Joel Hunter, MD Refractive Surgeon, Hunter Vision Updated 11/24/20 12:00 PM
You may not need toric contacts for astigmatism.
Turns out that wearing toric contact lens to correct astigmatism may actually make your vision worse. You might have a better result with regular contacts instead. Here’s why.
What are Toric Contact Lenses?
If I could accomplish one thing for you with this article, my hope is to alleviate your desire to wear toric contacts if you see well enough with your current contact lenses.
Standard contact lenses have a spherical surface to create a balanced lens power all throughout the optical area. This is designed to accommodate the case of patients suffering from nearsightedness or farsightedness.
On the other hand, toric contact lenses (so named for their torus-shaped curvature) are shaped similar to a slice from the side of a cylinder, which is appropriate for patients with different corneal curvature. This gives such contact lenses variable meridians so the refractive ability gets higher or lower. Because of its shape, toric contact lenses must be fitted comfortably to avoid slipping, otherwise it will be very uncomfortable for the user to wear. It should also be positioned correctly on the middle axis to create a line of vision that is clear and sharp. These are just some reasons why you have to pay more for toric contact lenses compared to others.
Toric contact lenses come in different types with soft lenses being the most popular among them. Users feel most comfortable using these because of the hydrogel component (or silicone hydrogel for some brands) on the lenses. The problem, however, is that they often get misaligned so users have to constantly readjust their lenses while wearing them. As I mentioned above, the refractive power varies according to the meridian so the lenses have to be kept from rotating every time the eye blinks. So, keeping the lenses in place can be a hassle, especially when you're at work or engaged in outdoor activities.
Other toric contact lenses are designated as RGP (rigid gas permeable), which are reportedly much better in terms of alignment when compared to soft lenses because of their rigid nature. This type was made to achieve the benefits of toric design but with careful control of lens rotation. They are used primarily for severe cases of prescription astigmatism and cost more because of the customized fit that has to be designed.
Whatever toric contact lenses you prefer to use, your eye doctor must consider your comfort, visual acuity, and lens fit so wearing your lenses is always a pleasant experience. For instance, because keeping toric contact lenses can be a challenge, eye doctors achieve an (almost) perfect fit by adding additional bulk at the bottom to keep them from rotating every now and then.
Other methods of keeping the lenses in place include truncating (or sectioning a portion of the lens usually at the bottom area) and adjusting the think or thick zones to take advantage of the pressure on the lower and upper eyelids when blinking so that rotational stability can be achieved. You may also hear from your eye doctor that your toric contact lenses will need ballasting to create a prism-like stabilization (or thicker bottom) or eccentric lenticulation to produce a soft zone.
And yes, you may also request for colored lenses if you like.
Why are Toric Contact Lenses Prescribed for Astigmatism?
I often get this question, “What are the best contacts for astigmatism?” I try to answer them in the best and most honest way that I can.
Clinicians recommend toric contact lenses for patients with astigmatism because of the lenses' ability to accommodate varying degrees of refractive strengths for different amounts of vision. Toric contact lenses were initially approved in the United States in 1978 for commercial distribution to help patients with astigmatism.
In those days, no two toric contact lenses were the same, making it really uncomfortable for the patient to undergo many fitting procedures. The outcome was either a good fit or not at all.
Since then, the technology used to develop this type of lenses has improved to allow doctors to produce better visual acuity and comfort to patients. Eye doctors are now more consistent with the procedure and the results of their practice. They are able to design the lenses in such a way that users can now keep the lenses in place even if they blink several times. Because of this, the abnormal corneal curvature that results to impaired vision by way of differing eye refraction between horizontal and vertical orientations is best managed.
Several medical research publications prove this point. For example, an earlier study conducted in Spain revealed the benefits of disposable toric contact lenses as an appropriate type for correcting astigmatism. Researchers discovered fewer deposits and ocular reactions compared to daily-wear lenses after several tests.
On the other hand, a 2010 study by Turkish ophthalmologists revealed that its patients with low-to-moderate astigmatism have decreased corneal cylinder after using soft toric contact lenses on a regular basis. Patients also noticed improved visual acuity with their lenses on. A more recent study by American researchers in 2018 supports this claim. They conclude that toric contact lenses are a better option when improving patient vision with low-to-moderate astigmatism.
However, this may not always be the case for users.
Does Zero Astigmatism Exist?
Before analyzing why toric contact lenses may not be the answer to your astigmatism, let’s look into the reason why it was created in the first place.
It’s hard to find an eye with no astigmatism. If you keep your definition of astigmatism technically correct enough, it’s impossible to find an eye with zero astigmatism. Perfect curvature doesn’t exist on anyone’s cornea, because it is teeming with epithelial cells growing, moving into place, and falling away. It is a protean, ever-shifting surface where imperfections in curvature aren’t just likely, they’re a certainty.
Clearly, every person in contacts hasn’t been recommended to wear toric contact lenses, though. So where is the line drawn? Ah yes, the decision on where to cross over into toric lenses turns out to be the cause of the problem for most—and ideally the solution, if it’s redrawn correctly.
Why Toric Contact Lenses May Not Always Be the Answer to Your Astigmatism
Astigmatism is a diagnosis given to a lot of people. On the one hand, that’s fitting because the majority of people have some degree of astigmatism. On the other hand, a relatively small minority of those people have enough astigmatism to cause them to see worse than 20/20. This leads to a lot of people who are told (correctly) they have astigmatism, but then are told (usually incorrectly) they’ll have poor vision if they don’t use astigmatism-correcting contact lenses.
For many people—including most people with astigmatism—toric lenses actually lead to fluctuating and frustrating vision. People often try a few different prescriptions for toric lenses and then give up on them, with the lingering feeling that their vision isn’t being corrected as well as it should be. The feeling is reinforced when glasses, which accurately correct the astigmatism, give better vision than their contacts.
And if your toric lenses seem to make your vision worse, switching to a regular contact lens may be the best solution in the end.
Believe it or not, there are patients who have already purchased toric contact lenses and end up not using them because they don’t seem to work. This is attributed to the lens failing to align properly that blurs the line of vision or the pressure of the lens on the eye that creates an uncomfortable feeling.
Others experience excessive dryness as well after wearing the contact lenses. While dry eye syndrome is a common issue among contact lens users, its symptoms can be more pronounced with toric contact lenses too. Thankfully, though, there are already products that come with higher water in hydrogel lenses to retain moisture in the eyes.
Those with light sensitivity issues may also experience extreme fogginess in their eyesight. This, however, occurs less often in patients compared to dry eyes.
Perhaps one of the most persistent complaints that I encounter from patients are lens rotation issues. There was one patient who often complained about her lenses’ very slow return to the desired proper orientation after rubbing his eyes. Her vision fluctuates and ends up with more blur when shifting focus from one object to another.
A study by medical researchers in the United Kingdom measuring visual acuity fluctuations by patients wearing soft toric contact lenses revealed a startling discovery: tests done on the patient inside the clinic cannot simulate the post-session condition once the patient returns home. That is, lighting factors, humidity fluctuations, visual demands, among others are different inside and outside the clinic and thereby bring adverse impacts that cannot be felt by the patient during the lens fitting in a closed environment.
What is even more surprising is the growing number of contradicting research cases that conclude no significant difference between spherical and toric contact lenses when it comes to improving visual acuity. This was the result of evaluation among patients carried out by researchers from Midwestern University. They also reported axis mislocationin the cases they have observed.
There are folks with a lot of astigmatism (but it’s a minority of the population) where toric contact lenses aren’t an option—they’re a necessity. Those people, however, can answer the question of “Do I need toric lenses?” with a simple “yes” and probably aren’t reading this. (If you are in that group, however, then hello! I hope you find this interesting and can help a friend with the information someday!) But for the people who were pretty happy with their contacts until they were told to try toric contacts, maybe this explains why they stink for you.
Simply Test Your Vision with Regular Contact Lenses
When you’ve got a diopter or less of astigmatism, usually you’re going to find more annoyance than help with a toric lens. How would you find this out without having your prescription in front of you? A simple, but surprisingly reliable test is whether or not you feel like your vision is pretty decent with regular contact lenses.
What happens with toric lenses in these cases is you introduce a new variable into the vision. The result of a variable is, well, variable. Toric lenses add the variable of rotation. If you’ve got regular contacts, they can spin around on your eyes all day and you’re none-the-wiser. With toric contacts, if it is sitting 10 degrees off the planned axis, you’ve lost a third of its astigmatism correction and your vision looks weird.
Your toric contact lenses probably come in a box with a label that looks something like this. Here, the prescription has less than one diopter of astigmatism (highlighted in green). Also note the axis (in degrees) of astigmatism directly following it.
Part of the reason toric contact lenses have the shape they do is because a beveled, fatter lower half of the contact is designed to keep it from rotating in circles — almost like an anchor. The problem is how often it’s a super lame, ineffectual anchor. When the toric contact is rotating several degrees clockwise and counter, the fluctuating vision is noticeable and very annoying.
People with low amounts of astigmatism usually fall into the group where the visual cost of those fluctuations outweighs the benefits of trying to correct the astigmatism. It’s a lot easier to see the same 20/20 all the time than to deal with a shifting, on-again-off-again 20/15.
If you were satisfied with your contacts and decided to try toric contacts, there’s a decent chance it wouldn’t work out very well. For this reason, it’s common to see a little bit better with your glasses (which correct the minor amount of astigmatism) than you do with your contacts.
So, do you need toric contacts? If you’re looking for a slight improvement from your regular contact lenses, probably not. If you needed them, it’s likely you usually stick to glasses already because contacts didn’t work for you. The other possibility is you’re the kind soul who needs toric contacts, wears them successfully, and reads this blog just so you could help a friend someday.
What Other Solutions Can I Have for Astigmatism?
I often get asked, “I can't endure toric contact lenses anymore, but can my astigmatism still be corrected?”
When your doctor diagnoses very mild astigmatism, an immediate treatment isn't necessary because corrective lenses can still help your condition.
Your eye doctor may also recommend orthokeratology or what is commonly known as Ortho-K. Patients with fear of undergoing astigmatism surgery can be helped with this method. With permeable contact lenses worn overnight, the cornea is gradually reshaped by flattening the central epithelium. This contact lense covers parts that are thick or thin, forming an even surface. In the morning, the patient wakes up without depending on her glasses or contact lenses. This effect lasts for two days at the most. However, one's vision would revert to its blurry state once Ortho-K use is discontinued.
But if you are already suffering from mild-to-moderate, and severe cases, your doctor may likely recommend laser surgery for astigmatism to provide you with a possibility of achieving permanent solution to restore your 20/20 vision. With the use of excimer laser energy, you may undergo photo-refractive keratectomy or PRK (a method that removes the outer protective layer of the cornea and then removes the corneal tissue), or the more commonly known LASIK surgery.
LASIK has been around for more than 25 years and has earned favorable reviews from astigmatism patients who have noticed the instant results and quick recovery from the procedure. Correction occurs within a day after the surgery and they have no need to wear their eyeglasses or contact lenses anymore. As I’ve declared in my previous post, LASIK has the ability to help you see better than glasses or contact lenses.
While the process is complex, very few experience pain when a qualified and experienced surgeon handles the surgery. Should the patient require further vision correction as he ages (which is rare), adjustments using the same procedure can be made.
How Much Does Lasik Cost to Treat Astigmatism?
I’ll be frank about this topic. LASIK costs may be exorbitant depending on your eye and health condition, your region, your clinic or hospital, the laser technology used in the procedure, your doctor's expertise and qualifications, plus other factors that will definitely raise the bill.
So if you would like to have your astigmatism treated at a New York City hospital equipped with state-of-the-art LASIK technology, you can expect to foot a $6,000 bill. Some clinics can put you off when the costs are presented. If you want to know more about how I arrived at this calculation, you can check my detailed LASIK costs here.
And if you are suffering from extreme astigmatism, you could be recommended to undergo a customized treatment that uses newer technology such as wavefront LASIK and bladeless LASIK (or femtosecond laser technology). Don’t forget that your doctor's eye surgery experience and expertise can also drive the cost much higher.
Plus, some patients get to discover hidden costs only after attempting to check out of the clinic. These include (but are not limited to) medications and disposable medical supplies, royalty fees for the laser equipment manufacturer, overhead cost for the surgery clinic or hospital, pre-operation consultancy fee, eye examination fee, and the list goes on. This is a sad reality that the medical community is continuing to fight to preserve our integrity.
But with all these costs, I strongly urge you not to give up on getting the right treatment. There are still LASIK services that provide you with better quality and patient care for a price that is could fit within your budget. Here’s how you can find that.
Where Can I Find an Affordable Treatment for Astigmatism?
Now that you know about the possibility of helping ease your eye condition, it all boils down to the question: Can I afford a LASIK procedure for my astigmatism?
What I always advise my patients, before you ask about how much is LASIK, is you need to consider first the value you’ll be having from the procedure.
There’s no question that LASIK is a great personal investment but we understand if paying out-of-pocket is something impossible at this time.
The good news, however, is that eye surgery cost in Orlando, Florida is now more affordable with a payment plan tailored to your tight budget.
At Hunter Vision, we fully understand the value of taking care of your eyes with or without expensive procedures. You get expert care from one of Florida's best eye doctors BUT without asking you to dig a hole in your pocket though our payment plan.
Your eyes are too important to try to save a few dollars. Go somewhere that charges enough for you to be comfortable throughout the process.
We see far too many patients who tried to save a few dollars elsewhere end up here for help. Most of our patients pay a bit over $130 per month at 0% interest for 24 months to change their whole world. I’d love to see you here, but I care way more that the place you choose is giving you all you deserve.
Our affordable payment plans for vision correction surgeries including LASIK can fit your tight budget. That's why we offer payment plans for as low as $130 per month so you can start and end your day without your eyeglasses.
Author: Joel Hunter, MD is an Ophthalmologist, Refractive Surgeon, and the Founder of Hunter Vision, a LASIK Clinic in Orlando, Florida.
A recognized and respected specialist in vision correction who has performed a countless number of refractive surgeries, Joel gives lectures across the country and trains fellow doctors in the newest LASIK surgery techniques.