get on the same page and guide them in making an informed choice when it comes to their options.

I have found it beneficial to empower my staff to begin this conversation with patients before I see them. They may start by asking if the patient was aware that contact lenses may be an option for their prescription, or by telling them that contact lenses have advanced significantly, and there may now be an option that will work well for them.

This can help maximize the value of the limited time we get with each patient. Many are missing out on improved vision due to a lack of understanding, and I believe that, in our role as optometrists, it is part of our job to look for better ways to keep our patients informed. This not only benefits your patients, but also your practice.

LENS FITTING

The factors I pay attention to the most when looking for an optimal toric contact lens design are consistency, stability, comfort, and a wide set of parameters. This ensures I can fit the lens on the broadest variety of patients.

Improvements in the consistency and stability of toric lenses are, in my opinion, among the most significant of recent developments. In the past, the materials used for toric lenses were too thin, causing the lenses to move upon blinking and not settle correctly. Toric lenses also struggled in the past with consistency across their power profile, making it difficult to know how each lens would fit a patient.

However, modern innovations in prism-ballast designs, such as the OpticAlign design featured in the Infuse for Astigmatism lens (Bausch + Lomb), have come a long way in addressing these concerns. The Precision 1 for Astigmatism lens (Alcon) also features a modified prism-ballast design that I have found to be very stable. Other available toric lenses with a prism-ballast design include the Biofinity Toric (CooperVision), and the Dailies Total 1 for Astigmatism (Alcon).

Comfort is another area in which toric lens technology has made significant advances. When I first started practicing, many of my patients tried toric lenses but discontinued wearing them, even if their vision improved, because the lenses did not feel good on their eyes. Developments in the oxygen transmissibility and moisture properties of contact lens materials have greatly improved the comfort of toric lenses. As optometrists, we need to make our patients aware that they may now be able to achieve the same all-day comfort of a spherical contact lens while enjoying the visual benefits of a toric lens.

It is also important that a lens has sufficient parameters available to fit a variety of patients. There is nothing worse than extolling the virtues of a lens to a patient, only to come back and tell them it’s not available in their prescription. Ensure there are sufficient parameters in your fitting sets or available to order before opening the conversation.

CLINICAL PEARLS

Successfully carrying out and framing the conversations you have with patients goes a long way toward increasing their understanding of and comfort with products that are new to them. When I introduce a new lens to a patient, I want to let them know that I am evaluating the lens based on what will provide them the greatest amount of benefit to their quality of life. I also let them know that if they do not like the lens, we can try something else. This way, they do not feel like they are stuck with any particular selection.

I do not talk negatively about a lens before I have a patient try it because I do not want to give them problems to look for. I have found that if you tell someone that they might feel a lens, they often do feel it. Instead, I prefer to let them wear the lens, and then I ask them about their experience and address any of concerns without introducing external bias.

Do not be afraid to try new technologies. By educating your patients and keeping them informed on the newest offerings that can best improve their contact lens experience, you are giving them the best possible care and setting yourself and your practice up for success.