COVER HEADLINE: A Toric for Today
COVER SUBHEADLINE: ECPs discuss a new option: the PureVision2
with High Definition Optics For Astigmatism.
SECTION HEADLINE: Quality Vision with no Trade-Offs
SECTION SUBHEADLINE: PureVision2 HD For Astigmatism delivers
what patients say they want.
Thomas Quinn, OD, MS, FAAO (Moderator): One way we, as eyecare
practitioners, can describe how we serve our patients is “to help them live better by
seeing better.” I think we agree that in order to do that we have to determine our
patient’s needs, which means we have to learn about them. Toward that goal, when
you walk into an exam lane with a patient waiting for you, what do you want to
know about him or her?
Harue Marsden, OD, MS, FAAO: In the case history, patients don’t always
provide specific information about their vision, but they tell what they do for a
living, what they do for fun and how they use their eyes on a day-to-day basis. We
need to take that information and apply it to the clinical data we collect. The case
history should be more than just a piece of paper we ask patients to fill out.
Keith Basinger, OD: I agree. Learning about the patient’s lifestyle is key.
David Geffen, OD, FAAO: It’s crucial to ask open-ended questions. Patients
may think we want quick yes or no answers when we really want to reveal what
they’re truly thinking and what underlies the answers. I try to make sure everything
I ask incorporates discussion versus a quick answer.
Dr. Quinn: Do we have any tools to make this information-gathering process
Ami Abel Epstein, OD, FAAO: Typically, the intake form contains lifestyle
questions. However, some patients think they have a problem that can’t be
addressed, so they don’t mention it. With that in mind, we ask additional questions,
such as whether they’re having problems performing a specific activity.
Dr. Quinn: So the form is a place to start and then you follow up with a
Dr. Marsden: Yes, the history goes on throughout the examination. As we
are conversing with patients, topics arise that they may not have mentioned on
their intake form. For example, if they say they’re going camping next week, we
can ask what they do while they camp. I think, too, we should be careful not to
focus too narrowly on hobbies. We want to find out how patients use their eyes
every day of the week.
Dr. Geffen: We train our staff to ask questions during the pre-test exam and
when they take patients to the exam room. They make brief notes on the exam
chart, such as “patient works on a computer” or “patient’s hobby is X.”
Dr. Quinn: Do you train staff members to probe further in those areas?
Dr. Geffen: We have a list of questions for staff to ask during pre-testing. We
also train them on how to describe each test and they’re trained to ask additional
questions based on information provided on the intake form. We plant seeds
throughout the process about what vision-correction options are available to
address certain needs.
Research Reveals Patients’ Eye-Related Needs
Alexis Vogt, PhD: The recently conducted Needs, Symptoms, Incidence,
Global Eye Health Trends (NSIGHT) Study is a very useful assessment of the
needs and preferences of patients who require vision correction. (See “The
NSIGHT Study,” below.) The study provides a detailed look at patients’ eye- and
vision-related symptoms, which gives eyecare practitioners valuable clues about
how to ensure patient satisfaction with vision care products and treatment
According to NSIGHT, glare and halos are among the symptoms most often
experienced by patients who require vision correction. Nearly 90% of the 3,800
patients surveyed for NSIGHT reported experiencing glare and halos as well as
lacking an adequate resolution for the problems (Figure 1). Among patients with
astigmatism in particular (39% of respondents), a commonly reported symptom
was blurry or hazy vision. In that group, 46.5% of the patients experienced blurry
or hazy vision, and 87% considered it bothersome.
Other studies contain similar findings. In one that specifically examined
patients who wear toric contact lenses, 47% of subjects reported experiencing
blurry or hazy vision, 37% reported fluctuating vision, 32% reported distorted
vision and 32% reported glare and halos in low-light conditions.
Interestingly, a common thread across studies is the value patients place on
quality vision. NSIGHT revealed that product features relating to vision quality are
highly important to patients around the world. In the study’s analysis of 40 product
features, six of the seven top-ranked features related to vision, all with scores
signifying high importance. In the hierarchy of eight major categories of product
features, vision ranked highest and was the only category in the “highly important”
range. Similarly, in a survey of 201 astigmatic contact lens wearers, the benefit of a
soft toric contact lens considered to be of the highest relative importance was that
the lens “deliver consistently clear vision at all times.”
Given all of this data, eyecare practitioners should expect that achieving the
best vision possible is of paramount importance to their patients. From my point of
view as an optical physicist at Bausch + Lomb, it’s my job to wonder why so many
people are experiencing these problems and feeling as if there is no solution.
Dr. Marsden: Because for decades, they’ve heard that’s as good as it gets.
Dr. Vogt: Exactly, and market research confirms that. A 2005 report indicated
that only 21% of astigmatic patients are wearing soft toric contact lenses. A
report from 2008 indicated that 40% of astigmatic patients believe their
astigmatism precludes them from wearing contact lenses, 30% have not tried toric
contact lenses due to advice from their eyecare practitioners, and two out of three
are highly motivated for a solution to better address their vision needs.
Many patients have problems with vision because they’re frequently in
settings where glare and halos are frequent. For example, millions of us drive to
work in the dark and sometimes home from work, too. We have headlights coming
toward us, which are a major source of glare and halos. When I try to explain glare
or halo, I always mention the car headlight. People can recognize that, and they’ve
seen what it looks like. We also see a lot of movies. More than half the population
goes to a movie at least once per month. So, we’re in situations where glare and
halos are prevalent.
Also, as we know, the imperfections or optical aberrations in our eyes
contribute to the visual symptoms we experience, and spherical aberration relates
directly to glare and halos (Figures 2 and 3). In addition to contributing to glare
and halos, it degrades retinal image quality and reduces contrast sensitivity and
low-contrast visual acuity.
Reducing Spherical Aberration Improves Quality of Vision
Dr. Vogt: It follows then that if we can reduce the presence of spherical
aberration, we can reduce glare and halos. Through the research we reviewed
previously, patients are telling us they want the glare and halos they experience
while wearing their eyeglasses and contact lenses to be reduced. This is precisely
what Bausch + Lomb has done with its new contact lens, PureVision2 with High
Definition Optics For Astigmatism.
This new lens reduces spherical aberration similar to the PureVision2 HD
lens, but it reduces it in both the sphere and cylinder meridians, across the entire
power range, at every quarter-diopter step. Positive spherical aberration is present
in every eye inherently, and these contact lenses are designed to reduce that
amount. All of the light rays entering the eye then come together at one focal point,
which provides the most clear, crisp and consistent vision possible.
Dr. Quinn: How much variation in positive spherical aberration is present in
Dr. Vogt: B+L has determined that amount by individualizing, i.e., modeling
with optical software, more than 1,300 eyes. While there may be some people who
don’t have exactly the average amount of spherical aberration, a large percentage
do. By knowing the average amount, we can benefit the greatest number of patients
with the lens design.
The other key part of designing HD optics is the spherical aberration induced
simply by the wearing of a contact lens. The design of the PureVision2 HD For
Astigmatism addresses those aspects as well.
Vision + Comfort Equals Wearability
Dr. Vogt: Furthermore, the PureVision2 with High Definition Optics For
Astigmatism not only reduces spherical aberration like no other silicone hydrogel
toric lens currently on the market (Figure 4), but it also incorporates several other
elements that make it a no-trade-off lens when it comes to patients’ vision and
comfort. As is typical of B+L, a great deal of research went into the development
of all of the elements. An understanding of eyelid blink mechanics, for example,
led to Auto Align Design. A hybrid ballasting geometry with optimized thick and
thin zones works with patients’ eyelids to provide excellent orientation for
consistent vision. A relatively large, 14.5-mm, lens diameter improves centration,
which contributes to outstanding acuity. Auto Align Design also includes a large
optic zone that helps deliver clear vision in varied lighting conditions.
Dr. Quinn: Making the lens larger makes it more stable because it reduces the
interaction between the lens and the eyelid?
Dr. Vogt: It’s due more to the increased surface area, which gives more area
to work with for elements like the ballasting and large optic zone.
The Comfort Moist elements of the PureVision2 HD For Astigmatism provide
benefits, too. The edges are rounded and thinner than they are on other torics,
including the original PureVision Toric. This creates a gentler transition from lens
to conjunctival tissue, which is more natural-feeling on the eye and enhances all-
day comfort. In addition, the lenses come in a moisture-rich packaging solution,
which fosters comfort upon insertion. (figures 5 and 6)
Finally, this new lens has fewer edge markings than the PureVision Toric, one
instead of three, which helps to improve comfort scores. Overall, the three lens
design attributes — HD Optics, Auto Align Design and Comfort Moist — work
together to achieve lens performance. Feedback from eyecare practitioners and
patients has been positive. Practitioners agree 97% of the time that PureVision2
HD For Astigmatism delivers excellent stability and agree 89% of the time that the
lenses deliver consistently clear vision. Eighty-three percent of patients rate
overall comfort positively when wearing the lenses, and 71% of patients agree that
they provide superior vision.
SIDEBAR: The NSIGHT Study
The Needs, Symptoms, Incidence, Global Eye Health Trends (NSIGHT)
Study is an online survey of 3,800 vision-corrected patients, age 15-65, from seven
different countries in three regions. Participants in the study, which was conducted
by independent research firm Market Probe Europe with funding from Bausch +
Lomb, include spectacle and contact lens wearers.
NSIGHT gathered comprehensive baseline data on all respondents, including
gender, age, social class, education, community type, occupational status, work
environment, level of physical activity, type of vision disorder (Figure 1) and
method of correction. For contact lens wearers, data included lens type, when and
how lenses are worn, replacement timing, brand and details of lens care solution
used. The study explored two main areas:
• Eye-related symptoms: NSIGHT surveyed respondents on 14 eye
symptoms (halo, glare, fatigue, sensitivity, itching, dryness, eye strain, redness,
puffiness or swelling, pain, headaches after near work, blurry or hazy vision,
watery eyes, burning sensation). Respondents reported which symptoms they
experience, rated their frequency and intensity, how they are currently treated and
with what degree of success.
• Eye/vision care product needs: NSIGHT respondents reviewed a list of 40
potentially beneficial attributes of eye/vision care products (e.g., “provides vision
that is as close to natural as possible” and “protects eyes in dry environments”).
They then ranked individual features as among the most or least compelling. The
results allowed creation of a Hierarchy of Needs, a ranking from most to least
compelling of the 40 individual features and the eight categories into which they
can be grouped (vision, health, environment, eye condition, convenience, comfort,
personal performance, personal appearance). (Figure 2)
The results of the NSIGHT Study are providing eyecare practitioners with
new, and in some cases unexpected, insights into patients’ needs and preferences.
The findings provide an evidence-based framework for discussing vision and
eyecare treatment options.
SECTION HEADLINE: Clinical Experience with PureVision2 HD For
SECTION SUBHEADLINE: Doctors say the lens is fitted efficiently and
fulfills unmet vision and comfort needs.
Dr. Quinn: All of us on the panel who are in clinical practice have had
experience with the PureVision2 with High Definition Optics For Astigmatism.
What are your thoughts about this new contact lens?
Dr. Epstein: I like the stability of it. Stability is very important when we
address fluctuating vision, which is a complaint we’ve experienced with toric
lenses in the past.
Dr. Marsden: It stabilizes fast.
Dr. Basinger: The stabilization is quick, so chair time is quick.
Dr. Epstein: How it sits is very repeatable.
Dr. Marsden: The ultimate visual outcome has been startling. Some doctors
only refract to 20/20, but I can consistently get a solid 20/15 with this lens. That is
rare for a toric lens, in my experience.
Dr. Quinn: How long do you need to wait before evaluating this lens on the
Dr. Basinger: Not long at all. I insert the lenses in our contact lens room and
then walk the patients back to the chair. By the time I let them blink a few times
and ask a few more questions about how things feel, I can start checking acuities
and they’re ready to go.
Dr. Geffen: We have switched patients out of several different toric lenses to
the PureVision2 with High Definition Optics For Astigmatism. Patients
immediately say this lens is more comfortable. Also, as Dr. Marsden said, the
optics are unsurpassed. I’ve done aberrometry over this lens, and the amount of
aberrations is much lower than with every other toric lens I have measured.
Patients come back and, without my even asking, say their night vision is much
Dr. Quinn: They specifically comment on night vision?
Dr. Geffen: Yes.
Dr. Quinn: Have patients had issues handling the lens because of its larger
Dr. Epstein: I haven’t had anybody complain about handling issues.
Dr. Marsden: No.
Dr. Epstein: One of my general goals in practice is to make sure patients
leave seeing better than when they walked in. This lens makes it very easy to
achieve that goal.
Toric Lens or Spherical Equivalent?
Dr. Quinn: At what degree of astigmatism do you become uncomfortable
fitting a spherical lens?
Dr. Basinger: I changed my mind several months ago, largely because of my
daughter. She’s a 4.50D myope with about 0.75D of astigmatism. She had been
wearing daily disposable lenses, but when she tried PureVision2 HD For
Astigmatism she said “Dad, I can really see out of these!” Now instead of thinking
I should gloss over that amount of astigmatism in a similar refraction, I try the new
lens to see what it can do.
Dr. Geffen: I perform a quick test in my office. If a patient has 0.50D or more
of astigmatism, I place a trial lens with 0.75D of cylinder in front of that spherical
lens and ask if it makes a difference. Most patients say it does and then I tell them
we should fit this new lens that has optics specifically designed for this situation.
Dr. Quinn: How many of your patients know they have astigmatism?
Dr. Geffen: I think the majority of patients know they have “stigmatism,” but
may think it is a disease. They’re not sure that it’s part of their prescription.
Dr. Quinn: How do you educate them about astigmatism?
Dr. Geffen: I use the analogy of a spoon versus a ball. I say they have an
oblong eye that’s shaped like a spoon, so the power is different in one side vs. the
other. I have a little handheld model for illustration. I explain that this condition
distorts vision, which is why they often don’t see as well in contacts as they do in
eyeglasses and also why we should try PureVision2 HD For Astigmatism.
My most powerful tool in communicating astigmatism is, after telling patients
it’s not a disease, it’s a shape issue, at the end of the refraction, I take the
astigmatism correction out and put it back in. They really get that. They may not
fully understand astigmatism, but at least they know how it affects them.
Dr. Quinn: Speaking of the word “try” in reference to the PureVision 2 HD
for Astigmatism, we’re all using it in this discussion because we all understand
each other, but we should avoid it when talking to patients. Instead, we should
communicate clearly the benefits of correcting astigmatism. A demonstration is a
powerful way to do that, and then we can say, “We’re going to fit you with a lens
that will meet your need.”
With that type of attitude, patients will buy into the approach. We’re asking
them to pay slightly more for toric lenses compared to spherical lenses, but if we
believe in the benefits and convey that belief to our patients, they will know it’s
Dr. Epstein: When I describe astigmatism, I say we can have little differences
between our eyes and within the patient’s one eye, he or she has differences that
we require two powers to correct or part of the eye will be out of focus when left
uncorrected. I usually use a toric lens when an eye has 0.75D of astigmatism or
more at the corneal plane, but often I prefer a toric for 0.50D. It depends where it
is. Against-the-rule astigmatism degrades vision more. Those patients would rather
be left with a quarter diopter with the rule than a half diopter against the rule.
Dr. Quinn: That is supported by research as well. Several studies [7,8] have
shown eyes with both low and moderate astigmatism obtain improved visual acuity
with toric contact lenses.
Dr. Marsden: Improvement doesn’t even have to be lines of improvement to
benefit the patient. The improvement can be in the quality of vision. In the past, we
taught a four-to-one rule, meaning that for every four diopters of spherical
refractive error, the patient can tolerate a diopter of astigmatism. I’ve never been
able to find support for that in the literature. In reality, we would never follow that
rule with spectacles. Why would we impose that on our contact lens patients,
especially given today’s toric lens designs?
Patients have gone through decades of being told their correction options are
as good as it gets, and maybe they don’t want the added expense of toric lenses,
but once I demonstrate what is possible, it really drives home the point that vision
is important. That’s what I love about diagnostic lenses. I put them on and know
right away if the lenses will give the patient that “aha!” moment. Once they realize
what they’ve been missing, they want that clear, sharp vision.
Patient Assessment of Initial and End-of-Day Comfort
Dr. Quinn: Prior to the introduction of the PureVision2 HD For Astigmatism,
what had been your experience with toric contact lenses?
Dr. Geffen: Historically, toric lenses have been more uncomfortable than
spherical lenses. Now we have this lens that is very stable and has a great edge
design. I had been using torics for years and they were OK. They correct
astigmatism, but patients would often tell me they see better when they put their
eyeglasses on in the evening. Now, with aspheric optics correcting some of the
higher-order aberrations, patients are telling me their vision with their contact
lenses is better. They’re wearing their lenses longer because they see better with
them, they see better at night, and they’re happier overall. They don’t drop out of
lens wear down the line either.
Dr. Basinger: Much like gas-perm vision but with a soft lens.
Dr. Quinn: Dr. Vogt provided compelling information about halos and glare.
How do you discuss this topic with patients?
Dr. Basinger: We have a video for patients while they’re waiting. It talks
about high-definition lenses, likening them to high-definition TV and how it makes
the image so much sharper and crisp than standard-definition TV. Also, I’m in a
suburban area, so many people live out in the country, where street lights are few
and far between. They relate easily when I have them think about what they see
when car headlights are coming toward them at night.
Dr. Epstein: If patients have large pupils, I ask whether they experience
problems with night vision because that’s what we would expect. From there I say
we can use newer contact lens technology to address those problems.
Dr. Geffen: Our intake form asks patients if they experience glare or halos,
and staff ask again during pre-testing. We perform screening aberrometry on every
patient and if I see higher-order aberrations, I use that as the starting point to
explain how they can degrade vision and what we can do about it.
Another thing I do in the exam room, which is simple but effective, is turn the
lights down, put a white dot at the end of the room on the wall with a pen light, and
ask patients to describe what they see while they’re wearing their current lenses.
The ones who have spherical aberration will often tell me they see a “flare” or “a
glow around the light.” Then I insert the new lenses with the aspheric optics and
we do the same thing. Right away, patients usually say “wow that light is now nice
Dr. Quinn: Are we creating a problem because we have a solution? Or are
glare and halos a real problem for patients? Don’t they typically drop out of lens
wear because of comfort?
Dr. Marsden: But is it visual comfort or the sensation within the eye? If I’m a
patient, maybe I don’t know what you mean by comfort. All I know is at the end of
the day, I have wrinkles from squinting and then a headache or some kind of eye
Dr. Geffen: The NSIGHT Study included a large number of people, 3,800. It
showed patients’ number one concern to be vision. Comfort was far down the list.
In my practice, I don’t see many contact lens wearers dropping out because they
have comfort problems. Drop out occurs as they age and their prescriptions start to
change; perhaps they develop some presbyopia. I think if we can keep the optics
crisper, we can keep our patients happier.
Dr. Quinn: What I’m hearing is maybe we as a profession have heard the
word “comfort” and thought of physical issues, but comfort is broader than that.
Visual performance can play into the perception of comfort for the contact lens
Dr. Epstein: I’ve been getting a positive response on the PureVision HD For
Astigmatism on initial comfort and on end-of-day comfort at follow-up.
Dr. Geffen: Yes, the comfort has been excellent. The edge design is
impressive. With some edge designs, I feel as if I have to be careful judging the
movement of the lens. Some edges tend to clamp and bind to the conjunctiva, and
even though the lens will move a millimeter, if I see the conjunctiva moving a
millimeter, I am not going to get adequate transport of oxygen and fluid and waste
material in and out from behind the lens. This new edge design has really
incorporated great comfort but also good movement, and it doesn’t bind.
Dr. Quinn: It’s a tall order, asking a lens to move but not rotate. Is the
PureVision HD For Astigmatism delivering on that?
Dr. Marsden: Yes. I think we had become used to tolerating less movement,
especially with silicone hydrogel materials because more oxygen was getting
through the lens. But we still have the issue of tear exchange and making sure it
isn’t stagnant under the lens. This lens helps in both areas.
Benefits for Patients and Doctors
Dr. Quinn: What else has stood out for you as you are using this new lens?
Dr. Marsden: Definitely the improved comfort.
Dr. Epstein: The stability.
Dr. Marsden: My patients require less chair time because I don’t necessarily
have to do a left add, right subtract (LARS) calculation to adjust for lens rotation.
Dr. Geffen: The lens fits a very wide range of patients and it stabilizes
quickly on the full range of cases. The first lens I put in is usually the lens I
dispense because I don’t have to make any axis adjustment. For efficiency in the
trenches, that’s a wonderful benefit. Plus, my personal experience is backed up by
Bausch + Lomb statistics.
Dr. Quinn: How about the diagnostic set? What can practices expect?
Dr. Basinger: It’s been fantastic. Everything I need is in there. The chair time
is almost the same as that for fitting a spherical lens. It just fits.
Dr. Marsden: The fitting set is nice and compact, but it’s comprehensive.
I’ve had initial trial sets in the past where we go to pull a lens and because of the
volume it’s not there. I haven’t had that issue with this one.
Dr. Epstein: To me, fitting the PureVision2 HD For Astigmatism is no more
difficult than fitting a spherical contact lens.
Dr. Geffen: It’s very straightforward. I’m amazed at some of my peers who
say they don’t like fitting astigmatic lenses. If they haven’t in the past, this is the
lens for them. With the straightforward usage and great fitting set, they should get
on the train.
Dr. Quinn: So practitioners don’t have to feel like they need to be contact
lens specialists to fit this kind of lens?
Dr. Marsden: No.
Dr. Quinn: Let’s say you recognize that patients with low levels of
astigmatism can benefit from a toric contact lens. When a patient who has already
been wearing a toric lens and seems happy presents in your chair, do you switch
him to the new lens design?
Dr. Basinger: My patients almost expect me to change something now
because I’m always talking about something new. Plus, they’re so used to new
things (like iPhone apps), they want to know about them.
Dr. Quinn: And what benefits do you tell them they would get from making
Dr. Basinger: With the PureVision2 with HD lenses, it’s the vision, the
clarity and stability of it, how well they see.
Dr. Geffen: Also, and studies reinforce this, when we are able to go that extra
yard and give patients 20/15 or even 20/12 vision, it can make an enormous
difference in their lives. Just using high-definition optics alone can, for example,
give an athlete better performance. They want that crisper vision for their active
lifestyle, and it gets them excited about referring patients to me. Suddenly, I have a
team of people coming to me. Easier and safer night driving, too, can be huge.
Dr. Quinn: Do we need to prepare patients for any adjustments as they switch
from another toric lens to his one?
Dr. Basinger: I tell patients they may notice a difference in how the lens feels
in their eye. I point out, however, that it’s the same as getting a new ring or watch,
anything new you might put on. It feels differently than your old one at first, but in
a week or so, you don’t even notice it’s there.
Dr. Epstein: In a slightly different scenario, switching patients from a
spherical lens to a toric, I tell them they might have an awareness of the toric at
first. I had a patient come in with headaches. We fit her in a toric lens in one eye
because she needed it, but the other didn’t. She commented that her husband had
tried toric lenses but could never wear them because of comfort issues. At follow-
up, she reported more awareness of the toric lens, but said her vision and
headaches were so much better that she wanted to continue with it.
Dr. Marsden: Certainly “awareness” is a better term than discomfort.
Nobody wants to be uncomfortable.
Providing Patients with the Whole Package
Dr. Quinn: To summarize all we’ve discussed, I would say that we all agree
that the PureVision2 HD For Astigmatism is not a difficult or time-consuming lens
to fit, yet it allows our patients with astigmatism to no longer have to compromise
between comfort and clear vision. In other words, for practitioners to use comfort
as an excuse for fitting spherical lenses when torics would be more beneficial to
patients is no longer acceptable. We can utilize this new lens in our practices to
take what we do up a notch by meeting patient needs better.
Dr. Marsden: We can actually exceed patients’ needs because I don’t think
they realize how good their vision can be. It’s time we take back the refraction. We
shouldn’t stop at a certain line of acuity without identifying the best vision each
patient can experience. When we do that, it’s what brings our patients back to us.
Dr. Geffen: Yes, perhaps we’ve forgotten that more than 90% of the patients
who come into our offices do so in order to see better. I would add that this new
toric has great comfort as well as absolutely the best optics of any toric lens we can
put on our patients’ eyes.
Dr. Marsden: We touched on this earlier, but it’s worth repeating. Someone
said, “It’s time to put vision back into vision care.” I take that to mean we
underestimate our patients’ desire to see well. This is perhaps because we’ve had
products in the past that gave them 20/20 or 20/25 vision and they were happy. But
the reality is that we can give them better vision. Even if their acuity number is the
same, we can enhance the quality of vision. So we need to realize 20/happy isn’t
good enough anymore. We’ve got to provide vision that is the best it can be.
SIDEBAR: Fewer Markings on Lens Still Effective
Dr. Quinn: In designing its new contact lens, the PureVision2 with High
Definition Optics For Astigmatism, Bausch + Lomb reduced the number of edge
markings to one. This was in an effort to enhance comfort for patients. When we fit
the lens, where should that mark be that indicates how the lens is orienting on the
Dr. Marsden: From the academic standpoint, we teach students LARS (left
add, right subtract), that lenses are going to rotate, and they are mathematically
adjusting for that rotation. Yet, after they graduate, the number-one call to
consultation lines is practitioners annoyed that the line is not at 6 o’clock. They’re
thinking because they made the mathematical adjustment, the line is going to go to
6 o’clock. It’s not. They’ve moved the power axis so that when the lens rotates, the
power axis is where it needs to be. The lens should still rotate to wherever it
rotated at the initial fit. If it doesn’t, or if it’s variable, then stability is an issue. I
haven’t experienced a stability problem with this new lens at all.
Dr. Quinn: The lens can rotate as long as it rotates in the same direction, to
the same degree, each time?
Dr. Marsden: Yes, correct.
Dr. Quinn: So we’re not looking for that mark to be at six o’clock, although
often with this lens it is?
Dr. Marsden: Pretty darn close.
Dr. Quinn: How easy is it to see the marking, now that it’s a single mark?
Dr. Basinger: You may have to pull down a patient’s eyelid, but other than
that, it’s easy to see.
Dr. Geffen: I have no problem with the visibility of the mark.
Dr. Epstein: Same here.
Dr. Quinn: I see having just one mark as a benefit because in the past when a
lens would rotate I have pulled the lid down and seen a mark I thought was the
middle mark, but in fact it was one of the edge marks.
Dr. Marsden: That would be a 30-degree differential.
Dr. Quinn: Yes, I would be assessing the lens to be 30º off from where it
really is. In many ways, it’s simpler to have just one lens marking.
1. Needs, Symptoms, Incidence, Global Eye Health Trends (NSIGHT) Study.
Market Probe Europe. December 2009.
2. Consumer Toric Needs Study: US. Millward Brown. December 2010.
3. Mack CJ, Rah MJ. Visual Benefits of Highest Importance to Eye Care
Professionals and Patients When Choosing Contact Lenses for Astigmatism. Poster
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