Taming torics

Here, optometrist, clinic supervisor at Aston University, and Alcon professional education faculty member Hatim Hassanali speaks to OT about how he developed his toric contact lens skills.

Can you describe a moment when your confidence in fitting toric lenses noticeably improved? What made that experience a turning point for you?

A key turning point came from recognising the importance of carrying the same level of precision from the sight test into contact lens fitting.

During refraction, a considerable amount of time is spent refining the cylinder power and axis to achieve the clearest possible vision. In the early stages of my practice, I had a tendency to question whether that precision was always necessary when selecting contact lenses, and whether masking the astigmatism was a suitable alternative, particularly for patients with lower levels of astigmatism.

My confidence with fitting toric lenses noticeably grew through seeing first-hand the difference that toric lenses could make in practice. Patients would almost always report sharper, more stable vision and improvements in everyday tasks such as driving, prolonged screen use or reading fine detail. Observing these outcomes repeatedly, reinforced that even relatively small amounts of astigmatism can have a meaningful impact on visual quality despite the initial acuity being good in spherical only lenses.

That shift in perspective transformed my toric fittings from something that occasionally felt like a judgement call into an evidence-based approach of the clinical findings, making recommendations feel more tailored to the patient’s lifestyle and needs.

My confidence with fitting toric lenses noticeably grew through seeing first-hand the difference that toric lenses could make in practice

What were the biggest challenges or misconceptions you faced as a newly-qualified optometrist when first fitting toric lenses, and how did you overcome them?

One of the biggest misconceptions I had early in my career was assuming that patients with lower levels of astigmatism would be adequately corrected with a spherical contact lens. It was easy to view a small cylinder value as being clinically insignificant, particularly if the patient did not have any visual concerns. Over time, I realised that even low levels of uncorrected astigmatism can have a noticeable impact on visual comfort, particularly for patients with demanding visual tasks, such as prolonged screen use or night driving.

Another challenge was recognising that fitting toric lenses successfully relies on more than simply selecting the correct prescription. Understanding lens orientation and different stabilisation designs became just as important as the refraction itself. As my experience grew, so did my confidence in assessing these factors and making adjustments where necessary.

Ultimately, overcoming these challenges came from having open conversations about the patient's visual expectations in contact lenses. Seeing the improvement in both visual comfort and patient satisfaction reinforced the idea that toric lenses should be considered as the first choice, rather than being reserved only for higher levels of astigmatism.

Combining the results of the clinical assessment with open conversations has helped me build confidence and achieve more consistent results

What practical techniques, communication approaches, or habits help you achieve successful toric lens fits and positive patient outcomes?

A key habit that has helped improve my success rate with toric lens fittings is taking the time during history and symptoms to understand exactly what the patient is hoping to achieve from contact lenses before selecting a lens. Instead of focusing solely on the prescription, I consider their lifestyle, visual demands and the situations where they most want freedom from spectacles.

From a clinical perspective, I’ve learnt the importance of maintaining the same level of precision throughout the process. If time is spent refining the cylinder power and axis during the sight test, it makes sense to carry that attention to detail into the contact lens fitting.

I have also found it beneficial to understand the different stabilisation techniques used by different lens manufacturers, as this allows me to make informed adjustments if the initial lens does not perform as expected.

As always, clear communication remains paramount for successful outcomes. I set clear expectations from the outset, explaining that toric lenses can feel different to spherical lenses and that finding the right lens may occasionally require refinement. This helps patients view the fitting process as a journey rather than expecting an immediate perfect outcome. Combining the results of the clinical assessment with open conversations has helped me build confidence and achieve more consistent results.

Looking back at your early career self, what advice would you give yourself about fitting toric contact lenses in practice?

The biggest piece of reassurance I would give my early career self is that confidence comes through experience, and it is important to keep offering contact lenses as an option even whilst still developing your skills. Early on, it can be easy to focus on achieving the ‘perfect’ fit straight away, but successful contact lens practice is often about understanding the patient, managing expectations, and being able to successfully refine the fit when needed.

I would also remind myself that successful contact lens fitting is not just about selecting the correct lens; it is about understanding the patient sitting in front of you. Taking the time to ask the right questions, understand their visual priorities, and setting realistic expectations plays a huge role in achieving a positive outcome. A lens fitting is only truly considered successful when it meets the patient’s lifestyle and gives them the confidence in their lenses.