A Guide to Clinical Contact Lens Management

Signs, Symptoms, Diagnosis and Management

Academy for Eyecare Excellence™
IN COOPERATION WITH
Centre for Contact Lens Research
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Toric Lens Designs
Various Toric Lens Markings

Lens Mislocation – Soft Toric

Tear break-up time, deposits

Symptoms

  • Decreased or variable vision

Signs

  • Toric location marks misalign
  • Sphero-cylindrical over-refraction is non-plano

Etiology

  • Axis of hydrogel toric lens fails to locate correctly or consistently

Prevalence

  • Common. But newer designs reducing the prevalence

Differential Diagnosis

  • Compare with actual change in ocular refraction
  • For empirical confirmation of toric lens power, check:
    1. relationship to refraction
    2. relation between ocular and corneal cylinder axis y

Management

  • If asymptomatic, no treatment
  • Reorder lens with compensatory axis change
  • Change lens design. Figure above shows designs with shading for the thickened stabilization zones
  • Avoid compromising cornea with low Dk/t toric lenses; consider SiH toric lenses or GP lenses