getting toric contacts to orient properly

[DougLassiter]

I have new contacts with larger-than-before astigmatism correction. CYL=-3.75. They are sometimes blurry, and the optometrist says that's because the lenses haven't oriented themselves properly. He suggests blinking a few times to make that happen. Doesn't work that well. Some strategy to help toric contacts get properly oriented? Maybe lubricating eye drops? Drops of saline and multi-purpose solution don't seem to help.

[Ron_AKA]

You may want to try eye drops with a higher amounts of hyaluronic acid which acts as a lubricant. Here is an article which has some information on brands that have higher amounts of it.
https://www.drmikeng.com/new-blog/2020/3/4/comparing-preservative-free-eye-drop-products-in-canada

Some put a drop on the contact before putting it in your eye.

[DougLassiter]

So far, I've been trying Refresh, which seems to help. Good for 3+ months. But I appreciate the pointer.

[John C Hagan III, MD, FACS, FAAO]

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[Ron_AKA]

I don't believe Refresh Tears has any hyaluronic acid in it.

[John C Hagan III, MD, FACS, FAAO]

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[DougLassiter]

Never said it did. FWIW, hyaluronic drops are substantially pricier, and to the extent Refresh works, doesn't seem necessary to pay extra. If I become dissatisfied with Refresh, I'll try hyaluronic.

[John C Hagan III, MD, FACS, FAAO]

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[Ron_AKA]

I thought you had a problem with the toric lenses not rotating into position properly.

[DougLassiter]

I did. Before I tried the Refresh. My original question was whether lubricating eye drops might help. I answered that myself, I guess. But it's useful to know that some lubricating eye drop are more effective than others

[John C Hagan III, MD, FACS, FAAO]

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[Ron_AKA]

Presuming you are in the US I don't really know what drops are available to you as I am in Canada. My wife is sold on Hylo drops which are 0.1% sodium hyaluronate. At Costco here one 10 ml container is about $38! I use HydraSense Advanced which is 0.15% sodium hyaluronate, and costs about $24 for three 10 ml vials, again at Costco. That product is made by Bayer, and I am not sure is available in the US, but I would think there must be other similar and reasonably priced products.

Your other option to solve this issue would be to get a refractive lens exchange, even though you do not have cataracts. Most likely you would have to pay the full cost of the procedures. And you would need multifocal lenses or mini-monovision to get a full range of vision without glasses. I can't say that I would recommend it, but some do it. At age 70 cataracts are probably not far away, so it may make more sense at your age than for a younger person, assuming cost is no concern. When you have cataracts healthcare or insurance may pay all or most of the cost.

[DougLassiter]

Thanks, but evidently I've solved this issue already. Refresh is $7 for 12ml. Yes, I can get HydraSense Advanced from Amazon 3x10ml for $28. Not a lot pricier than Refresh. To the extent that Refresh becomes less useful, that's a good strategy. That's correct about payment for cataract surgery. My last optho exam suggested that I show some very early evidence for cataracts, but I have no symptoms at all. So it'll be a while. I really missed the boat on Lasik!

[Ron_AKA]

I was getting a heads up from my optometrist for 2-3 years that cataracts were developing, but I was not seeing any symptoms. Then all of sudden I started seeing double with one eye. That was when I got referred for cataract surgery. If you have found a work around with drops, you should probably wait until the official diagnosis and save some money. IOLs are not issue free either...

[John C Hagan III, MD, FACS, FAAO]

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[DougLassiter]

My understanding is that cataract development is usually slow (as in, years), but there are "fast growing cataracts" that can develop within a month. We shall see.

[John C Hagan III, MD, FACS, FAAO]

At age 70 you don't have to worry about 'fast growing cataracts" those develop in young and middle age people e.g. posterior subcapsular cataracts and post trauma.

[DougLassiter]

Interesting. I was responding to Ron above, but maybe he is indeed younger. But true, for older people I've known who have gotten cataracts, it's very gradual process.

[John C Hagan III, MD, FACS, FAAO]

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[Ron_AKA]

I probably was about 68 when I was first told there were signs of cataracts, and 70 when I got referred for cataract surgery in one eye. I went a year and a half more before having the second eye done, and it wasn't at the real necessary stage. I wanted to be eyeglasses free and was getting tired of wearing a contact in the second eye, so I pushed for an earlier date to get it done. I'm days away from 74 now.

It is best to plan for cataract surgery and not let it go until vision is significantly affected. For example if you have any thoughts of doing mini-monovision with IOLs, now would be the time to simulate it with contacts while you can still see well. I think it is a much better alternative for am eye glasses free full range of vision than a multifocal IOL, but one really should test drive it to be sure you are OK with it.

[John C Hagan III, MD, FACS, FAAO]

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[John C Hagan III, MD, FACS, FAAO]

Torics with that degree of astigmatism often not successful. If you can't make your peace with glasses then suggest you see ophthalmologist specializing in cornea/refractive surgery and discuss refractive surgery.

[DougLassiter]

Um, no. I can get that degree of astigmatism correction with XR Torics. They aren't cheap, but they'll make them up. What do you mean that they are not often successful? They can successfully make them. But you're saying they don't successfully orient? I wanted to go Lasik, but my doctor says that at my age of 70, I'll probably eventually need cataract surgery anyway, so it would be a waste. They don't do Lasik on patients of my age for that reason.

[John C Hagan III, MD, FACS, FAAO]

Low success rate:  contacts rotate and blur vision, no not align with axis of astigmatism,  at your age low motiviation, dry eyes,  contact has distance RX but not at near so reding glasses needed.  Yes LASIK not appropriate at your age.

[DougLassiter]

Thank you. I have this problem just occasionally, and it does seem that wetting the eyes with a commercial lubricant helps with orientation. Not completely clear why high CYL contacts don't rotate properly. Because of their strong asymmetry, they must be more heavily weighted than lower CYL contacts. But perhaps because of that strong asymmetry, maybe blinking tends to pivot them around more? I've been using reading glasses for years, so that's not an issue. Yes, these are distance Rx.