Why stock torics struggle
A soft toric lens has the astigmatism correction built into it at a specific axis, and it must stay at that axis on the eye. Manufacturers stabilize it with thicker zones that the eyelids press into place. Higher cylinders need thicker, less comfortable zones and are made in fewer parameters; unusual axes may not be stocked; and on some eyes the lids simply rotate the lens with every blink, so vision swims. At higher cylinders, or at oblique axes, stock options narrow quickly.
Custom soft toric lenses
Lathe-cut custom torics are made in any sphere, cylinder and axis, with stabilization designed to the patient's lid anatomy and with base curve and diameter matched to the cornea. For many high astigmats they give comfortable, stable vision in a soft lens. They are replaced quarterly to yearly.
Lenses that do not rotate
Rigid gas permeable lenses correct corneal astigmatism by holding a spherical surface over the toric cornea, so there is no axis to lose; a toric back surface is used for very high corneal astigmatism. Hybrid lenses do the same with a soft skirt for comfort. Scleral lenses vault the cornea and correct any amount of corneal astigmatism, with front-surface toric optics for the lenticular component. For patients who have chased rotating torics for years, these lenses are a revelation.
Astigmatism and keratoconus
High astigmatism that is increasing, that is different between the two eyes, or that glasses correct less and less well is a warning sign of keratoconus, and corneal topography at the fitting is how it is found. If keratoconus is present, the lens choice changes and the cornea specialist becomes involved, because progression can be stopped with cross-linking.
The surgical alternative
For a stable, regular high astigmatism in a healthy cornea, LASIK and PRK correct moderate to high astigmatism, the toric EVO ICL also corrects astigmatism, and toric lens implants correct it at cataract or lens surgery. Patients who would rather not depend on specialty lenses can discuss these at a consultation.
Is this right for your eyes?
Nothing on this page is a diagnosis. Whether this is the right choice for you is decided by a full examination at one of our 4 offices: Pasadena, Huntington Beach, Woodland Hills and Beverly Hills.
About this content: This page was written with the assistance of AI tools and reviewed for medical accuracy by Dr. Arbi Melikian, OD. It is general information, not medical advice, and does not replace an eye examination. Individual results vary. Read our medical disclaimer.
