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Astigmatism Contact Lens Options

I have been told I have astigmatism, and now I want to try contacts....can I?

Explaining astigmatism to patients is one of the most common educational opportunities I encounter with patients.  This is one of those things that sounds really scary, but for the most part it is very simple.  In an ideal scenario, a person's cornea, the clear window on the front of the eye, is perfectly rounded in all areas.  In reality this is not always the case, and when certain areas of the cornea are more steeply curved than others, the resulting condition is known as an astigmatism.  I explain it to patients in a few ways.  If a normal cornea is shaped like a beach ball, a cornea with an astigmatism is more shaped like a football with certain areas being steeper than others.  Another way to think about it is that in a perfectly spherical cornea the prescription in the entire cornea is the same at every point while in an astigmatic cornea the prescription changes in different parts.  Now in order to fit a contact lens to a cornea, the shape of the lens has to match the shape of the eye, and the lens needs to be oriented in such a way that the lens provides the correct prescription to the exact area of the cornea intended.  This is where specially designed contact lens options come into play.

My friend wears soft contact lenses.....can I try these?

People with astigmatism have several options when it comes to contact lenses.  A soft contact lens intended for astigmatism is known as a toric contact lens, and these enable the lens to remain in the exact orientation on the eye the as needed.  You would not want your eyeglasses rotating from side to side every time you blinked, and a toric lens is designed to provide this same level of stable vision.  The tricky part about astigmatism is that the more misshapen the cornea becomes, the less rotation is acceptable for clear vision.  A problem with many of the most common contact lenses is that they are only available in limited shapes and sizes.  When someone falls out of this range, specialty contact lenses are used in order to ensure a good stable fit.  These are one-of-a kind lenses designed using a patients exact eye prescription and shape measurements.  A specialty contact lens lab designs these lenses to perfectly match the needed dimensions.  By allowing the exact measurements to be used in the lens design, the overall fitting success in high astigmatic patients in significantly improved.  Some of these lenses are used on a monthly replacement schedule, but some are used for even up to three months.  This can be a great option for astigmatic patients who have a prescription too high for the common contact lens brands.

I had a doctor mention hard contact lenses.....why would anyone use these?

You may have heard of hard contact lenses and thought they were a thing of the past, but in fact they are still regularly used.  There are many reason why a patient would be a better candidate for hard lenses instead of soft lenses, and astigmatism is one of the most common reasons.  As I mentioned before, in cases of astigmatism the cornea is misshapen to the point where a spherical soft contact lens will not properly match the shape of the cornea.  For many cases, especially with relatively mild astigmatism, this is not the case with hard contact lenses.  A hard contact lens is designed in such a way that it somewhat masks the irregularities in a misshapen cornea because it holds its shape and does not mold to the eye.  It generally is also true that a hard contact lens is not sensitive to lens rotation in the same way as a soft lens.  It may sound surprising, but for a patient with astigmatism, the best option for the most precise vision will often be a hard contact lens.  These lenses are also very healthy for the eyes, and can be used for many months or sometimes even years without needing to be replaced.  The main drawback of hard contact lens wear is patient comfort.  Initially when first trying these lenses it is common to feel a foreign body sensation, but with a well fitted lens that will generally go away within a short period of wear.  This is a hurdle to get over, but with some patience it can provide someone excellent vision and eye health where other contact lens options have not worked.

There are many patients with astigmatism, and I never understand when a patient tells me they have been told in the past they cannot wear contact lenses for this reason.  It is true that standard lens options and the most common contact lens brands may not be an options, but there are many really great specialty contact lens companies that can help design lenses for each individual case.  It may take a little longer to find something that works, but if you have ever had a hard time with contact lenses, and you want to try them again, please let the doctors at Optique know so we can help with your individual needs.

-Dr.  Z       

08 June, 2018