It is not uncommon for patients to have difficulty wearing contact lenses for a number of reasons. A hard-to-fit contact lens patient is one who have tried conventional soft contact lenses and is not satisfied with the vision and/or comfort. Due to the individual eye shape, certain conditions or impairments or the aftermath of surgery, some patients are considered to be “hard to fit” as contact lens wearers. These patients may have severe dryness in the eyes or irregular shape of the cornea which prevents them from wearing conventional soft lenses successfully.
For hard to fit patients that prefer to wear contact lenses, there are options available that can provide comfortable and effective contact lens wear. This will require a specialized fitting with an eye doctor that is an expert that knows your condition and the various products available to find the right match for your specific condition. You may be considered a hard to fit contact lens candidate if you have one of the following conditions:
- Dry Eyes
- Giant Papillary Conjunctivitis (GPC)
- Pellucid Marginal Degeneration
- Post-LASIK or other refractive surgery
- Presbyopia (reduced near vision common in individuals aged 40 and over).
- Corneal Scarring
What are the types of contact lenses used for hard-to-fit patients? What are the benefits of each type?
The types of contact lenses used for hard-to-fit patients include custom soft contact lenses, rigid gas permeable hard contact lenses, hybrid contact lenses (gas permeable lens with a soft skirt/outer ring) and scleral contact lenses.
Custom soft contact lenses can provide extended parameters and power in addition to good comfort. However, it may not be suitable for patients with irregular cornea.
Rigid gas permeable provides good clear optics but patients may have difficulty adjusting to the comfort.
Hybrid contact lenses provide good optics and comfort but require special handling of the lenses to prevent breakage.
Scleral lenses provide good optics and good comfort but will require special handling of the lenses.
Our eye doctors will discuss with you the best option that fits your lifestyle.
I have issues with contact lenses due to dry eyes, can you help?
Dry Eye Syndrome causes your eyes to feel dry, gritty, burning, red, and irritated. Dry Eye Syndrome can also cause blurred vision. Often these symptoms can sometimes worsen by the use of contacts. In fact, many people who do not normally suffer from chronic dry eyes, will experience some of these symptoms as a result of contact lens wear.
First of all, if you have chronic dry eyes, you should see your eye doctor for treatment ad relief before you think about contact lenses. Our eye doctors will examine your eyes and treat the underlying cause for dryness. Once the dryness condition is addressed, we will assess which contact lens materials and modality that best suits the health of the eye.
Many brands of soft contacts and products such as disinfectant and cleansing solutions are made with ingredients that are designed to be more comfortable for individuals with dry eyes. Your eye doctor will be able to recommend some of these brands and products to you. Alternatively, gas permeable (GP) or rigid gas permeable (RGP) lenses are made with a hard material that in some cases does not dry out like soft lenses and they are able to hold a certain amount of moisture beneath the lens to keep the eye from drying out. Gas permeable lenses are a very good option and can be quite comfortable for individuals with dry eyes.
Additionally, your doctor might recommend a specific wearing schedule such as limiting the time you wear your contacts throughout the day or replacing your contacts on a more frequent basis.
Toric Lenses for Astigmatism
Astigmatism is a condition that causes blurred vision (in some cases double vision) because rather than being round, the front of the eye (the cornea) has two curves instead of one, therefore, having two focal points instead of one. This makes it hard for traditional contact lenses to fit and therefore requires specialized contact lenses such as toric lenses or rigid gas permeable lenses (RGPs).
Toric contact lenses are designed to correct astigmatism and custom made to fit the eye of the patient. Most are made of soft material designed to stay in place on the eye, however in some cases, when the rotation of the lens (due to blinking and eye movement) can’t be stopped, gas permeable lenses might be tried. Due to the customization and more complicated fitting process required for these lenses, they are more expensive and take more time for the contact lens laboratory to make than traditional lenses.
Giant Papillary Conjunctivitis (GPC) and Contact Lenses
GPC is a type of conjunctivitis in which the inner surface of the eyelid becomes swollen. The condition can be caused or worsened by a buildup of protein deposits on contact lenses. Your eye doctor may either recommend daily disposable lenses or RGP lenses (which are not water based) and therefore do not have a tendency for protein buildup. Your doctor may also prescribe medicated eye drops and require you to stop the use of contact lenses until the symptoms improve.
Rigid Gas Permeable (RGP) or Gas Permeable (GP) Lenses
Rigid Gas Permeable (RGP) also known as Gas Permeable (GP) lenses are effective for many hard to fit patients. The hard, oxygen permeable material lets the eye breathe and significantly reduces the chance of infection due to protein deposits which tend to harbor bacteria on soft lenses. RGPs also hold moisture under the lens to keep eyes from drying out.
Rigid Gas Permeable (RGP) Lenses for Keratoconus
Keratoconus is a condition in which the cornea thins and bulges forward into a cone shape. Traditional contact lenses may cause some discomfort in these patients and the vision may still be blurry therefore RGPs are often used for treatment for mild, moderate, and some severe cases. Rigid gas permeable lenses may help to slow down the cone shape from worsening in some cases. Further, RGPs are able to assist in vision correction for keratoconus which is often not possible with soft contacts or even eyeglasses.
Is irregular astigmatism the same as Keratoconus?
No. Some patients with irregular astigmatism do not have Keratoconus. Irregular astigmatism could be due to an injury to the eye. Irregular astigmatism and Keratoconus can be differentiated by mapping the contours of the eye with our Medmont topographer.
What is pellucid marginal degeneration? How is it treated?
Pellucid marginal degeneration is an eye condition where the inferior and peripheral cornea (usually 4 o’clock to 8 o’clock) begins to thin. Patients with pellucid marginal degeneration can be fitted with specialty contact lenses where they can enjoy good vision and comfort.
Post-LASIK or Vision Correction (Refractive) Surgery
While LASIK surgery has a very high success rate, there are vision complications and symptoms that sometimes remain. Night vision after LASIK, in particular, can sometimes give you side effects such as glare or halos around lights. RGPs are often effective in helping with these side effects and restoring clear vision.
Bifocal and Multifocal Contact Lenses for Presbyopia
Presbyopia is a common condition in those people usually over 40 years old iin which the eyes’ ability to focus on close objects is impaired. Many people keep a pair of bifocal or multifocal glasses on hand for times when they have to read menus, newspapers, books, and other objects that require near vision. For those that prefer contact lenses over eyeglasses, bifocal and multifocal contact lenses are an option.
For some patients that have presbyopia and need correction for distance vision as well, one option is monovision. Monovision is a contact lens fitting process in which you wear a contact lens in one eye for distance vision and the other contact lens of your other eye for near vision. Another option is multifocal contact lenses. In this contact lens fitting process, both eyes are usually fit for distance vision and both eyes are used for near at the same time. Both contact lens fitting options usually take about one week for the brain and the eyes to adjust.
If you have one of these conditions or find contact lens wear difficult for another reason, speak to your eye doctor. As technology improves there are more and more options for hard to fit contact lens patients to benefit from the comfort and convenience of contact lens use.
What are the costs for hard-to- fit contact lens patients? Are they covered by insurance?
Our eye doctors will need to examine your eyes to determine if the eye condition diagnosis falls into a medical necessity category. If so, our office will request insurance approval for the procedure.