Toric SCL -Teaching versus Practice. How to achieve an ideal fit and vision? | OOLS |

Lakshmi Shinde, informs us about the subtle nuances between teaching the soft contact lenses(SCL) toric and practicing the SCL toric. She summarizes the basics, which include astigmatic focal planes, prevalence of different astigmatism types, and different design considerations. She details the key points that the educators must keep in mind while teaching about the SCL toric and comments on the common aspects of confusion for students and practitioners alike. She explains the different stabilization techniques used in toric SCL by individual brands and how these can impact vision and comfort for specific patients. She also explains the thickness considerations of the toric SCL. She discusses in depth the fitting methods and makes a strong case for using empirical fitting for toric SCL in today’s world.

Lakshmi Shinde details the toric SCL fitting process, pitfalls, and the unique lens rotation considerations to keep in mind for the toric SCL. She enlists the likely difficult toric SCL cases and their management for practitioners and educators alike. Then, she goes on to talk about the current changes in the prescribing trends, especially the shift in mindset needed to prescribe low cylinder lenses. In the end, she presents cases to help review the challenging decisions that we see in practice, and the educators should warn their students about it.

Resources

IACLE Slides and Modules for educators

https://iacle.org/previous-iacle-contact-lens-course/

Brainscape Flashcards

https://www.brainscape.com/packs/contact-lens-i-part-2-3461329

References

Prevalence of astigmatism

Fledelius HC, Stubgaard M. Changes in refraction and corneal curvature during growth and adult life. A cross-sectional study. Acta Ophthalmol (Copenh). 1986 Oct;64(5):487–91

https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1755-3768.1986.tb06959.x

Incidence by age

Fledelius HC. Prevalences of astigmatism and anisometropia in adult danes. Acta Ophthalmol (Copenh). 1984 Jun;62(3):391–400.

https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1755-3768.1984.tb08419.x

Contact lens thickness considerations

Harris MG, Chu CS. The effect of contact lens thickness and corneal toricity on flexure and residual astigmatism. Am J Optom Arch Am Acad Optom. 1972;49(4):304-307.

https://pubmed.ncbi.nlm.nih.gov/4503501/

Eghbali F, Hsui EH, Eghbali K, Weissman BA. Oxygen transmissibility at various locations in hydrogel toric prism-ballasted contact lenses. Optom Vis Sci. 1996;73(3):164-168.

https://pubmed.ncbi.nlm.nih.gov/8725017/

Wechsler S. Average thickness across the surface ofspherical and toric hydrogel lenses. Journal of The British Contact Lens Association. 1985 Jan;8:46–8.

https://www.contactlensjournal.com/article/S0141-7037(85)80026-4/pdf

Toric SCL for less than 0.75 Cyl

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.

https://pubmed.ncbi.nlm.nih.gov/28945646/

Morgan PB, Efron N, Woods CA; International Contact Lens Prescribing Survey Consortium. An international survey of toric contact lens prescribing. Eye Contact Lens. 2013;39(2):132-137.

https://pubmed.ncbi.nlm.nih.gov/23392302/

Troubleshooting difficult toric fits

Tran, LD. Troubleshooting difficult toric fits. Contact lens spectrum, November 2016

https://www.clspectrum.com/issues/2016/november-2016/troubleshooting-difficult-toric-fits

Watch the complete session below:

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