Figure 1: Results showing extent of agreement or disagreement with the statement ‘I usually do not offer soft toric contact lenses because fitting them takes too much communication and chair time.’ Data is from 2022 for all markets except Russia, which is from 2021
Soft toric contact lens prescribing rates have continuously increased over the past two decades. An international survey in 2011 reported that 23% of all soft contact lens fits were torics,1 which steadily increased to 28% by 2022.2
Despite this increasing trend, a wide range in toric lens prescribing levels remains between various countries. Toric lens prescribing rates range from a low of 14 to 18% in Lithuania and Japan, up to more than 50% in the Netherlands and Israel.2
Factors attributed to this variability include differences in cost, training and beliefs among practitioners.3 There is also a long-held belief that toric lens fittings are complex and time-consuming.4
Expansions in toric lens parameters have allowed for an increase in toric lens fits,3 but patients still report not knowing toric lenses exist or that they are not being offered by their eye care practitioner (ECP).4
Professional Belief Survey Results
A recent survey of 1,028 ECPs conducted in 2021 in Russia and in 2022 for the other markets, assessed the prescribing beliefs of ECPs in all six countries5 (see figure 1).
Globally, on average 68% of practitioners surveyed disagreed with the statement that ‘fitting soft toric lenses takes too much chair time’, while 14% of practitioners agreed.5
Those in the United Kingdom, United States and South Korea had the greatest level of disagreement with the statement, ranging from 68% to 87%.5 Meanwhile, 21% to 46% of practitioners in Japan, China and Russia felt that toric lens fits are too time consuming.5
What the Evidence Shows:
Research shows that soft toric fitting is relatively simple and quick, with one study reporting that the average time to fit non-toric lens wearers into toric lenses is approximately 22 minutes.4
No significant difference in time between fitting spherical and toric lenses has been demonstrated6 and this study demonstrated that fitting a spherical lens took 9.0 minutes, compared to only 10.2 minutes for a toric lens.6
This misbelief of soft torics taking longer to fit may result in practitioners thinking that toric lenses take significant time to orientate to intended position, have poorer success rates and a greater number of lenses are needed during fittings.
However, a high rate of success is seen with toric lens fittings, with studies demonstrating 88-90% success rates on initial fits.4,7 Of note is one study that showed the rate of achieving a successful fit on the first attempt is actually slightly higher in torics at 84%, compared to spherical lenses at 79%.6
Transitioning spherical lens wearers into toric lenses can also be easily achieved, with a 94% success rate reported.4 In addition, the number of lenses needed to achieve a successful fit is equivalent between spherical and toric modalities.6
With the comparable fitting times and success rates between spherical and toric lenses, there are many benefits of using soft torics in those with astigmatism. Overall, toric lenses outperform spherical lenses in astigmatic patients.
This is shown by over 71% of astigmatic participants reporting a preference for toric lenses across two studies.6,8 Furthermore, even individuals with lower levels of astigmatism (0.75D cyl) report a preference for toric lenses.8
This is likely due to the improved vision experienced by spherical wearers who were refit into toric lenses.4,6 Ratings of subjective comfort between spherical and toric lenses are also comparable.8
Conclusion
Practitioners should be proactive in fitting toric lenses as fitting times and success rates have clearly been demonstrated to be comparable to spherical lenses. In addition, practitioners should be aware of the benefits patients gain from being fit with toric lenses.
- Dr Junghee Seo is a clinical associate at the Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo.
- John Meyler is head of global professional education at Johnson & Johnson Medical Ltd.
References
1. Morgan PB, Woods CA, Tranoudis IG, et al. International contact lens prescribing in 2011. Contact Lens Spectrum. 2012; 27: 26-31.
2. Morgan PB, Woods CA, Tranoudis IG, et al. International contact lens prescribing in 2022. Contact Lens Spectrum. 2023; 38: 28-35.
3. Morgan PB & Efron N. Global contact lens prescribing 2000-2020. Clinical and Experimental Optometry. 2022; 105(3): 298-312.
4. Sulley A, Young G, Lorenz KO, Hunt C. Clinical evaluation of fitting toric soft contact lenses to current non-users. Ophthalmic Physiol Opt. 2013; 33(2):94-103.
5. Johnson & Johnson Vision Care. Online survey of 1,028 Eye Care Professionals across United States, United Kingdom, Russia, China, Japan and South Korea. Data on file 2021 (Russia) and 2022 (other markets).
6. Cox SM, Berntsen DA, Bickle KM, et al. Efficacy of toric contact lenses in fitting and patient-reported outcomes in contact lens wearers. Eye Contact Lens. 2018; 44 Suppl 1: S296-S299.
7. Morgan PB, Efron SE, Efron N, Hill EA. Inefficacy of apheric soft contact lenses for the correction of low levels of astigmatism. Optom Vis Sci. 2005; 82(9):823-28.
8. Dabkowski JA, Roach MP, Begley CG. Soft toric versus spherical contact lenses in myopes with low astigmatism. Int Contact Lens Clin 1992; 19;11/12: 252-255.
9. Richdale K, Berntsen DA, Mack CJ, Merchea MM, Barr JT. Visual acuity with spherical and toric soft contact lenses in low- to moderate-astigmatic eyes. Optom Vis Sci. 2007;84(10):969-75.
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