THERE ARE A lot of patients who report to the office with symptoms that are very vague; sometimes they say their eyes feel fatigued, sore, tired, and dry. Upon evaluation, they report that the problem is not as noticeable when they wear their glasses. They say that they feel fine at the end of the day on the days on which they wear their glasses.

When taking a history, ask the patient two key questions: 1) Do your eyes feel better when you put a lubricating drop in? and 2) Do the symptoms get better when you take your contact lenses out in the evening? These two questions dig further into the common condition that is seen all too often—contact lens dryness. If the patient does not report improvement, we must think visual discomfort rather than ocular discomfort.

 Patients who have 0.50D to 1.00D of cylinder often get fit into spherical contact lenses. We might even over-minus them in an attempt to make their prescription spherically equivalent. When measuring visual acuity, patients may even read at the same level as their refraction that you just completed.

When patients are overminused, we effectively are overcorrecting them in one of the meridians and undercorrecting them in the other meridian. It may seem obvious, but we still need to remember that we are not correcting the cylinder in any way; patients still have the same amount of cylinder. Doing this could have an effect on their accommodative system and stress their eyes, especially with excessive computer use.

Regardless of practitioners’ motives in not giving patients their toric correction, many believe that their patients will get by just fine, their vision will be fine, and they ask: Why make the process more difficult with a very complicated toric lens? This realization has been challenged with the advent of newer toric lenses, especially daily disposables.

This class of lenses is more complicated for low-cylinder patients and simpler for mid- to high-cylinder patients. Eyecare practitioners have come to expect them to give good vision, quick stabilization, and incredible comfort. Why not do the same for low-cylinder patients?

For low-cylinder patients, try putting them into a toric lens that corrects their cylinder. Alternatively, consider a scleral lens that corrects their sphere, toricity, and, when needed, their add. Some patients even get 0.50D benefit from the practitioner correcting it with a toric lens. We may just find that the all-too-common discomfort complaint from our contact lens patients will go away. CLS