Confidence with low astigmatism correction

When the cylinder value was relatively small, I certainly sometimes questioned whether a toric contact lens was truly necessary, and whether a spherical option would provide sufficiently good vision. This occasionally made me more cautious when raising the topic of toric contact lenses with patients, particularly if they reported that they only wanted to wear contact lenses for social use, and did not report doing any tasks that would be visually demanding.

However, with experience, I gradually began to recognise that correcting even low levels of astigmatism could have a meaningful impact on vision quality in everyday tasks. For example, some patients would describe subtle shadowing, or reduced visual comfort with activities such as night driving or prolonged screen use, despite having good visual acuities. In these situations, I quickly realised that these symptoms were clearly important to patients and not to be overlooked. Observing overall satisfaction levels when these patients were fitted with low-cylinder toric lenses highlighted the clinical value of addressing even small refractive astigmatism. This realisation strengthened my confidence in recommending toric options more proactively.

Observing overall satisfaction levels when these patients were fitted with low-cylinder toric lenses highlighted the clinical value of addressing even small refractive astigmatism. This realisation strengthened my confidence in recommending toric options more proactively

The low astigmat challenge

Fitting low astigmats can sometimes be more challenging than initially expected because the patients’ visual needs often sit in a grey area between toric correction and the mean spherical equivalent.

When the refractive cylinder may appear clinically small and therefore a spherical equivalent is given, the patient may still experience symptoms such as subtle shadowing or reduced contrast sensitivity. These issues are not always obvious during the initial consultation, particularly because tests such as contrast sensitivity are not routinely carried out. This makes it harder to predict which patients will genuinely benefit from a toric contact lens.

In addition, low-cylinder toric lenses typically offer modest but important visual improvements, and these differences can be more noticeable in real-world scenarios rather than in the consulting room.

With modern day lens materials and quick settling times, I’ve learnt that when it comes to fitting low astigmats, the challenge lies not in the fitting process itself, but rather in recognising when small refractive changes will translate into a meaningful improvement for the patient.

Rather than relying solely on the visual acuity values, I began to place greater emphasis on the patient’s symptoms and real-world visual demands

Overcoming uncertainty

As a newly-qualified optometrist, I overcame my initial uncertainty around fitting low astigmats by becoming more attentive to the subtle visual cues that patients described.

Rather than relying solely on the visual acuity values, I began to place greater emphasis on the patient’s symptoms and real-world visual demands. For example, asking targeted questions about real world tasks such as night driving or screen use, as well as asking further follow-up questions to get an overall understanding of the patient’s lifestyle and needs during history taking helped me to identify when prescribing even small cylinder values was clinically significant.

Trialling toric contact lenses more proactively allowed me to see how meaningful the improvement could be for patients. Over time, these experiences strengthened my clinical judgement and confidence in recommending toric options for low astigmats.

I also realised that during sight tests, I would spend time carefully refining the cylinder power and axis to achieve the best possible clarity, and that it did not make sense to invest that level of precision in the refraction, only to disregard it and rely solely on a spherical equivalent when fitting contact lenses.

One of the most valuable lessons I have learnt is to consider the patient’s habitual tasks more closely. Low astigmats who spend long hours on screens or who drive frequently tend to be more sensitive to subtle reductions in clarity, so selecting a toric lens upfront avoids unnecessary trial and error.

I’ve also learnt the value of being consistent in correcting astigmatism across all visual solutions. If a patient relies on full astigmatic correction in their glasses, they often notice even small reductions in clarity when switching to a spherical contact lens. In these cases, starting with a toric lens option helps maintain visual consistency and reduces the likelihood of patients perceiving the vision in their lenses as not as sharp as their spectacles.

Another key point is not to underestimate the role that material and comfort plays. For example, if a patient already has symptoms of dryness, choosing an appropriate material to help with this can support both comfort and stable vision. Ultimately, as with all contact lens work, matching the lens to the patient’s needs and lifestyle gives the best chance of success.

I make it a point to explain that toric lenses can feel slightly different physically compared to spherical lenses, particularly during initial wear

Educating and explaining

When it comes to explaining the need for toric contact lenses to patients, I start off by explaining what astigmatism is. I often find that patients are aware that they have astigmatism and that they have heard the term before but are unaware of what it is and how this translates to needing toric lenses. Using layman’s terms and highlighting the rugby ball versus the football analogy works well for patients as it enables them to visualise their corneal structure.

To help patients appreciate the benefit of correction, I often demonstrate the difference using a trial frame. I show them their vision with and without the astigmatism correction so they can see firsthand how clarity improves. This hands-on approach helps patients understand why even low astigmatism is worth addressing and reassures them that the correction is meaningful.

One habit that has helped me improve consistency in fitting low astigmats is proactively managing patient expectations from the onset. I make it a point to explain that toric lenses can feel slightly different physically compared to spherical lenses, particularly during initial wear, so patients understand what ‘normal’ lens awareness feels like. This helps prevent unnecessary concern and supports adherence.

Another habit I find useful is to reflect on each fitting, noting what worked well and any challenges that were faced, stating how these were overcome and apply these lessons to future low-astigmatism contact lens fittings. Over time, this approach has strengthened both my confidence and success rate in fitting low astigmats.