The landscape of corrective optics is undergoing a significant transformation, particularly regarding the management of complex refractive errors that combine presbyopia and astigmatism. For UK consumers and patients, the availability of specific trial lenses is the primary gateway to achieving optimal visual acuity. Recent industry shifts indicate a decisive move away from certain material compositions toward advanced silicone hydrogels, specifically in products that are made-to-order. This transition is epitomised by the strategic discontinuation of the Proclear multifocal toric trial lenses, a move designed to align product portfolios with current material science and patient demand for higher comfort and improved visual performance. The shift toward silicone hydrogels is not merely a manufacturing preference but a response to the evolving needs of patients who require a seamless refit—defined by the intersection of physical comfort, precise lens fit, and high-level vision performance.
The management of astigmatism, whether through contact lenses or intraocular lenses (IOLs), requires a sophisticated understanding of rotational stability and refractive vectors. In the context of toric trials, the goal is to determine the exact axis of astigmatism correction. When a lens rotates away from the prescribed axis, the corrective effect is diminished, which can lead to suboptimal visual outcomes. This is why the transition from legacy products like Proclear to newer alternatives like Biofinity is critical. The Biofinity family of lenses represents an upgrade in material technology, offering enhanced patient satisfaction and improved comfort. Clinical data highlights this disparity; for instance, in comparative evaluations, Biofinity toric multifocal lenses showed a satisfaction rate of 76% compared to only 6% for Proclear multifocal toric lenses. Furthermore, comfort levels at a two-week follow-up were significantly higher for Biofinity (80.9±21.6) than for Proclear (73.0±25.0).
Beyond contact lenses, the trial and implementation of toric solutions extend to surgical interventions, specifically for cataract patients. The use of toric intraocular lenses (IOLs) allows for the correction of corneal astigmatism during the cataract surgery process, reducing the patient's dependency on spectacles. The success of these trials depends on the haptic design of the lens—the part that holds the lens in place. Different haptic types, such as C-loop and plate-haptic designs, exhibit different levels of rotational stability. Rotational stability is the most critical factor in a toric trial, as any unplanned movement of the lens after implantation can result in residual astigmatism, thereby compromising the visual quality for the patient.
Proclear Multifocal Toric Discontinuation Timeline
The phase-out of the Proclear multifocal toric range is structured to allow patients and Eye Care Professionals (ECPs) sufficient time to transition to alternative options. This process is not an immediate cessation but a staggered withdrawal of trial lenses and commercial revenue packs.
- Proclear multifocal toric trial lenses will be discontinued on November 1, 2025.
- Proclear multifocal toric revenue packs will be discontinued on November 1, 2026.
The impact of this timeline is significant for the consumer. The discontinuation of trial lenses in November 2025 means that new patients will no longer be able to test this specific lens variant to determine fit and performance. For existing users, the discontinuation of revenue packs in November 2026 provides a one-year buffer to transition to a different product, such as the Biofinity range. This transition is encouraged because the contact lens industry is shifting toward silicone hydrogel materials, which are increasingly preferred for made-to-order products due to their superior oxygen permeability and comfort profiles.
Biofinity Transition and Clinical Performance
The transition from Proclear to Biofinity is presented as a seamless refit. In the ophthalmic industry, a seamless refit is defined by three core pillars: comfort, the physical fit of the lens on the cornea, and the overall vision performance.
The clinical evidence supporting the switch to Biofinity is substantial. In a non-dispensing, subject-masked, randomized, bilateral, cross-over short-term clinical evaluation involving 17 participants, the following results were observed:
- Patient satisfaction was significantly higher for Biofinity toric multifocal lenses (76%) compared to Proclear multifocal toric lenses (6%), with a p-value of <0.005.
- Comfort levels at a two-week follow-up were measured at 80.9±21.6 for Biofinity, compared to 73.0±25.0 for Proclear, with a p-value of 0.04.
These metrics indicate that the material upgrade to Biofinity provides a tangible improvement in the user experience. ECPs are advised to use fitting guides to ensure the correct selection of lens parameters, including power, to maintain these performance gains.
Toric Refractive Calculation and Analysis
Achieving the correct result in a toric lens trial requires precise mathematical calculations to account for the ocular refraction and the vertex distance. The use of toric calculators is essential to translate spectacle refraction into a lens order.
The process for calculating the required toric power involves several critical steps:
- Setting the spectacle refraction, which includes the sphere, cylinder (Cyl), and the axis of the astigmatism.
- Adjusting for lens rotation to ensure the lens is aligned correctly on the eye.
- Adjusting the back vertex distance, which is the distance from the posterior surface of the lens to the cornea.
The calculated theoretical power at the corneal plane determines the final lens for order. If the back vertex distance is altered, the ocular refraction changes, which may lead to different results (e.g., 0.00 / 0.00 x 90). This precise calculation is what prevents the residual astigmatism that would otherwise degrade the quality of vision.
Toric Intraocular Lens (IOL) Trials and Stability
In surgical contexts, toric trials involve the implantation of IOLs to correct preoperative corneal astigmatism. This is particularly relevant for patients with astigmatism greater than 1 D. The effectiveness of these lenses is measured by their rotational stability and the amount of residual astigmatism present post-surgery.
A comparative study analysed two different haptic types: C-loop haptic toric IOLs (AcrySof-toric IOL) and plate-haptic toric IOLs (AT TORBI 709 M IOL).
- Group A (C-loop) showed a rotation degree of 3.85 ± 2.92°.
- Group B (Plate-haptic) showed a rotation degree of 2.33 ± 2.31°.
A significant difference in intraocular lens rotation was identified between the two groups (P < 0.05), suggesting that plate-haptic designs may offer superior rotational stability. This stability is paramount because the lower the rotation, the more accurate the astigmatism correction.
Plate-Haptic Multifocal Toric IOL Specifications
The AT LISA toric 909 M is a specific example of a plate-haptic diffractive bifocal IOL designed for cataract patients, particularly those with long axial length and corneal astigmatism.
The technical specifications of the AT LISA toric 909 M are as follows:
- Material: Hydrophilic acrylate with 25% water content.
- Surface properties: Hydrophobic surface.
- Refractive index: 1.46.
- A-constant: 118.3.
- Design: Single-piece, 4-haptic design.
- Total diameter: 11.0 mm.
- Optic diameter: 6.0 mm.
- Angulation: 0 degree.
- Near addition (ADD): +3.75 D at the IOL plane.
- Light distribution: 35% to near focus and 65% to distant focus.
The clinical outcomes for patients receiving this IOL indicated significant improvements. Preoperatively, mean manifest sphere and cylinder were -6.66 ± 5.37 D and -1.88 ± 1.11 D, respectively. Postoperatively, these were reduced to 0.13 ± 0.23 D and -0.29 ± 0.32 D. Furthermore, 91.7% of patients experienced IOL rotation of less than 5 degrees at 3 months.
Comparative Analysis of Toric IOL Systems
The Panoptix Trifocal toric IOL platform provides another alternative for patients seeking to minimize spectacle dependency by providing effective near, intermediate, and distance vision.
The effectiveness of the Panoptix system was evaluated in a retrospective cohort of 466 eyes from 254 patients. The results showed a high level of precision:
- 91% to 98% of eyes were within 0.50D and 1.00D of the target.
- The mean absolute difference from the Spherical Equivalent (SE) target was 0.22 ± 0.24Ds.
This high rate of accuracy demonstrates that multifocal toric IOLs can effectively manage both presbyopia and astigmatism, provided that preoperative corneal astigmatism is properly considered.
Comparison of Toric Lens Technologies
The following table compares the key characteristics of the contact lens and IOL toric options discussed.
| Feature | Proclear Multifocal Toric | Biofinity Toric Multifocal | AT LISA toric 909 M | Panoptix Trifocal Toric |
|---|---|---|---|---|
| Type | Contact Lens | Contact Lens | Intraocular Lens | Intraocular Lens |
| Material | Legacy material | Silicone Hydrogel | Hydrophilic Acrylate | Proprietary IOL Material |
| Primary Benefit | General Correction | High Comfort/Satisfaction | Rotational Stability | Near/Int/Dist Vision |
| Key Metric | Discontinuing 2025/26 | 76% Satisfaction | < 5° Rotation (91.7%) | 91-98% target accuracy |
| Focus | Presbyopia + Astigmatism | Presbyopia + Astigmatism | Bifocal / Toric | Trifocal / Toric |
Surgical Implementation and Exclusion Criteria
The success of a toric IOL trial is dependent on the surgical technique and the selection of the patient. For the AT LISA toric 909 M, specific exclusion criteria were applied to ensure the integrity of the results.
Patients were excluded if they presented with: - Glaucoma. - Retinal disease. - Irregular corneal astigmatism. - Corneal disease. - Uveitis. - Neurophthalmic disease. - Abnormalities of the iris, zonules, or lens. - A history of ocular trauma or surgery.
The surgical process involved microincision phacoemulsification with a 2 mm main incision. A Callisto Eye System was utilised to mark the 135° main incision and 45° side incision, ensuring the IOL axis was perfectly aligned. The Barrett Universal II formula, based on True-K value, was employed for power calculation.
Analysis of Visual Outcomes and Refractive Vectors
The clinical utility of toric lenses is measured through vector analysis, often using the Alpins method. This analysis allows clinicians to determine the difference vector and the correction index.
For patients implanted with the AT LISA toric 909 M: - The difference vector was 0.34 ± 0.26 D. - The correction index was 0.93 ± 0.40 at 3 months.
These measurements indicate that the lens effectively corrected the intended amount of astigmatism. In contrast, the failure to maintain rotational stability would result in a higher difference vector, indicating a gap between the intended and achieved refractive outcome.
Conclusion: The Future of Toric Refractive Solutions
The transition from Proclear multifocal toric lenses to Biofinity signifies a broader industrial movement toward materials that prioritise oxygen permeability and long-term ocular health. The discontinuation timeline—ending with revenue packs in November 2026—is a strategic pivot toward silicone hydrogels, which have demonstrated superior patient satisfaction (76% vs 6%) and comfort (80.9 vs 73.0). This evolution highlights that for contact lens wearers, the "trial" phase is not just about the power of the lens, but the material's interaction with the corneal surface over time.
In the surgical domain, the focus remains on the intersection of rotational stability and refractive precision. The comparison between C-loop and plate-haptic IOLs demonstrates that design significantly impacts the stability of the lens, with plate-haptics showing lower rotation (2.33° vs 3.85°). When combined with advanced platforms like Panoptix, which achieves target accuracy in up to 98% of cases, the potential for spectacle-free vision is greatly enhanced.
Ultimately, whether through contact lenses or IOLs, the efficacy of a toric trial depends on the precision of the initial calculation—incorporating vertex distance and axis alignment—and the stability of the lens post-application. The shift toward higher-performance materials and more stable haptic designs ensures that the next generation of toric solutions will offer higher visual acuity and greater patient comfort.