For years, patients with lower levels of astigmatism were often fit with spherical-equivalent contact lenses. That approach still has a place in selected cases, but the thinking behind it has changed. As toric lens technology has improved, clinicians have gained more opportunities to correct the patient’s actual prescription without sacrificing comfort or convenience.
During a recent discussion, Mile Brujic, OD, FAAO and Kriti Bhagat, OD, FAAO, explored how a clearer explanation of astigmatism, more precise correction, and newer toric lens designs can improve fit, visual performance, and patient satisfaction.
Astigmatism and specialty contact lenses fast facts
- A toric contact lens contains different powers in different meridians and must remain aligned with the patient’s astigmatic axis.
- Patients with 0.75D of astigmatism will likely experience meaningful visual benefits from toric rather than spherical-equivalent correction.1,2
- Lens rotation can shift the cylinder axis and cause blur or fluctuating vision.
- Daily disposable toric lenses now combine improved materials, wettability, and stabilization.
- Multifocal toric lenses can address astigmatism and presbyopia in the same lens.
Astigmatism requires a more precise fit
The first step in fitting an astigmatic patient is helping the patient understand what is being corrected. Dr. Bhagat compares an eye with equal curvature in every direction to a basketball and an astigmatic eye to a football.
A basketball curves similarly in every direction, while a football is flatter in one direction and steeper in another. Dr. Brujic describes the same idea as having one focusing power from top to bottom and another from side to side. That difference explains why astigmatism requires more than adjusting spherical power alone.
A toric contact lens places different powers in specific directions, much like fitting a glove precisely rather than choosing an approximate size. Because those powers must remain oriented to the patient’s axis, the lens must also stay stable on the eye.
Correction with toric lenses for low astigmatism
For many years, clinicians often relied on the spherical equivalent when cylinder power was modest. That approach simplified fitting, particularly when toric parameters were limited or lens rotation produced inconsistent vision.
“Today, improved optics and broader parameter ranges make that compromise less necessary.”
Research supports the value of correcting lower levels of astigmatism. In a randomized crossover trial involving patients with 0.75 to 1.50D of astigmatism, toric daily disposable lenses improved near visual acuity, digital reading performance, and subjective visual quality compared with spherical-equivalent lenses.1
A separate trial found that participants could read smaller text on digital devices with toric correction, and 85% preferred the toric lenses.2 Low astigmatism may appear minor on a prescription, but its effects can become more noticeable during sustained reading, computer use, and other visually demanding tasks.
Stability is part of the prescription
One of the most important insights from the discussion is that cylinder power alone does not determine success. A spherical lens can rotate without changing its optical effect. A toric lens cannot. Excessive or inconsistent rotation can move the cylinder power away from the intended axis, producing blur or fluctuating vision even when the lens feels comfortable.
That makes stabilization, material science, and surface performance inseparable from the prescription. Dr. Bhagat noted that earlier advances improved oxygen transmission but sometimes required compromises in comfort or stability. Modern designs aim to support oxygen delivery, hydration, wettability, and consistent orientation at the same time.
Recent research also found better near acuity with toric correction, along with improvements in reading speed and eye-movement efficiency, particularly among participants with greater cylinder.3 These findings reinforce a practical point: The correct prescription can only perform as intended if the lens remains stable on the eye.
More options can improve compliance
One of the most practical changes in toric fitting is the growing number of options available to patients. Daily disposable toric lenses were once treated mainly as a problem-solving modality.
Today, broader parameter ranges and improved designs allow many clinicians to recommend them first. A fresh lens each day also eliminates cleaning and storage requirements, which can simplify the wearing routine and support better compliance.
Options are also expanding for presbyopic patients with astigmatism. These patients need distance correction, near support, and stable cylinder correction in the same lens. In a recent prospective trial of a multifocal toric daily disposable lens, more than 96% of participants were successfully fit with 2 or fewer pairs of lenses.4 In addition, more than 94% of eyes remained within 10° of the intended orientation, and participants achieved functional vision at distance, intermediate, and near.
These patients still need realistic expectations, and refinement may be necessary. However, many do not realize an option exists until the clinician presents it. A clear recommendation can turn a technically available lens into a practical solution the patient is willing and able to wear.
Final thoughts
Toric lenses have not simply become more available; they have become more precise. Perhaps that is the biggest shift in caring for patients with astigmatism. Clinicians can begin by explaining how the eye focuses, then offer a lens designed for the prescription the patient actually has.
“Why leave visual cards on the table, for lack of a better way to describe it?”
The question is no longer simply, “Is the spherical equivalent good enough?” It is, “Would correcting this astigmatism provide clearer, more stable, and more useful vision?” With current toric technology, the answer may be yes more often than clinicians once assumed.
