Presenting Astigmatism in Light of New Contact Lens Options

BY THOMAS G. QUINN, O.D., M.S.
MARCH 1998

Things just keep getting better for astigmats interested in contact lens wear. Here's what's happened, what it means to you and how to communicate it all to your patients.

Changes in the options available for patients with astigmatism have been taking place in the past year, and most of them have occurred in the frequent replacement toric contact lens category. Prior to the advent of frequent lens replacement, we managed our astigmatic patients by either keeping them in conventional toric lenses or by fitting them with spherical frequent replacement lenses with the hope that they could tolerate the uncorrected cylinder. We essentially told these patients, "You can have convenience or clear vision, but you can't have both." Of course, sometimes we just said, "You have astigmatism... you can't wear contact lenses." Fortunately, numerous frequent replacement toric lenses are now available, ranging from two-week to three-month replacement cycles (Table 1).

Making the Move

How do we make the move into frequent replacement torics? You're probably already employing strategies in your office that could be directed toward this population. I'm confident that most offices are proficient in describing the advantages of frequent lens replacement, regardless of the replacement cycle, to their spherical contact lens candidates. You can use a similar script with toric lens candidates.

Conventional contact lens wearers are familiar with the comfort and vision of a fresh, new contact lens. Equally understood is the concept that many contact lens complications are associated with dirty lenses. Safety, comfort and visual performance all increase when patients replace their lenses at some regular interval ... what an incentive!

Specialty lens wearers know the panic that sets in when a lens is torn or lost. Due to the more intricate design of these lenses, eyecare practitioners rarely have replacements in stock. Conventional toric soft lens wearers will readily appreciate the benefit of having immediate access to a spare lens.

The convenience of eliminating most of the care required for conventional lenses is enough to convince many patients that frequent lens replacement is a beneficial system.

The Money Question

What about the cost of frequent replacement toric contact lenses? In addition to the obvious increase in material fees over spherical lenses, your service fee should reflect the additional time and expertise required to achieve a successful outcome with these lenses. Knowing that you are being compensated adequately enables you to provide specialty care without a chip on your shoulder.

Information Power

Astigmats need to be educated about their refractive error. I begin this process while the patient is still behind the phoropter, and with my final manifest refraction in place, I demonstrate in each eye the visual degradation that occurs following removal of the cylinder lenses. This is a powerful demonstration after which patients will understand the need for a more specialized form of correction and will generally not balk at the additional cost required to properly correct their vision. For those astigmatic patients who have been "getting by" with spherical frequent replacement lenses, this simple demonstration of enhanced visual performance makes the transfer to torics fairly straightforward.

Expanded Parameters

The initial group of frequent replacement toric lenses served only those patients with the most common refractive errors. We now have the ability to provide frequent replacement toric correction with spherical powers ranging from +6.00D to -8.00D and cylinder powers from -0.75D to -6.00D at axes around the clock in five-degree increments!

Ease of care improves compliance. Replacing each lens at a different interval is asking for trouble. We had been faced with this scenario previously when a patient wearing two-week replacement lenses developed the need for astigmatic correction in one eye. It became necessary to implement unequal replacement cycles or back off of the replacement cycle for each lens to monthly or quarterly. The current wide range of toric lens replacement cycles (two-week, monthly and quarterly) provides us with the opportunity to correct one eye with a toric and one eye with a sphere while keeping the replacement cycle for both lenses in tandem.

The Old Standby

Rigid gas permeable lenses continue to be a mainstay for astigmatic correction. They perform particularly well for those with high astigmatic errors and critical visual requirements. But for those patients who are good toric soft lens candidates, the opportunity to provide safe, comfortable and convenient correction has never been better.