EYECARE PROVIDERS often come up with a prescribing plan before they even enter the exam room. Sometimes the final answer is unexpected and requires both science and creativity.
A 36-year-old female patient presented for a routine eye exam and to be refit in soft contact lenses. She had discontinued contact lens wear several years ago due to suboptimal vision quality and symptoms of discomfort. Her refraction the day she came in was:
–2.50 –0.75 x 17320/20 OD
–3.00 –1.00 x 17620/20 OS
Her overall eye health was excellent. Due to her active lifestyle, she was fit in daily disposable toric lenses. At her follow-up visit, the patient complained of blurry vision, especially when driving at night or in bad weather and when giving presentations at work. The lens comfort was acceptable.
Over the next several weeks, she was refit in several different toric lens designs, materials, and replacement modalities. Each time, she returned with the same complaints. She liked her cosmetic appearance with contact lenses but not the suboptimal vision, especially at distance.
After some discussion, a different approach was used. The patient liked the idea of wearing glasses for astigmatism correction over spherical contact lenses for driving at night or giving presentations at work. She was fit in a spherical daily disposable contact lens and her distance vision was 20/20-2 OD and OS. Over the spherical contact lenses, she was trial framed with:
plano –0.75 x 173 20/20 OD
plano –1.00 x 176 20/20 OS
At the follow-up appointment, she was happy with the prescription arrangement. She was no longer concerned about nighttime driving and was enjoying the cosmetic and activity benefits of contact lens wear.
The importance of high-quality vision is well known among eye-care providers and greatly appreciated by patients. Significantly improved visual acuity has been reported with the correction of as little as –0.50D of against-the-rule and oblique astigmatism and with –0.75D of with-the-rule astigmatism (Tan et al, 2020). Perhaps equally important, the same low amounts of astigmatic correction have shown to enhance quality of vision by significantly improving other important factors, such as ocular scattering and contrast sensitivity (Tan et al, 2020).
Most patients are keenly aware of their vision quality, especially for events like driving in poor conditions. The correction of astigmatism can help achieve optimal vision quality. While the final prescription for this patient was not typical and not appropriate for every patient, she was pleased with the outcome. She described how she felt more confident driving in unfamiliar locations and giving presentations. Quality of vision is what we hope to achieve for all of our patients.
REFERENCES
- Tan QQ, Wen BW, Liao X, Tian J, Lin J, Lan CJ. Optical quality in low astigmatic eyes with or without cylindrical correction. Graefes Arch Clin Exp Ophthalmol. 2020 Feb;258:451-458.
