Toric soft lens prescribing almost doubled over the time-course of a recently published survey, from 24.4 % of standard soft daily wear single vision lens fits in 2000, to 46.2 % in 2023 (p < 0.0001).¹ I think optometrists can do better by disproving these misconceptions:

“Soft spherical lenses mask astigmatism”
An observational study shows that wearing spherical soft contact lenses cannot be expected to predictably mask astigmatism.² The researchers arrived at this conclusion by employing spherocylindrical refraction over the soft lenses. A study on the impact of lens thickness and modulus has, likewise, failed to provide evidence that thicker or stiffer lenses mask more regular astigmatism.³ Further, superior vision can be achieved for low astigmatic contact lens wearers using soft toric lenses vs. aspheric soft contact lenses.⁴

“Toric lenses are less comfortable”
Actually, contemporary soft toric lenses are manufactured to promote proper orientation, minimal rotation, and reduced edge thickness. While I have found that some patients require a day or two to adapt to a toric de-sign when fit monocularly, they rarely report a significant difference in comfort post-adaptation. Additionally, research shows no significant difference in the level of discomfort between spherical and toric wearers in neophyte contact lens dropouts.⁵

“Toric lens fitting adds chair time”
All types of soft lenses typically settle within 10 minutes.⁶ Most current soft toric lenses achieve rotational recovery in less than two minutes after insertion, so no extra chair time is needed to fit a toric soft lens.⁷

“Small amounts of cylinder are fine”
When was the last time you arbitrarily omitted the astigmatic component of a spectacle prescription? We should not assume that small amounts of cylinder do not negatively impact patients’ contact lens-wearing experience.

“Torics are more expensive”
I explain to patients that the difference in cost between soft spherical and toric lenses is nominal, but that it is a “value judgement.” Then, I let them decide based upon their perception of the improvement when demonstrating the vision without the cylinder in place. OM

References:

1. Efron N, Morgan PB, Woods CA, Jones D, Jones L, Nichols JJ. International trends in prescribing toric soft contact lenses to correct astigmatism (2000-2023): An update. Cont Lens Anterior Eye. 2024;47(5):102276. doi:10.1016/j.clae.2024.102276.

2. Snyder C, Talley DK. Masking of astigmatism with selected spherical soft contact lenses. J Am Optom Assoc. 1989;60(10):728-31.

3. Kurna SA, Sengör T, Un M, Aki S. Success rates in the correction of astigmatism with toric and spherical soft contact lens fittings. Clin Ophthalmol. 2010;4:959-66. doi: 10.2147/opth.s9464.

4. Morgan PB, Efron SE, Efron N, Hill EA. Inefficacy of aspheric soft contact lenses for the correction of low levels of astigmatism. Optom Vis Sci. 2005;82(9):823–828. doi: 10.1097/01.opx.0000177792.62460.58.

5. Sulley A, Young G, Hunt C. Factors in the success of new contact lens wearers. Cont Lens Anterior Eye. 2017;40(1):15-24. doi: 10.1016/j.clae.2016.10.002.

6. Boychev N, Laughton DS, Bharwani G, Ghuman H, Wolffsohn JS. How should initial fit inform soft contact lens prescribing. Cont Lens Anterior Eye. 2016;39(3):227-33. doi: 10.1016/j.clae.2015.11.001.

7. Momeni-Moghaddam H, Naroo SA, Askarizadeh F, Tahmasebi F. Comparison of fitting stability of the different soft toric contact lenses. Cont Lens Anterior Eye. 2014;37(5):346-50. doi: 10.1016/j.clae.2014.05.003.

Susan A. Resnick, OD, FAAO, is president and managing partner at Drs. Farkas, Kassalow, Resnick, and Associates, a contact lens and anterior segment specialty practice in New York. She is a diplomate in the Cornea, Contact Lens, and Refractive Technology section of the AAO, a diplomate of the ABO, and a fellow of the Scleral Lens Education Society.