Does offering only the spherical contact lens trial to the low astigmats mislead the practitioners?

To compare the visual acuity (VA), comfort, and patient preference in a soft toric contact lens (TCL) versus soft spherical contact lens (SCL) in low astigmatic subjects during the contact lens (CL) trial.

This subject-masked, block randomized, 2×2 crossover study recruited 40 neophyte subjects (80 eyes) aged 18 to 33y with astigmatism in the range of 0.75-1.25 D with or without spherical power from -6.00 D to +6.00 D. The participants were scheduled for two days CL trial and were fitted with the best-fit SCL and TCL. After 4h of wear, they were assessed objectively for high contrast VA and subjective vision, comfort, and preference.

The responses of 36 subjects (response rate 90%) with a mean age of 23.02±2.97y (range 18 to 33y) were analyzed. One-line improvement of monocular VA in the logMAR chart was reported to TCL as compared to SCL (-0.044±0.06 vs 0.04±0.03 logMAR, P=0.01) but the binocular vision remained similar (-0.12±0.07 vs -0.14±0.04 logMAR, P=0.38). Subjects felt a noticeable difference in clarity when shifted to TCL as compared to the SCL. The satisfaction with vision (vision quality) was significantly better with TCL (P=0.03). The fatigue with TCL was graded less at 2.5±0.6, compared to SCL at 4.6±1.3 (P=0.04). Thirty-three participants (91.6%) preferred to use contact lens of which 26 participants (79%) preferred TCL.

The findings suggest that VA and comfort are better with TCL as compared to SCL which is only observed if the patient was offered both offering SCL with spherical equivalent power alone as the first option can mislead the practitioner; TCL trial should be the first choice of the lens in low-to-moderate astigmatism.