Background: The purpose of this study is to investigate and compare spectacle and contact lens (CL) prescription trends, with an emphasis on astigmatic refractive error prescribing differences for patients who purchase spectacles or CLs in South Korea. Methods: A retrospective study of patient records of a major optical chain in South Korea was conducted. De-identified data of age, gender, power of prescribed spectacles and/or CLs were extracted from the practice database. Inclusion criteria were being within the first 10,000 purchasers of spectacles or CLs or both. Results: The first 10,000 purchases comprised spectacles (59%) and CLs (41%) (male:female ratio 4:6). The proportion of purchasers who were female was significantly higher for CLs (88% female, 12% male) than spectacles (43% female, 57% male) (χ2=4480.36, df=1, P<0.0001). There was a significant difference in the proportions of purchases by age group for spectacles and CLs (χ2=3246.69, df=3, P<0.0001). Spherical power distribution of prescribed lenses was similar between the groups; however, cylinder power and axis were significantly different (P<0.0001). CL astigmatic powers were more likely to be 1.00 DC or greater, whereas the majority of spectacle lenses had astigmatic power of 0.75 DC or less. In total, 90% of toric CLs were prescribed ×180 and 9% other meridians, unlike spectacles where 50% were prescribed ×180, 14% ×90 and 40% at oblique meridians. Conclusion: There is scope for providing increased toric lens correction amongst CL wearers and increasing the proportion of wearers who are male. The estimated gap for toric lens prescription amongst CL wearers who have clinically significant astigmatism ≥0.75 DC is about 59%.