prescribing for astigmatism
Finally Breathing Easier with Soft Toric Lenses
BY PETER D. BERGENSKE, OD, FAAO

With all the talk over the last several decades regarding permeability of contact lens materials, we've had to accept minimal oxygen transmission in soft toric lenses. To make toric lenses stable and to incorporate their more complex optics, the lenses are necessarily larger and thicker than their spherical counterparts. Combining this greater mass with low Dk has resulted in compromise for many toric lens wearers. Neovascularization, myopic creep and corneal distortion have all posed greater problems with soft toric lenses, even in daily wear. Although a number of soft toric contact lenses have approval for overnight wear, that wearing schedule isn't a prudent idea for the vast majority of patients.

A New Era

Fortunately, we've now entered a new era with the introduction of silicone hydrogel toric lenses. Though in somewhat limited distribution at this time, expect expansion of parameters and availability to improve steadily.

The first entry in this category is Vistakon's Acuvue Advance for Astigmatism. This lens isn't a silicone hydrogel version of the Acuvue Toric — the Advance incorporates an entirely new design. Although the manufacturer claims that it offers "accelerated stabilization," practitioners can think of this lens design as a variant of a double thin zone design. It has no prism power, and the lens may orient in either of two positions.

Sphere powers range from +6.00D to –9.00D, with three cylinder powers up to –6.00D and two cylinder powers above that. Cylinder axes are available at every 10 degrees for plano to –6.00D sphere powers and at every 20 degrees for the rest. The single base curve is 8.6mm and the diameter is 14.5mm. The material is the same as that of the Acuvue Advance lens, with a Dk of 60 and Class I UVA and UVB blocking. It has approval for daily wear use only.

Bausch & Lomb is in the process of rolling out the PureVision Toric in somewhat limited parameters and availability at this time. Based on the successful Soflens 66 Toric design, the PureVision Toric incorporates an aspheric front surface to improve visual performance. Its current sphere power range is from –0.25D to –6.00D with three cylinder powers at every 10 degrees. The PureVision Toric has approval for up to 30 nights continuous wear.

More to Come

On the horizon, CIBA Vision has promised the roll out of its O₂Optix for Astigmatism lens, though little specific information is available at this time. Word has it that we'll also eventually see a toric in the Night and Day (CIBA) line, and the high oxygen permeability of that lens material should offer an exceptional overnight wear option for toric lens patients.

The expansion of silicone hydrogel technology to astigmatic correction is a needed and welcome development. It remains to be seen whether this generation of lenses will solve most of the presumed physiological issues with toric lenses and still allow patients to happily wear them. My guess is that we'll continue to need and see improvements with time, but in the meantime, these new toric lens entries are as welcome as a breath of fresh air.

Dr. Bergenske, a past chair of the American Academy of Optometry's Section on Cornea and Contact Lenses, has practiced for over 20 years in Wisconsin and now is on the faculty at Pacific University College of Optometry. E-mail him at: berg1101@pacificu.edu.