Prescribing for Astigmatism

Say Yes to Correcting Astigmatism

BY BROOKE MESSER, OD, FAAO, FSLS

Those of us fitting contact lenses have already committed to a higher level of care for our patients. Contact lens fittings require more time, patient education, and troubleshooting compared to a standard comprehensive eye exam. The desire to provide the best vision function with options that keep our patients free from glasses is obvious in both the steady growth of contact lens fittings performed each year across the globe (Morgan et al, 2016) and the continuous investment of the contact lens industry to develop new technologies in both soft and GP lens designs.

What the Numbers Say

Despite these positive trends, other data show that we, as fitters, have yet to utilize toric soft contact lenses in a way that matches the prevalence of astigmatism in the general population. Morgan et al (2013) showed that only 25% of all contact lens fittings were with toric soft lens designs. A similar number of 22% was reported in the International Contact Lens Prescribing in 2015 article (Morgan et al, 2016). Yet, the percentage of patients in the general population who have at least 0.75D of astigmatism in one or both eyes is 50% and 31%, respectively (Young et al, 2011).

Why the discrepancy in the numbers? Perhaps our astigmatic patients are unaware that most can now be fit in their preferred modality. Maybe some practitioners are worried that their patients will not appreciate the vision gained in exchange for the adaptation to lens awareness, lens cost, or handling of a toric contact lens.

It’s Time for a New Trend

With that in mind, I encourage the contact lens community to step up to the challenge of our patients who have astigmatism. We now have more soft toric lens options available than ever before, including daily disposables, silicone hydrogels, multifocals, and extended parameter options. In addition, custom soft lenses are also available in silicone hydrogel materials, multifocal optics, and any amount of astigmatism at all axes. Our patients deserve access to our full range of options.

The following patients may especially benefit from our renewed energy in fitting toric lenses:

• Athletes The improved stabilization methods of soft toric contact lenses can maximize any type of athlete’s vision and reaction speed. Most athletes will appreciate the improved acuity of a soft toric lens, but if mild vision fluctuation affects those who have high astigmatism, a scleral lens designed for normal corneas is another great option.

• Aging Patients Maintaining the highest level of vision correction in aging adults is critical in preserving optimal function during activities of daily living (ADLs). A Salisbury Eye Evaluation Study of adults ages 65 to 84 found a direct correlation between decreasing visual acuity levels and difficulties in ADLs (Lam et al, 2013).

• Children While kids can be the least sensitive to uncorrected astigmatism, they also have the greatest potential for easy adaptation, especially in new wearers.

• Night Shift Workers As expected, the glare and vision distortion from uncorrected refractive error increases with increased pupil size. Optimally correcting these patients can give them a new lease on safe driving in the dark.

So tell patients that their astigmatism no longer limits their lens comfort and vision quality. When our patients ask if they can wear a certain type of contact lens, “even with my astigmatism,” our answer can be an excited “Yes!” CLS

For references, please visit www.clspectrum.com/references and click on document #249.

Dr. Messer practices in Minneapolis in a private optometry office focused on specialty contact lenses. She is a consultant to Precilens and CooperVision, has received research funding from B+L, and has received honoraria from Alden Optical.