The Evolution of Toric Contact Lenses

Before I became an optometrist, I worked as an optician, travelling between several Walmart stores and collaborating closely with many optometrists. In the early days of toric contact lenses, most eye care providers hesitated to recommend them, because fitting these lenses required extra chair time, and the fitting sets had limited power ranges. Furthermore, there were very few options for frequent-replacement lenses. For example, the first daily disposable toric lens was introduced in 2002 (Focus Dailies by Ciba Vision). I would often excite patients about the possibility of wearing toric contact lenses, only for them to leave the examination room disheartened, saying, “No, the doctor said I wasn’t a good candidate.”

TRADITIONAL TORIC CONTACT LENSES POSED SIGNIFICANT CHALLENGES FOR USERS

Many patients discontinue using toric contact lenses due to poor lens stability and comfort. In the past, when patients inserted these lenses, it would often take several minutes of blinking for the lens to stabilize and provide clear vision. Additionally, many patients would report feeling aware of the lenses in their eyes, contributing to increased discomfort (Figure 1). For these reasons, I have observed a high dropout rate among patients using older toric contact lenses (Figure 2).

Figure 1. Many wearers of older-technology toric contact lenses were not satisfied with the comfort of those lenses. In a large survey of contact lens wearers conducted in 2020, patients with astigmatism who wore toric lenses (n=362) were 57% more likely than non-astigmatic lens wearers (n=1,094) to report that they experienced dryness. Comparing the same lens-wearing populations, toric lens wearers were 82% more likely to report discomfort at the end of the day.¹
1. Multi Sponsor Surveys Inc. The 2020 Gallup target market report on the market for toric contact lenses.

Figure 2. A 2018 survey of more than 500 contact lens wearers revealed that 1 in 4 toric lens wearers (25%) discontinued their lenses within 1 year of being fit. Contrastingly, 19% of new spherical lens wearers dropped out over the same time period.¹ The most cited reasons for dropping out were visual issues and discomfort.
1. Sulley A, Young G, Hunt C, et al. Retention rates in new contact lens wearers. Eye Contact Lens. 2018;44(Suppl1):S273-S282.

NEW DESIGNS, MATERIALS, AND STABILITY FEATURES BROADEN THE APPEAL OF TORIC CONTACT LENSES

Fortunately, once I earned my optometry degree, toric contact lens technology had significantly improved. I am a big fan of innovations in eye care and enjoy introducing the latest technologies to my patients. As I mentioned, astigmatic patients were often fitted with spherical contacts to compensate for their astigmatism for various reasons. While this sometimes provided “good enough” results, we optometrists can now offer these patients clearer vision and greater comfort, in addition to a broader availability of dioptric powers.

Materials

Recent advancements in contact lens materials have been impressive. Several manufacturers have produced materials made with a high water content to prevent dehydration and to be more comfortable for wearers; one example is silicone hydrogels that are more porous and hydrophilic than regular hydrogel materials. These materials also transmit oxygen to the corneal surface better than previous versions, thereby promoting the health of the cornea. Another new, beneficial innovation is biomimetic coatings that help contact lenses resist bacteria and lipid deposits.

Stability

Stability is of the utmost importance with toric contact lenses so that the astigmatic correction targets the affected area of the eye, and this is where the technology has greatly evolved in recent years. Several manufacturers have improved the orientation and stabilization features of toric contact lenses in a way that makes them more comfortable and less noticeable for patients. Some examples include CooperVision’s Optimized Toric Lens Geometry™ on the MyDay^® Toric; Bausch + Lomb’s OpticAlign^® Design in its ULTRA line of contacts; and Alcon’s PRECISION BALANCE 8|4^® in its TOTAL^® and PRECISION^® contact lenses.

Most toric contact lenses also feature orientation markings to help patients insert them correctly for the best placement. For example, I use DAILIES TOTAL1^® for Astigmatism (Alcon), which has a single scribe at the 6-o’clock position and stabilization points at the 4-o’clock and 8-o’clock positions to help patients orient them during insertion. Patients tell me these lenses settle quickly, are comfortable, and their vision remains clear for a full day.

I believe that these stabilization technologies and orientation marks for patients have made the adaptation period of new-technology toric contact lenses much shorter for patients.

Wider Dioptric Ranges

In addition to improving toric contact lenses’ designs and materials, manufacturers have expanded their treatment ranges in recent years. Therefore, we no longer need to mask low amounts of astigmatism with a spherical lens, and the lenses can accommodate changes in astigmatism over time.

I introduce a toric lens for even a minimal amount of astigmatism, as little as 0.75 D. Visual acuity really affects how people of any age perform, and we should use the technology we have available to give our patients their best possible vision.

NAVIGATING DISCUSSIONS ABOUT PRICE

Most of my patients work blue-collar jobs. They work very hard and save their money. They believe they deserve the best quality for the purchases that matter to them. I’ve learned that one of the worst things we practitioners can do is assume that a hardworking person cannot afford the premium option. I always present my patients with all the available options and allow them to make their own decisions. I encourage them to say, “This is what I can afford; what do you recommend?” I cannot emphasize enough the importance of not prejudging patients’ ability to pay.

My highest conversion rate with toric contact lenses is when I introduce new-technology lenses. I typically educate my patients on the advantages of toric contact lenses compared to spherical ones by explaining that toric lenses provide better visual acuity and increased comfort for those with astigmatism. Communicating these benefits to patients often helps them overcome any concerns about the price.

THE IMPORTANCE OF EDUCATION

Toric contact lenses aren’t in broader use because of an education gap about the new technologies for physicians and patients. In my area, it is primarily that patients are unaware of these options, mainly because of the language barrier. For many of them, I am the first doctor they’ve encountered who speaks fluent Spanish, and most of them recount that their previous eye care professionals told them they weren’t good candidates for toric contact lenses. They are surprised when I tell them there is a contact lens that can treat their astigmatism. Ultimately, it’s up to us clinicians to deliver the message and present it in an engaging and motivating way. There’s a difference in presentation between: “I have these new lenses that you can try if you like,” and: “I’m so glad you’re here. I have these great lenses I want you to try, because they’re amazing and I think you’ll love them.”

Conclusions

From a business perspective, introducing patients to new-technology contact lenses at each visit motivates them to stay in their contacts, because their comfort and performance improve yearly. Keeping patients in the exact same contact lenses year after year diminishes the value of scheduling a visit with their optometrist. If we are not changing anything, we devalue ourselves and our services.