Prescribing for Astigmatism

Uncovering and Fixing the Problem of Toric Lens Dropout

prescribing for astigmatism

Uncovering and Fixing the Problem of Toric Lens Dropout


As contact lens technology for astigmatic patients progressively improves, the overall contact lens industry remains flat. In fact, almost two-thirds of toric contact lens wearers are in silicone hydrogel toric lenses. Nevertheless, approximately 65 percent of astigmatic patients drop out of contact lenses within their first year of wear. This statistic is staggering. The big question is why is this happening?

Possible Causes for Dropout

The number-one reason why astigmatic patients drop out of lens wear is inadequate vision, followed by comfort complaints. Based on my experience in clinical practice, I would agree that's correct. It wasn't long ago that toric lenses were quite challenging to fit. In fact, I have heard many experienced lens fitters express frustration with toric lenses.

With older toric lens designs, reproducibility was a major issue. Until recently, we still noticed issues with lens rotation and fluctuation. This meant poor vision and dissatisfaction for patients. Even successful toric wearers felt that they had to compromise vision to wear contact lenses. With newer technologies, compromise should be less acceptable.

In the past few years, I've noticed toric lens fitting has become much easier. Patients seem to be attaining stable, clear vision more quickly — which means less chair time and happier patients. The improved efficiency can be attributed to newer lens designs. Almost every major contact lens manufacturer has released a new toric lens over the past few years.

But even with the improvements in new toric lenses, the dropout rate is still high. Why are astigmatic patients still complaining about vision and comfort?

Finding the Right Technology

I do not believe that choosing the newest technology is always the solution. We must choose the appropriate technology to satisfy vision and comfort for each patient.

As we all know, every patient is different. Make sure that you are asking astigmatic patients the right questions to uncover the silent sufferers. "Does your vision fluctuate during the day? Can you see clearly throughout the day? If you could change anything about your lenses, what would it be?" I know that these are loaded questions, but I find that they help throughout the fitting process with choosing the best technology for my patients.

In recessionary times, we cannot help but consider economics. Many practices in the United States have seen the volume of patients decrease over the past year. Don't let this affect lens selection. Even if patients are buying less from your practice, if you give them lenses that will satisfy all of their needs, they will remain loyal to you. And in the future, this loyalty will pay dividends. It is much easier to grow your practice based on the patients you already have than it is to recruit new patients.

Fitting for astigmatism has become a much more efficient process. Communication is critical in keeping our toric patients happy in contact lenses. If you listen to your patients and satisfy their vision and comfort needs, you and your patients will learn to love toric lenses. CLS

For references, please visit and click on document #169.

Dr. Thakrar has a specialty contact lens practice and is a clinical optometrist at TLC Laser Eye Center in Mississauga, Ontario. She is also a professional affairs consultant to Vistakon.