Thank you to Johnson and Johnson Vision for sponsoring this podcast episode
“I need really thick contact lenses to keep the weight in the right place on my eye.”
“My Contact lenses move around too much.”
You’ve probably heard all of these comments from patients in your chair that have astigmatism and/or wear astigmatism contact lenses. We’re here to confront these misconceptions head-on and discuss strategies for having successful conversations and visual outcomes regarding astigmatism and contact lenses. Today’s expert guest is Dr. Erin Rueff, OD, PhD, FAAO and Chief of the Cornea and Contact Lens department at Marshall B. Ketchum University Eye Center. Her passion for contact lens care started early in her career when she saw the difference a lens can make. “Contact lenses can correct vision, treat ocular diseases, take someone from being disabled — walking into your room not able to drive or having difficulties performing their day to day life activities– and you can design a lens for them and they can walk out able-bodied and able to take on whatever they want in their life.”
While it seems hard to believe that patients may be told that they aren’t candidates for contact lens wear due to astigmatism, the numbers show that there is a definite lag between the number of Americans that have astigmatism and those that wear astigmatism contact lenses. On average 45% of Americans have 0.75 DC or more, but toric contact lenses represent only 27% of soft contact lenses prescribed in the USA. This is despite research showing that prescribing for even low amounts of astigmatism have a significant visual benefit to patients. “The underutilization of astigmatism contact lenses is an eye care provider problem, not a patient problem,” Dr. Rueff explains. “There’s a perception amongst eyecare providers that toric lenses are going to cost you more chair time, that they’ll be more likely to fail, and that patients won’t get as good vision. Those things have been disproven time and again.”
Dr. Rueff cites a study by Dr. Stephanie Cox and Dr. David Berntsten that shows that patients with low amounts of astigmatism do achieve better objective vision in high and low contrast visual environments with toric lenses over spherical lenses. Additionally, patients achieved subjective improvements in vision when fit in astigmatism contact lenses, including improvement in eye strain complaints.
In reality, today’s contact lens designs provide a wide range of parameter option that serves the overwhelming majority of prescriptions with great stabilization and comfort. Studies show that ECPs significantly underestimate the percentage of their patients that are candidates for astigmatism contact lens wear. In a recent survey in the United States, ECPs were asked, “What percentage of your astigmatic patients would you say you could prescribe with just that one [reusable] product?” Responses ranged from 55% to 74% depending on the product. In actuality, the Acuvue Oasys family of lenses covers 99% of spherical and astigmatism prescriptions.
In this episode we talk through the differences between prism ballast astigmatism contact lens stabilization versus blink stabilized designs which incorporate a “double slab off” design, and how base curve, diameter, and sagittal depth all influence contact lens fitting success.