In the second episode of Toric Talks, Kelsi Sawatzky, OD, FAAO, is joined by John L. Ellis II, OD, and Ashley K. McFerron, OD, to discuss how to successfully fit patients with toric contact lenses.
Dr. Sawatzky is an optometrist at Elite Eye Care in Waukee, Iowa; Dr. McFerron practices at Canby Eyecare in Canby, Oregon; and Dr. Ellis is the owner of University Vision Centre in El Paso, Texas.
Selecting a toric lens for first-time contact lens wearers
Dr. Ellis noted that the expansive parameters of the MyDay toric contact lens (CooperVision) enable easy in-office fitting and make contact lenses a viable option for almost all patients with astigmatism.1 Studies have shown that the primary reason first-time contact lens wearers dropout is due to vision issues.2 Consequently, it is critical to choose the best power and optical design for these patients.3
Key parameters of the MyDay toric contact lens include:4
- Sphere power: +8.00D to -10.00D (0.50D steps after +/- 6.00D)
- Cylinder power: -0.75, -1.25, -1.75, -2.25
- Axis: Full circle in 10° steps
Fortunately, CooperVision has convenient fitting sets that allow for patients to be fit and sent home with a contact lens on the same day. He added that it can be disappointing for neophyte wearers to walk out of an appointment without a lens because it is not available in the necessary parameters. As a result, this may lead to them not returning to the office.
Protocols for first-time contact lens wearers
Explaining how to handle the lens when doing first-time lens fits is critical, because when patients struggle with insertion and removal from the get-go, they are much more likely to become frustrated and potentially even give up on using contact lenses.
Dr. Sawatzky added that at her practice, she or a technician always inserts the lenses in the patient’s eyes during the appointment and then assesses how they sit before continuing training. This means that the patient only has to focus on removing the lens (which is typically easier than insertion) at home on the first day—setting them up for success and giving them a sense of accomplishment.
With this workflow, Dr. Sawatzky’s practice often doesn’t have to schedule contact lens follow-ups because there is so rarely a problem. Instead, a staff member calls to check on the patient the following week, and if necessary, they schedule an appointment.
For a patient handout with instructions on contact lens insertion and removal, check out Contact Lens Care for Patients with Take-Home Instructions!
Common challenges with toric fits
Until recently, rotational stability was the largest challenge all three clinicians encountered with toric contact lens fits. However, advancements in toric lens designs have largely eliminated this issue, and led to soft toric lens fits requiring almost the same amount of chair time as soft spherical lenses—with similar rates of success.3,5
Dr. Ellis noted that setting clear expectations that the lens may take a few moments to settle into the correct position and that new wearers may need a week to fully adjust to the new lens helps prevent patient dissatisfaction. Optometrists can also comfort patients by assuring them that the goal is to give them excellent vision, and if that is not achieved, adjustments can be made to address any residual problems.
In addition, Dr. McFerron observed that patients with a hybrid contact lens prescription (ex., a toric and spherical lens) have reported less discomfort when wearing a MyDay toric lens, likely due to its excellent stability.
To remove financial barriers, Dr. Ellis explained that he provides patients with a form that outlines the fitting process and associated fees so patients know that if they need to switch lenses or require additional training, there are no additional costs. This gives them confidence and peace of mind that there will be no “hidden expenses” if they don’t have immediate success.
For more insights into how to discuss toric contact lenses with patients, check out Patient Education Essentials: Helping Astigmatic Patients with Toric Lens FAQs!
When to recommend toric lenses to patients with low astigmatism
Drs. Sawtzky and McFerron agreed that they consider prescribing a toric lens when patients reach at least 0.75 diopters (D) of cylinder. For patients with low astigmatism, Dr. Ellis uses the phoropter to determine whether they find a contact lens with or without cylinder power more comfortable.
In his experience, patients may notice a difference in their vision with just an extra 0.5D of cylinder, which prompts him to check if they report any improvements with an extra 0.25D (reaching the 0.75D threshold of the MyDay toric lens) to discern which type of lens would provide them with clearer vision.
Of note, studies have shown that patients with low astigmatism tend to favor and have improved visual outcomes with toric lenses compared to spherical ones.3,5,6
Conclusion
The MyDay toric lens offers astigmatic patients improved vision with the convenience and safety of a daily disposable lens.
Dr. Sawatzky emphasized that having a toric lens available that consistently provides patients with excellent vision allows her to not only meet patient expectations, but also go above and beyond to build long-term trust and loyalty.
