Objective To evaluate the effect of back surface toric gas permeable contact lens- es (BSTRGPCL) to correct high corneal astigmatism and changes in corneal topography. Methods Thirty-one patients (54 eyes) with high corneal astigmatism were recruited for the study. All the pa- tients were examined by autorefractor, objective refraction and phoropter. Corneal topography was per- formed to make sure that corneal astigmatism was equal to whole eye astigmatism. The best corrected visual acuity (BCVA) examined by phoropter was recorded (spectacle corrected vision). The two-third principle was followed to order BSTRGPCL. All patients had routine follow-up at 1 month. The fitting condition and ocular complications were evaluated. BCVA and corneal topography were recorded. Data analysis was performed using SPSS 13.0 software. A chi-square test and paired sample t test were performed. Results All patients had a favorable fitting and no severe ocular surface complications were found. Thirty-nine eyes (72.22%) had a BCVA equal to or better than 1.0 by wearing BSTRGPCL, which was significantly higher than spectacle correction (18 eyes, 33.33%). The differ- ence was statistically significant (X~2=16.38, P=0.00). The surface regularity index (SRI) and surface asymmetry index (SAI) were 0.66±0.21 and 0.36±0.18, respectively, which were not significantly changed (t=1.01, P=0.32;t=1.40, P=0.17). Ks (steep K) was (47.72±2.12)D, which was a significant decrease compared to Ks before wearing BSTRGPCL(t=2.42, P=0.02). Kf (flat K) was (42.70±2.04)D, and the change was not significant (t=0.05, P=0.97). Conclusion Satisfactory visual acuity correction and fitting are obtained by fitting BSTRGPCL on eyes with high corneal astigmatism. Corneal regulari-ty does not significantly change while Ks significantly decreased with short-term wear.