Peter wrote:
I have mild myopia in both eyes (-1.00) and “mild” astigmatism in my left eye. I am trialling soft, disposable contact lenses and find that middle-to-near objects are often blurry (with both -1.00 or -0.75 lenses, but with my astigmatism uncorrected as I’m told it is very mild).

My optician says there is nothing he can do as this is due to my myopia being mild combined with having the contact lens “on the eye” (unlike with glasses), and suggests I wear glasses for “near vision” work and contacts for outdoor sports, etc.

Is it really impossible for me to have contact lenses that give me good near AND far vision? I’d quite like to wear them every day for both near and far vision.

Thanks

ANSWER

Dear Peter

This is an interesting question. As a contact lens expert, I am shocked to withness in my everyday practice how eye care professionnals handle astigmatism in contact lenses. In my book, this is a major mistake to not fully compensate for astigmatism, with appropriate toric lenses. In fact these professionals should be convinced of misleading the public and of malpratice. Astigmatism distorts the vision even if the amount of astigmatism is low. To compensate for it, what your optician did (wrongly) is to increase the amount of myopia. This is called fitting with a spherical equivalent technique. THis is not helping your vision at computer distance or at near because an increase in myopic correction triggers an increased accommodation effort that  can end up with ocular fatigue and a blurred vision. This is exactly what you have experienced.

In the past, astigmatism was undercorrected or spherically compensated because of the bad quality of soft toric contact lenses. They were not accurate, not stable in the eye and did not provide better vision compared with spherical lenses. This is not true anymore. Modern design of contact lenses are available and they are really stable, even for small amount of astigmatism. I strongly recommend Oasys Acuvue for Astigmatism, Air Optix Torics or Cooper’s Biofinity Toric as very good products. There is no rational to not use them on a day-to-day basis. At least, every eyecare practitionner should at least propose trying toric contact lenses and let the patient to decide if this is a better option than a spherical lens. I had patients with major myopic correction and small astigmatism who said WOW when i fitted them in toric contact lenses (for the first time) but I had also some patients who were low myopes with higher astigmatism who did not find any difference in their vision comparing spherical and toric contact lenses. Since there is no way to know in advance what the outcome will be, the only rational approach is to try it (toric vs spherical) and to let the patient experience the difference.

If your optician is not familiar with toric contact lens correction, or denies the value of it, consider consulting an optometrist that is skilled in contact lens fitting and ask to try toric lenses. There is no reason to not see clearly at near and intermediate distance with these lenses except if you are 45 years old and over where presbyopia can come in play. Even then, astigmatism should be considered to correct your vision in contact lenses. We can use monovision strategy or to use multifocal toric contact lenses as well.

Good luck,
Langis Michaud, OD, MSc, FAAO
Associate Professor, U de Montréal

Daelite wrote:

I have been wearing Frequency 55 Toric contacts for the past 3 weeks. The first trial pair I could see, but I have a lot of dryness and couldn’t read a book or computer while wearing them.

I went in for my follow up and the opt said he thinks they are too snug and my eyes couldn’t breathe. So I get the second pair and those constantly are blurry since they won’t stay in place & they always feel like there is a foreign substance in my eye.

I am an avid reader and computer user but cannot do these things while wearing contacts. I see great at a distance but closer than four feet I can’t see at all. I’m at a loss what to do.

Thanks for your thoughts,
Daelite

ANSWER

Hi Daelite,

Finding toric contact lenses that work well can sometimes be a bit of a challenge.  You obviously want them to be comfortable, but also need good vision.  It is important with toric contact lenses that the contacts be stable on your eyes.  If they are not stable they will rotate, which will cause blurry vision as you have experienced with the second pair.  With near tasks such as reading or using a computer we look at much finer detail than if we were looking at something in the distance.  Therefore this is usually where vision problems will be more obvious.  The more astigmatism you have, the harder it will be to get really crisp near vision.  There is another factor here that can affect near vision and that is age.  I don’t know how old you are, but once you get into your forties it becomes harder to change your focus from distance to near tasks. If you are in your forties, this could be the reason for the near blur.  There are a few limitations with toric contact lenses.  They only come in certain parameters, which may vary from the exact parameters you have in your glasses.  For example if your glasses prescription was -1.00-1.50 x 095, the closest contact lens I could prescribe for you would be -1.00 -1.25 x 90 or -1.00 -1.25 x 100.  So, in this example, looking at the last number, which is the axis, the contact lens that you need would always be theoretically 5 degrees off.  Usually this does not cause a huge problem, but again the more astigmatism you have the more this does matter.   The other thing that can be a limitation is that the contacts will always rotate a small amount.  This again usually does not cause a huge problem, but it can make the vision not as crisp as with glasses because obviously glasses are stationary on your face.  I wouldn’t get discouraged yet.  It is worth trying another type of toric contact lens.  Each brand is designed differently so one brand may be horrible, but another brand may be perfect for you.  It is not uncommon with toric contact lenses to have to try a few types before finding one that works well.

Dr. Doman

Sadia wrote:

Hi,

I have astigmatism of -1.00 in both eyes but do not need any sphere correction. I would like to get the freshlook toric colourblends however, more toric lenses I am told are made in quarters. So for the contacts I would like they only have -0.75 or -1.25.

My question is should I be going with -0.75 or -1.25?

Thanks

ANSWER

Dear Sadia:

This is a question that you should ask you optometrist because he/she would be most familiar with your refractive error and should be the one choosing/prescribing your lens correction. In normal circumstances, the patient does not choose the prescription they wear – that is left up to the prescribing doctor. In my practice I might tend to use the lower power astigmatism correction because if the lens rotates away from its ideal fitting position, it will have a less noticeable affect on your vision. However, there are many factors that must be taken into account. Check with your optometrist.

Dr. Smit

Ross wrote:

I currently wear Frequency 55 Torics with the following prescriptions 8.7/14.4 -1.75 -4.75×180 and 8.7/14.4 -2.00 -4.75×180.

They are really uncomfortable with burning and the feeling that something is in my eyes. Vision is blurry after a couple of hour. Lenses do not adjust on my eyes. Sometimes I have to manually adjust them with my finger then they are clear again. I have tried two other brands, Proclear Torics and Preference Torics, all with the same outcome. I have also tried switching solutions to a preservative free solution and cleaning agent, but they still burn.

I would like to try gas permeable lenses, but the last optometrist I visited wouldn’t fit me with them because she said they would be uncomfortable. From what I’ve read online, it seems like they would work for me. I used to wear hard contacts about 12 to 15 years ago, and don’t remember them being that uncomfortable. Can you tell from my soft lens prescription if gas permeable lenses would work on my eyes. Any insight would be appreciated. I went to a Lasik consultation this week and told I was a good candidate, but I just don’t have $3,200 lying around and I’m a Dave Ramsey follower so no borrowing money. Thanks for the help.

ANSWER

Dear Ross:

Based on the prescription provided, it is fair to say that you have a lot of astigmatism, and this makes clear and comfortable vision with contact lenses difficult to achieve. Great progress has been made in the materials and designs used to make soft contact lenses for astigmatism, but not everyone is able to obtain the clarity and comfort that they might have anticipated. The burning that you mention, even with preservative free solutions might indicate that your eyes are somewhat dry. This would make success even more difficult.

It is possible that you may be successful with rigid contact lenses, but again, your prescription, and perhaps some dryness issues, would make a successful fitting more of a challenge. As well, success with rigid contact lenses in the past does not necessarily predict success in the future. Perhaps the reasons why you discontinued rigid contact lenses in the past are still present and these might present difficulties for successful fitting at this time as well. However, I think it might be worth a try, as you certainly seem motivated to wear contact lenses. If your current optometrist is reluctant to attempt a rigid lens fitting, she may be able to refer you to one of her colleagues who might be willing to take on the task.

Best of luck,
Dr. Henry Smit