If your trial rotates 10–15° at the 5‑minute mark, apply LARS and verify again at 20 minutes before ordering; in my fits, TBUT under 10 seconds reliably inflates rotation, so I treat the surface first. I’ve got a one‑page pocket card that maps common rotation marks to axis changes in 5° steps — happy to share if anyone wants it.
If I see 10–15° at 5 minutes with TBUT <10, I rewet, have them do 5 strong blinks, and recheck at 7 and 20 before applying LARS; that alone cut my axis remakes. > that maps common rotation marks to axis changes in 5° steps — happy to share — I’d use it; I keep a tiny 5° LARS grid taped to the slit lamp so anyone can call axes fast without head math.
@swallace89 I’ve had fewer remakes by using the slit beam as a protractor — start vertical, rotate it to the toric dot, read the tower scale as the rotation and apply LARS. Just make sure the scale’s zeroed and the chin rest isn’t tilted.
Quick tip: I use my phone’s level app as a protractor — hold it against the ocular, shoot a 10‑second clip at the 5‑minute mark, scrub to the midpoint, then average with the 20‑minute reading before I “apply LARS.” Small caveat: with TBUT <10 it tends to overcall, so a single lipid drop and a quick blink‑burp before recording keeps the rotation honest.
At the ‘5‑minute mark’ I do a gentle push‑up; vertical shift predicts later rotation — @OP that pocket card would help.